Evaluation of Clinical Outcomes of Hypoglossal Nerve Stimulation in Sleep Apnea: An Integrative Literature Review

Abstract

Introduction: Obstructive sleep apnea (OSA) is a common respiratory disorder characterized by recurrent episodes of upper airway obstruction during sleep, resulting in sleep fragmentation, daytime sleepiness, fatigue, cognitive impairment, and reduced quality of life. Although continuous positive airway pressure (CPAP) is considered the gold-standard treatment, its effectiveness may be limited by poor patient adherence. In this context, hypoglossal nerve stimulation (HNS) has emerged as a therapeutic alternative capable of maintaining upper airway patency during sleep, improving polysomnographic parameters and patient-reported clinical outcomes. Objective: To synthesize the available scientific evidence on the effectiveness of hypoglossal nerve stimulation in the management of obstructive sleep apnea and its impact on quality of life. Methodology: This is an integrative literature review. The search was conducted in the PubMed, PubMed Central (PMC), SciELO, Cochrane Library, and Virtual Health Library (VHL) databases using the descriptors “hypoglossal nerve stimulation” and “sleep apnea, obstructive,” as well as their Portuguese equivalents. Articles published between 2021 and 2025 that addressed effectiveness, safety, therapeutic adherence, and quality of life were included. After applying inclusion and exclusion criteria and full-text review of selected studies, 19 studies comprised the final sample. Results: The analyzed studies demonstrated that HNS significantly reduces the apnea–hypopnea index (AHI) and improves daytime sleepiness, fatigue, and quality of life. High adherence to treatment was observed compared to CPAP therapy, along with a favorable safety profile, with mild to moderate adverse events such as local discomfort and paresthesia. Some studies also reported potential cardiovascular benefits and high levels of patient satisfaction among those intolerant to CPAP. Conclusion: Hypoglossal nerve stimulation is an effective and safe alternative for selected patients with OSA, particularly those with low tolerance to CPAP. However, methodological limitations of the available studies—such as small sample sizes, heterogeneity in inclusion criteria, and limited follow-up duration—highlight the need for future research with greater methodological rigor and long-term follow-up.