Lateral wall collapse from sleep endoscopy and airflow shape predicts hypoglossal nerve stimulation efficacy in obstructive sleep apnoea

Daniel Vena^{1

2}, Sara Op de Beeck^{3

4

2}, Hyungchae Yang^{5

6}, Jeffrey Sumner⁵, Dwayne Mann⁷, Tsai-Yu Wang^{5

8}, Atqiya Aishah⁵, Ali Azarbarzin⁵, Ludovico Messineo⁵, Nicole Calianese⁵, Raichel Alex⁵, Neda Esmaeili⁵, Olivier M Vanderveken^{3

4}, David P White⁵, Andrew Wellman⁵, Phillip Huyett^{9

10}, Scott A Sands^{5

10}

Affiliations

¹ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA dvena@bwh.harvard.edu.
² D. Vena and S. Op de Beeck made equal contributions to this work as co-first authors.
³ Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
⁴ Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
⁵ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea.
⁷ School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia.
⁸ Department of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁹ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
¹⁰ P. Huyett and S.A. Sands made equal contributions to this work as co-senior authors.

PMID: 40774807
DOI: 10.1183/13993003.00236-2025

Observational Study

Lateral wall collapse from sleep endoscopy and airflow shape predicts hypoglossal nerve stimulation efficacy in obstructive sleep apnoea

Daniel Vena et al. Eur Respir J. 2025.

. 2025 Oct 7;66(4):2500236.

doi: 10.1183/13993003.00236-2025. Print 2025 Oct.

Authors

Affiliations

¹ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA dvena@bwh.harvard.edu.
² D. Vena and S. Op de Beeck made equal contributions to this work as co-first authors.
³ Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
⁴ Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
⁵ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea.
⁷ School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia.
⁸ Department of Thoracic Medicine, Chang Gung Memorial Hospital Linkou Main Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁹ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
¹⁰ P. Huyett and S.A. Sands made equal contributions to this work as co-senior authors.

PMID: 40774807
DOI: 10.1183/13993003.00236-2025

Abstract

Background: Patient selection for hypoglossal nerve stimulation (HGNS) for obstructive sleep apnoea (OSA) requires assessment of pharyngeal site of collapse using drug-induced sleep endoscopy (DISE). The current study aims to address two key knowledge gaps. First, we prospectively confirm that, among HGNS candidates, reduced HGNS efficacy is associated with oropharyngeal lateral wall (OLW) collapse (Aim 1). Second, given DISE is a resource-intensive procedure and delays treatment, we evaluate whether a recently developed non-invasive method for identifying OLW collapse using airflow shapes is associated with reduced HGNS efficacy (Aim 2).

Methods: Patients who underwent DISE, HGNS implantation and follow-up sleep testing were included in Aim 1 (n=369) as part of an observational cohort study. For Aim 2, airflow data estimating OLW collapse probability were collected during DISE via a pneumotachograph (n=138; DISE Flow cohort) and from a home sleep test (HST) via nasal cannula for validation (n=46; HST cohort). Linear regression quantified associations between HGNS efficacy (percent reduction in apnoea-hypopnoea index (AHI)) and DISE-determined OLW collapse (Aim 1) or flow shape-determined OLW collapse (probability score per 2sd) (Aim 2), adjusting for baseline AHI.

Results: Compared to non-OLW collapse, DISE-determined OLW collapse reduced HGNS efficacy by -18.0% (95% CI -31.9- -6.2%). Increased flow shape-determined OLW collapse probability (Δ2sd) was associated with reduced HGNS efficacy in both DISE Flow (-24.8%, 95% CI -40.4- -11.7%) and HST (-22.7%, 95% CI -50.0- -2.6%) cohorts.

Conclusion: This study prospectively validates OLW collapse as a key factor in HGNS failure and shows that airflow-based identification of OLW collapse can effectively estimate HGNS efficacy, representing a significant advancement in patient selection for HGNS.

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Conflict of interest statement

Conflict of interest: D. Vena reports support for the present study from the American Heart Association and the American Academy of Sleep Medicine, and consultancy fees from Inspire Medical Systems. S. Op de Beeck reports support for the present study from Research Foundation Flanders (FWO), grants from Fulbright Commission for Education Exchange, payment for lecture at “Slaapcursus der Lage Landen 2023”, and support for attending meetings from Research Foundation Flanders. D. Mann reports support for the present study from the University of Queensland (Research Stimulus Allocation Two, Fellowship) and the National Health and Medical Research Council of Australia (NHMRC 2001729 and 2007001). A. Azarbarzin reports grants from the American Heart Association, American Academy of Sleep Medicine and Somnifix, consultancy fees from Cerebra, ZOLL Respicardia, Eli Lilly, Apnimed, Somnifix and Inspire, patents planned, issued or pending for the system and method for endo-phenotyping and risk stratifying obstructive sleep apnoea and method for non-transitory computer readable medium and apparatus for arousal intensity scoring, and receipt of equipment from Philips Respironics. L. Messineo reports grants from Apnimed and Prosomnus, consultancy fees from SleepRes and Apnimed, and stock (or stock options) with SleepRes. O. Vanderveken reports grants from Research Foundation Flanders (FWO), Philips, SomnoMed, Inspire Medical Systems, ProSomnus, Nyxoah, Med-El and Cochlear, consultancy fees from Inspire Medical Systems, SomnoMed and GSK, and payment or honoraria for lectures, presentations, manuscript writing or educational events from SomnoMed and Inspire Medical Systems. D.P. White reports consultancy fees from Apnimed, Phillips, Mosanna, Onera, Xtrodes, Cerebra Health, Resonea, Cryosa, Lingua Flex, Bairitone, SleepRes and Nidra, and stock (or stock options) with Apnimed, Cryosa, Mosanna and SleepRes. A. Wellman reports grants from the NIH (HL102321 and HL128658), Somnifix and Sanofi, royalties or licences from Apnimed, consultancy fees from Apnimed, Somnifix, Nox, Inspire, Mosana, Takeda and Archaemenid, patents planned, issued or pending for detecting the site of airway collapse using flow shapes, and stock (or stock options) with Apnimed, a company developing pharmacological therapies for sleep apnoea. P. Huyett reports grants from Inspire Medical Systems and Nyxoah, and consultancy fees from Inspire Medical Systems. S.A. Sands reports support for the present study from NIH NHLBI (R01HL146697), grants from Apnimed, Prosomnus and Dynaflex, royalties or licences from the licensing IP for pharmacological therapy for OSA, consultancy fees from Nox Medical, Apnimed, Eli Lilly, Merck, Inspire Medical Systems, Forepont, LinguaFlex, Respicardia and Archaemenid, payment or honoraria for lectures, presentations, manuscript writing or educational events from Tufts University, patents planned, issued or pending for a combination pharmacological therapy and OSA phenotyping using wearable technology, both through his institution, and receipt of equipment, materials, drugs, medical writing, gifts or other services from Nox Medical. The remaining authors have no potential conflicts of interest to disclose.

Comment in

Airflow-based prediction of lateral wall collapse: advancing personalised hypoglossal nerve stimulation in obstructive sleep apnoea.
Li Y, Schwartz AR, Kent DT. Li Y, et al. Eur Respir J. 2025 Oct 7;66(4):2501567. doi: 10.1183/13993003.01567-2025. Print 2025 Oct. Eur Respir J. 2025. PMID: 41057216 No abstract available.

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Lateral wall collapse from sleep endoscopy and airflow shape predicts hypoglossal nerve stimulation efficacy in obstructive sleep apnoea

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Lateral wall collapse from sleep endoscopy and airflow shape predicts hypoglossal nerve stimulation efficacy in obstructive sleep apnoea

Authors

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