Current evidence on the safety and efficacy of hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information to support shared decision-making. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea (see NICE's interventional procedure outcomes audit tool).
Patient selection and the procedure should be done by clinicians with special expertise in the management of obstructive sleep apnoea.
Further research including the use of observational data from registries should provide information on patient selection, safety outcomes, quality of life, long-term outcomes and the position of the procedure in the treatment pathway. NICE may update the guidance on publication of further evidence.