Instalab ResearchHNS targets the hypoglossal nerve, which activates muscles that move the tongue forward and prevent airway obstruction. The device includes a sensor to detect the patient’s breathing pattern, a pulse generator, and a lead that stimulates the nerve.
It is typically used in adults with moderate to severe OSA who are unable to use CPAP successfully. Clinical trials have shown that HNS dramatically reduces apnea events, improves blood oxygen levels, and alleviates symptoms such as daytime sleepiness. In one comprehensive analysis, users showed a reduction in their apnea-hypopnea index (AHI) of over 15 events per hour after more than one year of use. Patients also reported better quality of life and improved energy levels.
Another major advantage of HNS is adherence. Unlike CPAP, which requires consistent nightly use of a device and mask, HNS is internal and generally well tolerated. Long-term users average more than seven hours of nightly use. Battery replacements are needed after eight or nine years, but replacement surgeries are relatively simple and carry low complication rates.
Evidence from long-term studies continues to build a strong case for HNS as an effective therapy. Patients monitored over four years or more maintain reductions in AHI and oxygen desaturation events. Moreover, the stimulation levels required to achieve these benefits remain consistent over time. This is important, since it suggests that the body does not become less responsive to the device, a concern in other forms of neurostimulation.
Patients in eight- to nine-year follow-up studies have sustained more than 50 percent reductions in their apnea events without a corresponding increase in side effects or drop in satisfaction. These results confirm that the implant is not just a temporary fix. For many, it remains a stable, long-term solution to a chronic condition.
Treating OSA is not just about sleep quality. The disorder has been linked to a wide range of cardiovascular problems. Repeated drops in oxygen levels during the night can increase blood pressure, promote inflammation, and strain the heart. Untreated OSA raises the risk of heart disease, stroke, and irregular heartbeat.
It stands to reason that reducing apnea events should lower cardiovascular risk. However, the evidence for HNS in this area is mixed.
In a recent randomized controlled trial, patients were monitored under both “active” and “sham” settings. In the sham phase, the device delivered minimal stimulation, acting as a placebo. The study found no difference in average 24-hour systolic blood pressure between the two groups. Even when looking only at nighttime measurements, the results were nearly identical.
This finding was disappointing, especially given that the same patients experienced clear improvements in breathing and oxygen levels while using the device.
Other studies offer more hopeful signs. In a real-world clinical review, patients who received HNS showed a significant drop in mean arterial pressure and required fewer medications to control their blood pressure. Some also demonstrated modest improvements in blood sugar control, though changes in weight were not observed.
These results suggest that for certain patients, HNS might offer modest cardiovascular benefits. But those effects are not guaranteed and likely depend on a range of factors beyond the implant itself.
Why doesn’t fixing breathing during sleep always result in better cardiovascular health? The answer lies in the complex relationship between OSA and heart disease. Oxygen deprivation is only one part of the problem. Apnea also disrupts the sleep cycle, increases sympathetic nervous system activity, and may worsen conditions such as insulin resistance.
Even CPAP, the most established therapy for OSA, has shown inconsistent effects on cardiovascular outcomes. Some large trials have found that CPAP improves symptoms but does not significantly reduce the risk of heart attacks or strokes. That has led many researchers to conclude that OSA treatment is only one piece of the cardiovascular puzzle.
HNS may fall into the same category. It can improve symptoms and sleep quality, which are meaningful benefits. But unless patients also address other risk factors such as obesity, high blood pressure, and diabetes, they may not see a dramatic change in heart health.
HNS is a strong option for patients with moderate to severe OSA who cannot tolerate CPAP. It offers consistent and long-lasting improvements in breathing, oxygenation, and daytime function. Patients report high satisfaction, and the technology appears safe for long-term use.
However, expectations must be managed. While the implant improves sleep, it does not necessarily reduce cardiovascular risk on its own. Patients should not view it as a replacement for comprehensive heart care. Even if a patient’s breathing normalizes during sleep, blood pressure, blood sugar, and cholesterol levels still need attention.
With that said, for many patients, the hypoglossal nerve stimulator offers life-changing relief from a condition that had few tolerable treatment options.
