Oropharyngeal Lateral Wall Collapse as a Predictor of Hypoglossal Nerve Stimulation Response: A Systematic Review and Meta-Analysis

Abstract

Purpose Oropharyngeal lateral wall collapse (OPLW) on drug-induced sleep endoscopy (DISE) may influence outcomes after hypoglossal nerve stimulation (HNS) for obstructive sleep apnea (OSA). This systematic review and meta-analysis evaluates whether DISE-defined OPLW collapse is associated with HNS treatment success. Methods PubMed, Embase, and Scopus were searched through February 2026. Eligible studies included adults undergoing HNS for OSA, assessed OPLW collapse using DISE, and reporting extractable postoperative outcomes. PRISMA guidelines were followed. Binary treatment success was pooled using Mantel-Haenszel random-effects models and reported as odds ratios (ORs) with 95% confidence intervals. Results Seven retrospective and prospective observational studies were included. In the primary meta-analysis of three studies comprising 502 patients, complete OPLW collapse was associated with significantly lower odds of HNS treatment success compared with non-complete collapse (OR 0.43, 95% CI 0.28 to 0.64; I 2 = 0.0%). Secondary analyses showed no significant association for any versus no OPLW collapse (OR 0.72, 95% CI 0.41 to 1.24), while complete versus no OPLW collapse remained significant (OR 0.50, 95% CI 0.27 to 0.91). Conclusion Complete DISE-defined OPLW collapse is associated with lower odds of HNS treatment success. These findings support complete OPLW collapse as an unfavorable airway phenotype that may inform preoperative counseling and patient selection.