Author(s):
Deveshkumar Mahendralal Kothwala, Kanan Anupkumar Patel, Mayur Dilipbhai Patel, Jigneshkumar Dasharathbhai Rohit, Bhartidevi Jitendra Pal
Email(s):
bhartidevi.pal@merillife.com
DOI:
10.52711/2349-2988.2026.00027 
Address:
Deveshkumar Mahendralal Kothwala, Kanan Anupkumar Patel, Mayur Dilipbhai Patel, Jigneshkumar Dasharathbhai Rohit*, Bhartidevi Jitendra Pal*
Meril Medical Innovations Pvt. Ltd., Bilakhia House, Survey No. 879, Muktanand Marg, Chala, Vapi, Gujarat.
*Corresponding Author
Published In:
Volume - 18,
Issue - 2,
Year - 2026
ABSTRACT:
Obstructive sleep apnea (OSA) is a common sleep-disordered breathing condition associated with substantial cardiovascular, metabolic, and neurocognitive morbidity. Continuous positive airway pressure (CPAP) remains the first-line therapy, however, long-term adherence is often limited, necessitating alternative treatment options. Hypoglossal nerve stimulation (HGNS) has emerged as a targeted, minimally invasive neuromodulation therapy for patients with moderate-to-severe OSA who are intolerant of CPAP. By selectively activating upper airway dilator muscles, particularly the genioglossus, HGNS stabilizes the airway and reduces pharyngeal collapsibility during sleep. This review synthesizes current evidence on the efficacy, durability, safety, and patient selection for HGNS, drawing from pivotal trials, long-term follow-up studies, real-world registries, and meta-analyses. Across these studies, HGNS consistently demonstrates clinically meaningful reductions in apnea hypopnea index (55–70%), improvements in nocturnal oxygenation and daytime sleepiness, and enhanced quality of life, with benefits sustained for up to five years. Patient adherence is high, and the therapy has a favorable safety profile, with serious device-related adverse events reported infrequently. Therapeutic success is strongly influenced by patient selection, particularly lower body mass index, absence of complete concentric palatal collapse on drug-induced sleep endoscopy and predominant retrolingual airway obstruction. Despite robust efficacy, current evidence is constrained by narrow eligibility criteria, device-specific outcome variability and limited randomized controlled trials. Future directions might include development of personalized stimulation algorithms, expanded patient eligibility, integration with home-based sleep monitoring, refined anatomical and functional phenotyping, and comprehensive cost-effectiveness analyses. Overall, HGNS represents an effective, durable, and physiologic alternative for CPAP-intolerant patients with moderate-to-severe OSA, bridging the treatment gap between conventional surgical interventions and standard therapy.
Cite this article:
Deveshkumar Mahendralal Kothwala, Kanan Anupkumar Patel, Mayur Dilipbhai Patel, Jigneshkumar Dasharathbhai Rohit, Bhartidevi Jitendra Pal. Efficacy and Durability of Hypoglossal Nerve Stimulation Therapy in Obstructive Sleep Apnea: A Review of Current Evidence. Research Journal of Science and Technology. 2026; 18(2):190-8. doi: 10.52711/2349-2988.2026.00027
Cite(Electronic):
Deveshkumar Mahendralal Kothwala, Kanan Anupkumar Patel, Mayur Dilipbhai Patel, Jigneshkumar Dasharathbhai Rohit, Bhartidevi Jitendra Pal. Efficacy and Durability of Hypoglossal Nerve Stimulation Therapy in Obstructive Sleep Apnea: A Review of Current Evidence. Research Journal of Science and Technology. 2026; 18(2):190-8. doi: 10.52711/2349-2988.2026.00027 Available on: https://www.rjstonline.com/AbstractView.aspx?PID=2026-18-2-10
14. REFERENCES:
1. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017; 34:70–81.
2. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypopnea with or without treatment with continuous positive airway pressure: An observational study. Lancet. 2005; 365(9464):1046–53.
3. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013; 177(9):1006–14.
4. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: The challenge to effective treatment. Proc Am Thorac Soc. 2008; 5(2):173–8.
5. Li KK, Powell NB, Riley RW, et al. Surgical modifications of the upper airway in obstructive sleep apnea. Sleep. 2002; 25(3):243–50.
6. Strollo PJ Jr, Soose RJ, Maurer JT, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014; 370(2):139–49.
7. Kezirian EJ, Shepard JW, Yueh B, et al. Drug-induced sleep endoscopy: The VOTE classification. Laryngoscope. 2011; 121(6):1095–101.
8. Mezzanotte WS, Tangel DJ, White DP. Waking genioglossal electromyogram in patients with obstructive sleep apnea and in normal subjects. Am J Respir Crit Care Med. 1996; 154(1):147–53.
9. Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: An AHA/ACC Scientific Statement. Circulation. 2008; 118(10):1080–111.
10. Schwartz AR, Smith PL, Wise RA, et al. Mechanism of airway collapse in obstructive sleep apnea. Am J Respir Crit Care Med. 2001; 164(10 Pt 1):2120–7.
11. Vanderveken OM, Dieltjens M, Hamans E, et al. Targeted hypoglossal nerve stimulation for treatment of adult obstructive sleep apnea: Clinical outcomes in a European cohort. Eur Respir J. 2020; 55(2):1901990.
12. Eastwood PR, Barnes M, Walsh JH, Hillman DR. Hypoglossal nerve stimulation for obstructive sleep apnea: A review of the literature. Sleep. 2011; 34(6):829–36.
13. Woodson BT, Soose RJ, Gillespie MB, et al. Upper airway stimulation for obstructive sleep apnea: 5-year outcomes. Otolaryngol Head Neck Surg. 2018; 158(6):1123–30.
14. Thaler E, Schwab R, Maurer J, et al. Results of the ADHERE upper airway stimulation registry and predictors of therapy efficacy. Laryngoscope. 2020; 130(5):1333–8.
15. Alrubasy WA, Abuawwad MT, Taha MJJ, et al. Hypoglossal nerve stimulation for obstructive sleep apnea in adults: An updated systematic review and meta analysis. Respir Med. 2024.
16. Braun M, Stoerzel M, Wollny M, et al. Patient-reported outcomes with hypoglossal nerve stimulation for treatment of obstructive sleep apnea: A systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2023; 280(10):4627-4639.
17. Soose RJ, Gillespie MB, Woodson BT, et al. Upper airway stimulation for obstructive sleep apnea: 36-month outcomes. Laryngoscope. 2016; 126(10):2455–62.
18. Bhat A, Chang JL, Durr ML. What are the Predictors of Success with Hypoglossal Nerve Stimulation? Laryngoscope. 2025; 135(1):5-7.