{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T22:08:29Z","timestamp":1777327709698,"version":"3.51.4"},"reference-count":50,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T00:00:00Z","timestamp":1607472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Veterans have an increasing prevalence of obstructive sleep apnea (OSA) and high levels of intolerance to positive airway pressure (PAP). The hypoglossal nerve stimulator (HNS) is a promising alternative surgical treatment for OSA in these patients, many of whom suffer from mental health conditions such as post\u2010traumatic stress disorder (PTSD) that may negatively affect their ability to use PAP. Our aims were: 1) to assess postoperative changes in OSA severity and sleepiness in a veteran only population after HNS; 2) to compare postoperative changes in OSA severity, sleepiness and HNS adherence between veterans with and without PTSD; and 3) to compare HNS adherence in our population to HNS adherence in the current literature as well as published PAP adherence data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective and prospective case series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical data on consecutive patients undergoing HNS in a Veterans Affairs hospital were examined for demographic data as well as medical, sleep, and mental health comorbidities. The overall cohort as well as subsets of patients with and without PTSD were examined for postoperative changes in OSA severity (apnea hypopnea index [AHI], lowest oxygen saturation (LSAT]), and sleepiness (Epworth sleepiness scale [ESS]), as well as for device adherence. PTSD and depression symptomatology were measured using the PTSD Checklist 5 (PCL\u20105) and Patient Health Questionnaire 9 (PHQ\u20109).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010six veterans were included. Forty\u2010four patients were male (95.6%), 45 were white (97.8%), and the mean age was 61.3\u2009years. Twenty\u2010six patients met PCL\u20105 criteria for PTSD and 17 did not. OSA severity and sleepiness improved significantly in the overall cohort after HNS; median (IQR) AHI decreased from 39.2 (24.0, 63.0) to 7.4 (1.2, 20.8) events\/hour (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001), mean LSAT increased from 81% to 88% (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001) and mean ESS decreased from 10.9 to 6.7 (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001). These improvements were similar between patients with and without PTSD (<jats:italic>P<\/jats:italic> = .434\u2013.918). Overall device adherence was 6.1\u2009hours\/night for the overall cohort and was not significantly different between patients with and without PTSD (<jats:italic>P<\/jats:italic> = .992).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>HNS is an efficacious therapy in a veteran population, providing patients with significant improvements in OSA severity and sleepiness. Veterans with and without PTSD benefited similarly from HNS when comparing improvements in sleep apnea severity and sleepiness as well as device usage. Adherence was similar to previously published HNS adherence data and better than PAP adherence reported in the literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 131:S1\u2013S11, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.29292","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T14:44:51Z","timestamp":1607611491000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Hypoglossal Nerve Stimulation: Outcomes in Veterans with Obstructive Sleep Apnea and Common Comorbid Post\u2010traumatic Stress Disorder"],"prefix":"10.1002","volume":"131","author":[{"given":"Reena","family":"Dhanda Patil","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery University of Cincinnati Medical Center  Cincinnati Ohio U.S.A."},{"name":"Department of Surgical Services Cincinnati Veterans Affairs Medical Center  Cincinnati Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0536-8886","authenticated-orcid":false,"given":"Kathleen M.","family":"Sarber","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology 96th Medical Group  Eglin Air Force Base Florida U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0887-5111","authenticated-orcid":false,"given":"Madison V.","family":"Epperson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Michigan Health System  Ann Arbor Michigan U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4300-5146","authenticated-orcid":false,"given":"Meredith","family":"Tabangin","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mekibib","family":"Altaye","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franklin","family":"Mesa","sequence":"additional","affiliation":[{"name":"Department of Surgical Services Cincinnati Veterans Affairs Medical Center  Cincinnati Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0997-9692","authenticated-orcid":false,"given":"Stacey L.","family":"Ishman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery University of Cincinnati Medical Center  Cincinnati Ohio U.S.A."},{"name":"Division of Pediatric Otolaryngology and Pulmonary Medicine Cincinnati Children's Hospital Medical Center  Cincinnati Ohio U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,9]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199304293281704"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/20.9.705"},{"key":"e_1_2_6_4_1","first-page":"233","article-title":"Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options","volume":"2","author":"Gharibeh T","year":"2010","journal-title":"Nat Sci Sleep"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-011-0632-8"},{"key":"e_1_2_6_6_1","unstructured":"Armed Forces Health Surveillance Center. 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