{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:52:35Z","timestamp":1787500355069,"version":"build-2736575974"},"reference-count":21,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Introduction: Hypoglossal nerve stimulation (HNS) \u201cInspire\u00a9 therapy\u201d has garnered popularity among obstructive sleep apnea (OSA) patients seeking an alternative to continuous positive airway pressure (CPAP) therapy. The growth in HNS has been particularly high in older adults living with OSA. Consistent and proper use of HNS in the geriatric population faces unique age-associated barriers: a high rate of multiple chronic conditions (MCC) and polypharmacy (being on five or more drugs). Early recognition and patient-centered management of these barriers will allow older patients to obtain maximum benefits from HNS. HNS has distinct advantages in the geriatric population because it overcomes many concerns related to CPAP therapy adherence, such as mechanical limitations due to manual dexterity, maxillofacial anatomy, dental issues such as usage of dentures, allergy\/otolaryngology-related disorders, and pre-existing post-traumatic stress disorder-related claustrophobia. This paper describes how we worked with older patients with OSA and their care partners to overcome these barriers so patients can continue to derive cardiovascular, neurologic, and quality of life benefits resulting from optimal OSA management. These benefits are especially important in the older population because of higher rates of comorbidities (dementia, coronary artery disease, and atrial fibrillation) exacerbated by sub-optimally treated OSA. In this article, we describe our clinical experience with elderly patients on Inspire\u00a9 therapy, with a focus on the everyday difficulties faced by these patients and the measures implemented to address and mitigate these barriers. Methods: A retrospective chart review was conducted to identify patients aged 65 and above who underwent hypoglossal nerve stimulator insertion. Experiences of older patients during and after the insertion procedure were documented and compared to a younger population of patients on HNS therapy. We specifically collected information on difficulties encountered during activation or follow-up visits and compared them between the different age groups. Using this information, we identified areas to improve treatment adherence from the patients\u2019 perspectives. Results: We identified 43 geriatric (65 to 86 years old) patients who received the Inspire implant at a tertiary academic medical center and compared them to a younger population of 23 patients. Most common challenges noted\u2014with a potential to impact adherence\u2014included orofacial and lingual neuropraxia (ischemic or demyelination-induced neuropathy) at activation, cognitive dysfunction (memory problems), preexisting anxiety, and insomnia. Other difficulties that are less commonly reported but equally important to consistent and proper use of HNS included headaches, concerns of device malfunction, change in comfort levels after cardiac procedures, and general intolerance of the device. The older patient population had a statistically significant higher incidence of cognitive difficulties (30.2% vs. 4.4%) and a smaller social support system (62.8% vs. 91.3%) affecting device usage compared to the younger population. There were no statistically significant differences in the rates of other more commonly reported adverse effects such as headaches, dry mouth, and anxiety between the two age groups. Conclusion: Despite several challenges faced by geriatric patients, Inspire\u00a9 hypoglossal nerve stimulation remains a viable, alternative treatment option for OSA with improved tolerance and adherence compared to CPAP. After identifying less commonly reported barriers such as cognitive decline, sensory deficits, and decreased social support systems, minor adjustments and appropriate education on use allows older patients to correctly use and benefit from Inspire\u00a9 device therapy, with subsequent improvement in sleep and overall quality of life.<\/jats:p>","DOI":"10.3390\/life15060861","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T06:25:04Z","timestamp":1748499904000},"page":"861","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Navigating Care Challenges in Elderly Patients Following Hypoglossal Nerve Stimulator Implantation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3849-8452","authenticated-orcid":false,"given":"Michael","family":"Joo","sequence":"first","affiliation":[{"name":"Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Gurski","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efstathia","family":"Polychronopoulou","sequence":"additional","affiliation":[{"name":"Office of Biostatistics, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukaila","family":"Raji","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8596-5191","authenticated-orcid":false,"given":"Rizwana","family":"Sultana","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","article-title":"Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis","volume":"7","author":"Benjafield","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"15015","DOI":"10.1038\/nrdp.2015.15","article-title":"Obstructive sleep apnoea syndrome","volume":"1","author":"Kohler","year":"2015","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2101649","DOI":"10.1183\/13993003.01649-2021","article-title":"Sleep apnoea in the elderly: A great challenge for the future","volume":"59","author":"Osorio","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1111\/resp.13838","article-title":"Global burden of sleep-disordered breathing and its implications","volume":"25","author":"Lyons","year":"2020","journal-title":"Respirology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S71","DOI":"10.1093\/sleep\/19.suppl_9.S71","article-title":"Evaluation of treatment efficacy in sleep apnea hypopnea syndrome","volume":"19","year":"1996","journal-title":"Sleep"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s40463-016-0156-0","article-title":"Trends in CPAP adherence over twenty years of data collection: A flattened curve","volume":"45","author":"Rotenberg","year":"2016","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.smrv.2011.01.003","article-title":"A systematic review of CPAP adherence across age groups: Clinical and empiric insights for developing CPAP adherence interventions","volume":"15","author":"Sawyer","year":"2011","journal-title":"Sleep Med. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/978-3-031-06413-5_21","article-title":"Hypoglossal Nerve Stimulation Therapy","volume":"1384","author":"Arens","year":"2022","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1001\/jamaoto.2023.0161","article-title":"Targeted Hypoglossal Nerve Stimulation for Patients with Obstructive Sleep Apnea: A Randomized Clinical Trial","volume":"149","author":"Schwartz","year":"2023","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102616","DOI":"10.1016\/j.amjoto.2020.102616","article-title":"Adverse events associated with the Inspire implantable hypoglossal nerve stimulator: A MAUDE database review","volume":"41","author":"Bestourous","year":"2020","journal-title":"Am. J. Otolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.amjoto.2018.06.011","article-title":"Hypoglossal nerve stimulator generator migration: INSPIRE device reimplantation with parallels to cardiac implantable electronic devices","volume":"39","author":"Tabatabai","year":"2018","journal-title":"Am. J. Otolaryngol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.5664\/jcsm.9492","article-title":"Space invader: Pleural penetration of a hypoglossal nerve stimulator sensor lead","volume":"17","author":"Lou","year":"2021","journal-title":"J. Clin. Sleep Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1177\/01945998221122696","article-title":"Iatrogenic pneumothorax during hypoglossal nerve stimulator implantation: A large database analysis","volume":"168","author":"Lorenz","year":"2022","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2473974X221106778","DOI":"10.1177\/2473974X221106778","article-title":"Hypoglossal Nerve Stimulator Explantation: A Case Series","volume":"6","author":"Patel","year":"2022","journal-title":"OTO Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111831","DOI":"10.1016\/j.ijporl.2023.111831","article-title":"Challenges and adverse events in pediatric hypoglossal nerve stimulation","volume":"176","author":"Chieffe","year":"2024","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5217","DOI":"10.1002\/lary.31589","article-title":"Are there hidden adverse events in hypoglossal nerve stimulation: Comparing social media and a federal database","volume":"134","author":"Ba","year":"2024","journal-title":"Laryngoscope"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1089\/pop.2016.0070","article-title":"Older Adults and Management of Medical Devices in the Home: Five Requirements for Appropriate Use","volume":"20","author":"Keller","year":"2017","journal-title":"Popul. Health Manag."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e033750","DOI":"10.1161\/JAHA.123.033750","article-title":"Wearable Devices, Health Care Use, and Psychological Well-Being in Patients with Atrial Fibrillation","volume":"13","author":"Rosman","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1002\/ohn.883","article-title":"Comprehensive Analysis of Adverse Events Associated with Hypoglossal Nerve Stimulators: Insights from the MAUDE Database","volume":"171","author":"Bentan","year":"2024","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"igac002","DOI":"10.1093\/geroni\/igac002","article-title":"A Systematic Review of Smartphone and Tablet Use by Older Adults with and Without Cognitive Impairment","volume":"6","author":"Wilson","year":"2022","journal-title":"Innov. Aging."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Oh, C.-M., Kim, H.Y., Na, H.K., Cho, K.H., and Chu, M.K. (2019). The Effect of Anxiety and Depression on Sleep Quality of Individuals with High Risk for Insomnia: A Population-Based Study. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.00849"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/6\/861\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:41:00Z","timestamp":1760031660000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/6\/861"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["life15060861"],"URL":"https:\/\/doi.org\/10.3390\/life15060861","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]}}}