Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Jared Keeley


Introduction: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that produces repetitive obstruction or collapse of the upper airway. Positive airway pressure (PAP) therapy is the gold standard treatment for OSA. Hypoglossal nerve stimulation (HNS) is considered an alternative treatment for patients who are unable to tolerate PAP therapy. The purpose of the study was to examine sleep, mental health, and cognitive health outcomes before and after HNS to determine its viability as an alternative treatment.

Methods: The study utilized a single-group, pretest-posttest design. Objective and subjective sleep was measured using actigraphy, sleep diary, and questionnaires. Objective and subjective cognitive health was measured using paper-and-pencil tests and questionnaires. Lastly, questionnaires were used to obtain data pertaining to mental health. Data were analyzed using two-tailed dependent samples t-tests and reliable change indices (RCI).

Results: Eleven middle-aged and older adults participated in the study. There was no significant difference in objective or subjective sleep, objective cognitive function, daytime sleepiness, depression, or anxiety between pre- and post-HNS. Participants showed significant improvement in sleep disturbance, insomnia severity, subjective cognitive function, and anger following treatment. Largest improvement was shown for subjective cognitive function, anger, and insomnia severity during RCI analyses.

Discussion: The results suggest longer follow-up periods that include post-operative care and titration visits are necessary for enhancing the effectiveness of HNS. Discrepancies between objective and subjective data suggested participants perceived just-noticeable improvement in sleep and cognition in the context of cumulative non-significant change.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission


Available for download on Saturday, June 22, 2024