Efficacy and Durability of Hypoglossal Nerve Stimulation Therapy in Obstructive Sleep Apnea: A Review of Current Evidence

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.