{Reference Type}: Journal Article
{Title}: The impact of neck circumference on hypoglossal nerve stimulator therapy outcomes.
{Author}: Hutz MJ;Plata DM;LoSavio P;Herdegen J;Zhang Y;Mokhlesi B;
{Journal}: J Clin Sleep Med
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jun 28
{Factor}: 4.324
{DOI}: 10.5664/jcsm.11260
{Abstract}: <B>OBJECTIVE: </B>Hypoglossal nerve stimulation (HGNS) therapy has historically had strict eligibility requirements including a body mass index (BMI) < 32 kg/m2. However, recent Food and Drug Administration approval expanded indications to a BMI < 40 kg/m2. There is a wide variability in body fat distribution. This study sought to determine if neck circumference is a better surrogate predictive variable for HGNS outcomes than BMI.<BR><B>METHODS: </B>A retrospective chart review was conducted at a tertiary care center on adults who underwent HGNS implantation by a single surgeon from March 2017 to October 2021. Baseline demographic data including neck circumference, diagnostic sleep studies and post-implantation HGNS titration studies were collected. Linear regression and Spearman's Correlation Coefficient (SCC) analysis were utilized to compare neck circumference (NC), percentage of predicted neck circumference (PPNC) and BMI with the apnea-hypopnea index at effective voltage (AHI-v).<BR><B>RESULTS: </B>This study included 43 patients who were middle aged (61.1 years), predominantly male (76.7%), with severe obstructive sleep apnea (median AHI 35) and mean neck circumference of 15.3 inches. Utilizing the NC and PPNC, positive correlations with AHI-v were observed (p = 0.0033, SCC = .438, and p = 0.0029, SCC = .444). While controlling for BMI, a 1-inch increase in neck circumference was associated with a 35% increase in AHI-v (p = 0.0411).<BR><B>CONCLUSIONS: </B>A larger neck circumference was independently associated with worse HGNS outcomes. Further research is needed to support and confirm these findings, particularly across sexes.