# Impact of Bariatric Surgery on Hypoglossal Nerve Stimulation Outcomes

## TL;DR

Bariatric surgery patients may experience better outcomes from hypoglossal nerve stimulation for sleep apnea compared to those without prior weight loss surgery.

## Contribution

This study is the first to evaluate hypoglossal nerve stimulation outcomes in patients with prior bariatric surgery.

## Key findings

- Patients with prior bariatric surgery had significantly greater reductions in apnea-hypopnea index compared to those without.
- Bariatric surgery was independently associated with improved hypoglossal nerve stimulation outcomes after adjusting for demographics and baseline metrics.
- Both groups achieved similar reductions in sleepiness scores following treatment.

## Abstract

The effectiveness of hypoglossal nerve stimulation (HGNS) for residual obstructive sleep apnea (OSA) in patients with prior bariatric surgery (BS) has not been previously reported. We evaluate and compare HGNS outcomes in this unique population.

We conducted a multi‐institutional retrospective review between 2014 and 2023. Patients with prior BS were compared to those without (nBS). A 1:2 propensity score matching (PSM) was performed using age, gender, race, and baseline BMI. Data collected included demographics, pre/post‐operative apnea‐hypopnea index (AHI), body mass index (BMI), and Epworth Sleepiness Score (ESS). Treatment success was defined using Sher15 criteria. Analyses were conducted in R‐Studio.

After PSM, 72 patients met inclusion (mean age 61.3 years, 62% male, 83% White), including 24 (33%) with BS. Sher15 response rates were 71% in BS vs. 56% in nBS (p = 0.2). BS patients had significantly greater mean AHI reductions than NBS (−28.44 ± 16.39 vs. −17.68 ± 21.23; p = 0.009). Both groups had comparable reductions in ESS (−4.67 vs. −3.44; p = 0.2), with a mean postoperative ESS of 6.78 in BS and 6.17 in NBS (p = 0.5). On multivariable linear regression adjusting for demographics, baseline AHI, and BMI, prior BS was independently associated with greater AHI reduction (β = −8.6; 95% CI −16, −1.1; p = 0.026).

Patients with prior BS achieve comparable or superior outcomes following HGNS. Prior weight loss may enhance HGNS effectiveness and merits further study.

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