This retrospective cohort study used a large US commercial insurance database (2015–2024) to compare cardiovascular disease (CVD) incidence in 3,786 adults who underwent hypoglossal nerve stimulation (HGNS) for OSA versus 3,395 propensity-matched controls who were HGNS-eligible but did not receive the device.
After 2 years, HGNS was associated with significantly lower hazard of diabetes (HR 0.19), hypertension (HR 0.49), and — among those with baseline diabetes/hypertension — minor (HR 0.42) and major (HR 0.40) cardiovascular events. Within the first 2 years, HGNS was paradoxically linked to *higher* hazard of hypertension (HR 1.70), minor CVD events (HR 1.44), and major CVD events (HR 1.62).
- OSA and CVD severity were not available for propensity matching, introducing residual confounding. - Retrospective claims data cannot confirm device adherence or therapeutic efficacy. - The early (< 2 year) increase in CVD diagnoses may reflect surveillance/detection bias rather than true harm.
HGNS appears to offer meaningful cardiovascular risk reduction beyond 2 years post-implant, including large reductions in diabetes and hypertension incidence. Counsel patients that early apparent increases in CVD diagnoses likely reflect closer monitoring rather than device harm, but longer follow-up data are still needed.
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