Updated German Sleep Society (DGSM) Treatment Guidelines

Include Recommendation for Hypoglossal Nerve Stimulation Therapy
for Subset of Sleep Apnea Patients

The German Society for Sleep Medicine (DGSM) has issued a written update to its sleep apnea treatment guidelines that now includes a recommendation for the use of hypoglossal nerve stimulation therapy in select sleep apnea patients who are unable to get consistent benefit from CPAP. In the annually published DGSM guidelines, hypoglossal nerve stimulation therapy received an “S3” classification which signifies the highest quality level of development methodology awarded by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF).

The updated guidelines states: “Neural stimulation of the hypoglossal nerve can be used in patients who do not have any anatomical abnormalities and who have moderate to severe OSA if positive pressure therapy cannot be used under the above-mentioned conditions. It should only be used in patients with CPAP intolerance or ineffectiveness with an AHI of 15–50/h and an obesity severity level of ≤ 1 if no concentric obstruction has been documented.”

The guideline is based on a large body of clinical evidence which includes a multi-center study that demonstrated the efficacy of the treatment by a randomized therapy withdrawal and a multi-center German post-market study. These studies have all shown consistent reductions in sleep apnea burden, clinically meaningful improvements in quality of life measures and high therapy adherence levels.