Recent Advancements in the Clinical Pathway of Respiration-Synchronized Hypoglossal Nerve Stimulation Therapy for Obstructive Sleep Apnea.

Background: Respiration-synchronized hypoglossal nerve stimulation (HGNS) is an effective treatment option for selected patients with obstructive sleep apnea (OSA). While literature on the standardization of the post-implant care pathway for patients treated with HGNS therapy remains limited, the growing global use of HGNS has made structured post-implant care management increasingly important. Methods: This narrative review summarizes the advancements related to the clinical pathway for respiration-synchronized HGNS therapy over the past 5 years, with a special focus on post-implant care management. Results: Selection criteria for respiration-synchronized HGNS are changing as new clinical findings emerge, including both anatomical and non-anatomical markers. Evidence suggests that adopting single-amplitude, full-night sleep testing may provide a more reliable assessment of HGNS treatment efficacy. Several studies have described optimization strategies for patients with suboptimal HGNS therapy response or therapy-related discomfort, including the use of awake endoscopy and drug-induced sleep endoscopy for advanced HGNS programming and the use of combination therapy, although data remains limited. Conclusions: The clinical care pathway for respiration-synchronized HGNS continues to evolve, including patient selection, evaluation of treatment success, and strategies for managing incomplete responders or patients with therapy-related discomfort. Nonetheless, addressing insufficient treatment responses remains a significant challenge and a key area for future research and clinical optimization.