Hypoglossal Nerve Stimulation for Obstructive Sleep Apnoea: A UK Expert Consensus Statement on Standards of Care in the NHS

¹Department of ENT, Royal National ENT Hospital, London, UK & Department of ENT, Barking, Havering and Redbridge University Trust, London, UK

²Department of ENT, Barking, Havering Redbridge University Trust, London, UK

*Corresponding author: Dr. Kurian George, MD, Department of ENT, Barking, Havering Redbridge University Trust, London, UK, Phone: 00447938480045, E-mail: [email protected]

Received: March 01 2026

Published: May 15, 2026

Citation: Veer V, et al. (2026). Hypoglossal Nerve Stimulation for Obstructive Sleep Apnoea: A UK Expert Consensus Statement on Standards of Care in the NHS. Clin Res. 7(1):32.

Copyright: Veer V, et al. © (2026).

ABSTRACT

Introduction: Hypoglossal nerve stimulation (HGNS) is an established implantable therapy for moderate-to-severe obstructive sleep apnoea (OSA) in patients unable to tolerate or benefit from continuous positive airway pressure (CPAP). As adoption expands within the National Health Service (NHS), significant variation exists in patient selection, governance, and service configuration across centres.

Aim of the study: To evaluate the level of expert consensus regarding the minimum clinical standards and governance principles for HGNS within the NHS from reviewing formal statements.

Methods: A national meeting of UK ENT surgeons actively engaged in HGNS was convened. Twenty-three binary (Yes/No) consensus statements covering patient selection, perioperative standards, governance, competency, and industry expectations were presented for structured discussion and voting. Consensus was defined as ≥80% agreement.

Results: Fourteen surgeons participated. Consensus was achieved on 21 of 23 statements (91.3%). Unanimous agreement (14/14) was reached on 16 statements (69.6%), including requirements for documented CPAP failure, mandatory drug-induced sleep endoscopy, prospective audit, standardised consent and patient information, service resilience with two trained surgeons per centre, access to both approved HGNS systems, and structured long-term follow-up. Two statements did not achieve consensus: mandatory full polysomnography and a formal multidisciplinary team structure including sleep neurology.

Conclusions: This national consensus establishes agreed minimum standards and governance principles for HGNS within the NHS. The high level of agreement reflects the maturity of UK sleep surgery practice and a shared commitment to patient safety, equitable access, and accountability. These standards are intended to support new centre development, provide a defensible framework for established services, and set shared expectations for device manufacturers operating in the UK market.

Keywords: Hypoglossal Nerve Stimulation, Obstructive Sleep Apnoea, CPAP, Consensus, Drug-Induced Sleep Endoscopy, NHS, Governance, Upper Airway Stimulation