HNS Tied to Reductions in 8 of 9 MACE Outcomes in Late-Breaking OSA Analysis: SLEEP 2026

In a late-breaking analysis presented at SLEEP 2026, treatment of obstructive sleep apnea (OSA) with hypoglossal nerve stimulation was associated with reductions in more major adverse cardiovascular event outcomes than positive airway pressure (PAP) therapy, raising new questions about the role of adherence in translating OSA treatment into cardiovascular benefit.

In the video above, Sairam Parthasarathy, MD, professor of medicine at the University of Arizona, discusses the rationale for evaluating cardiovascular outcomes among patients treated with hypoglossal nerve stimulation, PAP therapy, or no treatment. He explains that untreated OSA has long been linked with increased cardiovascular risk, including higher risks for myocardial infarction, stroke, hospitalization, cardiovascular mortality, and all-cause mortality. Yet, despite this association, prior randomized trials of PAP therapy have often failed to show significant reductions in cardiovascular events.

According to Parthasarathy, adherence may be central to understanding that disconnect. PAP requires patients to apply and tolerate an external device nightly, often for the full sleep period, which can be difficult because of mask discomfort, claustrophobia, anxiety, or other barriers. As a result, many patients do not use PAP consistently enough to realize its full therapeutic benefit.

Hypoglossal nerve stimulation, by contrast, is an implanted therapy designed to activate the hypoglossal nerve during sleep, moving the tongue forward to help prevent upper airway collapse. Because it does not require wearing a mask, Parthasarathy said adherence may be higher than with PAP in some patients.

The findings do not eliminate the role of PAP, which remains a standard and effective therapy for many patients with OSA. Instead, Parthasarathy frames the late-breaking data as an opportunity for clinicians, including primary care physicians, to think more carefully about adherence, cardiovascular risk, and when alternative OSA treatments may warrant discussion.

Dr Parthasarathy has no relevant disclosures.