Brigham and Women's Hospital
The goal of this clinical trial is to learn whether removing the tonsils at the time of hypoglossal nerve stimulation improves treatment of obstructive sleep apnea in adults whose airway collapses from the side of the upper airway during sleep. The main questions it aims to answer are: 1. Does hypoglossal nerve stimulation combined with tonsillectomy reduce the severity of obstructive sleep apnea more than hypoglossal nerve stimulation alone? 2. Does tonsillectomy improve how effectively hypoglossal nerve stimulation opens and stabilizes the upper airway? Researchers will compare participants who receive hypoglossal nerve stimulation with tonsillectomy to participants who receive hypoglossal nerve stimulation alone. Participants will: * Complete sleep studies, questionnaires, and other assessments before and after treatment * Be randomly assigned to receive hypoglossal nerve stimulation either with or without tonsillectomy * Return for follow-up visits and sleep testing to evaluate treatment effectiveness * In a subset of participants, complete additional overnight testing to measure how treatment changes upper-airway collapsibility
Obstructive sleep apnea (OSA) is commonly treated with hypoglossal nerve stimulation (HGNS), but treatment efficacy is substantially reduced in patients with complete oropharyngeal lateral wall (OPLW) collapse. HGNS primarily enlarges the airway by protruding the tongue and is therefore most effective in patients with anteroposterior patterns of airway collapse. Tonsillectomy reduces tissue contributing to lateral pharyngeal narrowing and may complement the mechanism of HGNS by addressing residual lateral wall obstruction. Preliminary clinical data suggest that combining tonsillectomy with HGN…
Inclusion Criteria: * Age ≥ 18 years * Diagnosis of obstructive sleep apnea with apnea-hypopnea index (AHI) ≥ 15 events/hour * Complete oropharyngeal lateral wall (OPLW) collapse identified on DISE * Candidate for HGNS implantation based on standard clinical criteria * Presence of small (1-2+) tonsils and eligibility for tonsillectomy * Untreated OSA at the time of enrollment * Willing and able to provide written informed consent Exclusion Criteria: * Absence of tonsils * Presence of large tonsils (3-4+; not eligible for HGNS) * Predominant central or mixed sleep apnea (\>25% central or mix…
Tonsillectomy
HGNS alone (without concomitant tonsillectomy)