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The STAR trial secondary analysis demonstrates that hypoglossal nerve stimulation therapy results in a significant reduction of hypoxic burden (HB) in patients with moderate to severe obstructive sleep apnea (OSA). This HB reduction correlates strongly with improvements in daytime sleepiness measured by the Epworth Sleepiness Scale (ESS), independently of Apnea-Hypopnea Index (AHI) or Arousal Index changes. Intriguingly, substantial HB improvement occurred even among participants classified as nonresponders by traditional criteria, underscoring HB as a valuable complementary biomarker for assessing treatment efficacy.
