Use of Hypoglossal Nerve Stimulation for Treating OSA in Military Patient Populations.

Background: Failure to effectively treat obstructive sleep apnea (OSA) and its symptoms is incompatible with military readiness. Continuous positive airway pressure (PAP) is the gold standard treatment for OSA, but it is impractical in austere environments. Another OSA treatment, hypoglossal nerve stimulation (HGNS), which is implanted, could have advantages for military patients but is unclear whether HGNS is efficacious. Methods: We conducted a review of randomized controlled trials and controlled trials published from 2013 to 2023. Primary outcome measures included the Apnea-Hypopnea Index and Epworth Sleepiness Scale. The quality of evidence was assessed using a rating of 1 to 5 based on a modification of the Oxford Centre for Evidence-based Medicine Levels of Evidence and Grades of Recommendation. Results: We identified 334 studies; 318 did not meet inclusion criteria. The remaining 16 articles were classified into 9 cohorts. Six articles were based on data from the STAR trial and 4 were based on data from a German postmarket long-term follow-up of upper airway stimulation for OSA efficacy. The remaining cohorts were smaller studies that examined moderate-to-severe OSA with nonadherence or failure, a randomized controlled crossover trial, and 1 direct comparator with PAP treatment. Conclusions: HGNS feasibility in military settings has not been adequately studied, considering the specific demands of operational settings and patient demographics. Understanding risks and benefits specific to military context will help guide practices and determine the suitability of HGNS for OSA in diverse military settings.