OBJECTIVES: Hypoglossal nerve stimulation (HGNS) emerged as an alternative treatment for patients with OSA a decade ago, and numerous studies have demonstrated substantial improvements in disease severity with this therapy by reducing apnea-hypopnea burden and improving quality of life. The objective of this review was to evaluate patient-reported outcomes and experiences with HGNS therapy in a systematic review and meta-analysis.

METHODS: MEDLINE, Cochrane, and Web of Science were systematically searched to identify randomized controlled and observational studies reporting outcomes relevant to HGNS therapy in patients with OSA. Of 406 articles screened, 55 publications were assessed for eligibility and risk of bias using the ROBINS-I tool. Meta-analysis using a fixed-effects model was performed when > 2 studies with data on a specific outcome were available.

RESULTS: Thirty-four studies with a total of 3,785 patients and a mean follow-up of 11.8 ± 12.2 months were identified and included in the meta-analysis. The fixed effects model showed a pooled effect size of 4.59 points improvement in daytime sleepiness as measured by the ESS questionnaire (Z= 42.82, p < .001), 2.84 points improvement in daytime functioning as measured by the FOSQ score (Z= 28.38, p < .001), and 1.77 points improvement in sleep quality as measured by the PSQI questionnaire (Z= 2.53, p = .010). Patient-reported outcomes were positive in all identified studies, adding relevant information about care processes and perceptions of therapy.

CONCLUSIONS: HGNS leads to significant improvements in health-related quality of life in patients with OSA and reliably produces clinically meaningful changes in daytime sleepiness, daytime functioning, and sleep quality. The therapy regularly meets or exceeds the minimum clinically important differences defined for the respective instruments. Further research is warranted to examine subjective outcomes beyond improvements in daytime sleepiness and daytime functioning.