Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: Update on French practices and position paper of the SFRMS, SPLF and SFORL sleep medicine work-group - 19/12/25

Doi : 10.1016/j.anorl.2025.11.001

J. Frija ^a,^b,^{^{1
J. Frija and E. Béquignon have equal contributions.},}⁎ , E. Béquignon ^c,^d,^e,^{^{1
J. Frija and E. Béquignon have equal contributions.}}, L. Laccourreye ^f, I. Atallah ^g, F. Gagnadoux ^h,^{^{2
F. Gagnadoux and R. Tamisier have equal contributions.}}, R. Tamisier ^i,^j,^{^{2
F. Gagnadoux and R. Tamisier have equal contributions.}}
^a Université Paris Cité, Inserm Neurodiderot, Paris, France
^b Assistance publique–Hôpitaux de Paris, Hôpital Bichat–Claude-Bernard, Centre du Sommeil, 75018 Paris, France
^c AP–HP, Hôpital Henri-Mondor, Centre Hospitalier Intercommunal de Créteil, Service d’Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, 94010 Créteil, France
^d Inserm, U955, 94010 Créteil, France
^e Université Paris-Est Créteil, Faculté de Médecine, 94019 Créteil, France
^f Service d’ORL, CHU d’Angers, Université d’Angers, Angers, France
^g Service d’ORL, CHU Grenoble Alpes, Grenoble, France
^h Service de Pneumologie, CHU d’Angers, Inserm 1083, UMR CNRS 6015, Équipe CarME, SFR ICAT, Université d’Angers, Angers, France
ⁱ Laboratoire du sommeil, Service Hospitalo-Universitaire de Physiologie et Pneumologie, CHU Grenoble Alpes, Grenoble, France
^j Université Grenoble Alpes, Grenoble, France

^⁎Corresponding author at: Assistance publique–Hôpitaux de Paris, Hôpital Bichat–Claude-Bernard, Centre du Sommeil, 75018 Paris, France.Assistance publique–Hôpitaux de Paris, Hôpital Bichat–Claude-Bernard, Centre du SommeilParis75018France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 19 December 2025

Abstract

Objectives

To update practices for setting up, follow-up and indications in hypoglossal nerve stimulation in France.

Methods

Analysis of Medline, Cochrane and Embase databases (1970–2024), with assessment of techniques, follow-up modalities, results and side effects. Six physicians (3 ENT specialists, 3 pulmonologists, all involved in hypoglossal stimulation) took part in a work-group between January 2024 and January 2025.

Results

Only one implant, Inspire IV, is available in France, indicated for non-obese (BMI < 32 kg/m ² ) patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome (OSAHS) (apnea/hypopnea index [AHI] 15–50/h), and failure of or contraindications for continuous positive airway pressure (CPAP) or mandibular advancement device (MAD). Prior drug-induced sleep endoscopy (DISE) is mandatory. Studies show a 68% decrease in AHI, 70% decrease in oxygen desaturation index (ODI) at 12 months, and improvements in somnolence and quality of life, which seem stable at 36 months. About 25% of patients experience side effects, which are mostly transient. Final set-up requires polysomnography; follow-up requires clinical examination and/or poly(somno)graphy.

Conclusion

This new alternative treatment in France should be proposed for symptomatic patients with failure of CPAP or MAD, rigorously screened in multidisciplinary centers.

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Keywords : Hypoglossal nerve stimulation, Alternative to CPAP, Drug-induced sleep endoscopy, Obstructive sleep apnea-hypopnea syndrome