Objective: Comorbid insomnia may impact outcomes of patients with obstructive sleep apnea (OSA) receiving hypoglossal nerve stimulation with respiratory sensing (HNS) therapy. To examine whether the presence of insomnia measured using the Insomnia Severity Index (ISI) is associated with patient-reported outcomes and objective OSA measures in patients receiving HNS therapy.
Methods: In this retrospective chart review, patients with an HNS implant and ISI score at follow-up assessment were categorized as having moderate/severe insomnia or no/subthreshold insomnia. OSA-related data (Apnea Hypopnea Index, AHI; Oxygen Desaturation Index, ODI), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and overall patient satisfaction was compared between these patient categories. Correlations between ISI scores and each of these variables were examined.
Results: Of the 132 patients, 26% had moderate/severe insomnia at follow-up assessment. ESS and FOSQ scores were worse in the insomnia group at baseline, follow-up, and in the change from baseline, but AHI and ODI scores did not differ between patients with and without insomnia. Frequency of overall satisfaction at follow-up was lower in the insomnia group (58.8% vs. 92.8% with no insomnia, P < .001). Patients with insomnia were more likely to have depression (56% vs. 27% without insomnia, P < .002).
Conclusions: Insomnia is associated with worse patient-reported outcomes of daytime sleepiness and sleep-related quality of life in patients with OSA receiving HNS therapy. Depression is more prevalent in patients with comorbid insomnia. The ISI may help physicians to address comorbid insomnia and achieve high patient satisfaction and adherence to HNS therapy.
Level of evidence: 4.
Keywords: hypoglossal nerve stimulation; insomnia; long‐term outcome; sleep apnea; upper airway stimulation.
© 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.