HYPOGLOSSAL nerve stimulation may reduce long-term diabetes and hypertension incidence in adults with obstructive sleep apnea.
Hypoglossal Nerve Stimulation Shows Delayed Benefits
A retrospective cohort study found that hypoglossal nerve stimulation was associated with potentially favorable cardiometabolic outcomes that emerged more than 2 years after implantation. However, the treatment was not associated with a significantly lower incidence of minor or major cardiovascular events after this period.
Researchers analyzed adults who underwent hypoglossal nerve stimulation between 2015 and 2024. These individuals were matched with controls who had obstructive sleep apnea and were nonadherent to positive airway pressure therapy but did not undergo device implantation.
The study included 3,786 people who received hypoglossal nerve stimulation and 3,395 controls. The median age of the intervention group was 53 years, and 67.7% were male.
Diabetes and Hypertension Diagnoses Declined
Among people without cardiovascular disease at baseline, hypoglossal nerve stimulation was not associated with diabetes diagnosis during the first 2 years. After 2 years, however, treatment was associated with an 81% lower hazard of diabetes diagnosis compared with no implantation.
The pattern for hypertension varied over time. Hypoglossal nerve stimulation was associated with a higher hazard of hypertension diagnosis during the initial 2 years, but this shifted after 2 years, when the intervention was associated with a 51% lower hazard.
These time-dependent findings suggest that potential benefits may take several years to become apparent. The researchers modeled hypoglossal nerve stimulation as a time-varying exposure because surgery was not expected to influence new diagnoses immediately.
Cardiovascular Event Findings Remain Uncertain
Among people with diabetes or hypertension at baseline, hypoglossal nerve stimulation was associated with higher hazards of both minor and major cardiovascular event diagnoses within 2 years.
After 2 years, the intervention was not significantly associated with either minor or major cardiovascular events. Although cardiovascular event hazards began to decline during longer follow-up, the estimates did not establish a definitive overall protective association after 2 years.
The analysis was limited by the absence of information on obstructive sleep apnea severity and cardiovascular disease severity, which could not be included in the matching process. The findings therefore indicate variable but potentially favorable longer-term associations rather than proving that hypoglossal nerve stimulation prevents cardiovascular disease.
Further research is needed to verify these associations, identify differences between clinical subgroups, and clarify the mechanisms that may connect sleep apnea treatment with changes in cardiometabolic outcomes.
Reference
Kondamuri N et al. Hypoglossal nerve stimulation and the incidence of cardiovascular disease. JAMA Otolaryngol Head Neck Surg. 2026;doi:10.1001/jamaoto.2026.1777.
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