{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T12:34:53Z","timestamp":1763642093048,"version":"3.45.0"},"reference-count":66,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm14228241","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T12:02:42Z","timestamp":1763640162000},"page":"8241","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recent Advancements in the Clinical Pathway of Respiration-Synchronized Hypoglossal Nerve Stimulation Therapy for Obstructive Sleep Apnea"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8578-3330","authenticated-orcid":false,"given":"Dorine","family":"Van Loo","sequence":"first","affiliation":[{"name":"Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium"},{"name":"Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8684-2852","authenticated-orcid":false,"given":"Eldar","family":"Tukanov","sequence":"additional","affiliation":[{"name":"Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium"},{"name":"Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marijke","family":"Dieltjens","sequence":"additional","affiliation":[{"name":"Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium"},{"name":"Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5978-9814","authenticated-orcid":false,"given":"Sara","family":"Op de Beeck","sequence":"additional","affiliation":[{"name":"Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium"},{"name":"Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eli","family":"Van de Perck","sequence":"additional","affiliation":[{"name":"Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6087-678X","authenticated-orcid":false,"given":"Johan","family":"Verbraecken","sequence":"additional","affiliation":[{"name":"Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium"},{"name":"Research Group LEMP, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier M.","family":"Vanderveken","sequence":"additional","affiliation":[{"name":"Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium"},{"name":"Department of ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium"},{"name":"Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1056\/NEJMoa1308659","article-title":"Upper-airway stimulation for obstructive sleep apnea","volume":"370","author":"Strollo","year":"2014","journal-title":"N. 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