LivaNova Gets Serious About OSA
The Company Presented Their Recent Plans at Investor Day 2025
LivaNova’s (Stock: LIVN) 2025 Investor Day 11/12/2025 was designed to reassure Wall Street that the company’s “strong core” cardiopulmonary and epilepsy businesses remain durable growth engines. But the most consequential part of the presentation was clear: LivaNova is positioning obstructive sleep apnea (OSA) as its next transformational franchise.
LivaNova is a global medical technology company with expertise in cardiopulmonary devices and neuromodulation. Its legacy businesses—heart-lung machines, oxygenators, and vagus nerve stimulation (VNS) therapy for epilepsy and depression—have historically provided steady, recession-resistant revenue. For most of the past decade, LivaNova operated as a focused but relatively quiet mid-cap medtech player, known more for clinical depth than commercial flash.
OSA represents its most ambitious expansion of the past decade: an opportunity to leverage its neuromodulation heritage, manufacturing capability, and physician-centric commercial model in a large, fast-growing sleep market. By pursuing proximal hypoglossal nerve stimulation (pHGNS), LivaNova is betting that second-generation stimulation technology—with broader patient eligibility and improved titration tools—can disrupt a market long dominated by Inspire. The company now positions OSA as a “transformative growth platform” and a core pillar of its strategy.
The sleep medicine and investment community is excited to see if they can execute on this plan. We have summarized their investor day commentary:
1. LivaNova is framing OSA as a “transformative growth opportunity”
OSA is one of three pillars of the company’s forward strategy—the other two being cardiopulmonary and depression neuromodulation. The language used was unambiguous:
“Transformative OSA opportunity” and a pathway to $200–$400M in revenue by 2030, driven by a U.S. commercial launch targeted for 2027.
2. The OSA market remains enormous—and underpenetrated
LivaNova reiterates what sleep clinicians know, but the broader market still underestimates: OSA is a massive addressable market. Key slides highlight:
23M Americans with moderate–severe OSA
Less than 5% HGNS penetration today
~2.5M CPAP-intolerant patients
What’s notable is LivaNova’s framing of the care pathway. They illustrate that:
80% of OSA cases remain undiagnosed
95% of diagnosed patients are trialed on CPAP
Up to 50% abandon CPAP
Yet <10% of CPAP failures ever reach an ENT, and fewer still qualify for Inspire
This framing sets up the company’s narrative: the bottleneck isn’t interest—it’s eligibility and workflow inefficiencies.
3. LivaNova is positioning pHGNS as clinically differentiated from Inspire
The core of LivaNova’s pitch is that proximal hypoglossal nerve stimulation (pHGNS) is a meaningfully different—and broader-reaching—technology compared to first-generation HGNS. They emphasize:
Multi-contact cuff with selective stimulation zones
More complete control of tongue and airway mechanics
Ability to treat “challenging patients” including CCC, higher BMI, and more severe AHI
All that via a short, minimally invasive surgery
This is a direct challenge to Inspire’s known limitations, particularly CCC exclusion.
4. The OSPREY RCT is being used as the clinical lynchpin
The OSPREY trial is positioned as the most comprehensive HGNS clinical study to date:
No exclusion of CCC patients
Higher baseline AHI and BMI than previous trials
At 12 months, OSPREY shows:
65% responder rate in the treatment group vs 14% in control
Strong durability of effect
This is strategically important—Inspire’s pivotal STAR trial, despite excellent outcomes, lacked CCC inclusion and broader BMI range. That said, it is important to mention that during OSPREY over 1200 patients were initially screened and only 138 got implanted after a detailed evaluation of inclusion and exclusion criteria. And while the median number of encounters to achieve therapeutic settings is not reported, the protocol describes therapy adjustment PSGs at months 1,2,3 and 10, highlighting the need for detailed follow-up.
5. PolySync may become a differentiating “X-factor”
LivaNova revealed early data on PolySync, a multi-contact titration algorithm leveraging up to six electrodes with independent control. Early data from OSPREY non-responders is striking:
35 non-responders invited
Of the 10 who have completed this novel algorithm, 80% converted to responders after PolySync.
If validated, this could meaningfully increase responder rates and reduce variability—a long-standing focus of sleep surgeons and sleep physicians.
PolySync will be available at launch, which signals the company’s intent to anchor its commercial strategy on additional software-enabled differentiation.
6. No direct-to-consumer advertising—this is a physician-first launch
LivaNova is explicitly rejecting Inspire’s early DTC-heavy strategy:
“No DTC. Second-line therapy that should target physician awareness.”
Instead, they plan to lean heavily on ENT trial centers, publications, and traditional device-based KOL engagement.
97% of surveyed ENTs indicated they would “definitely or probably trial” the device.
*This fits the current model. Inspire has been around 10+ years and is essentially a mature product in the market. LivaNova is positioning itself to be in any discussion that a patient has with surgeon re HNS.
7. A robust digital roadmap: from remote programming to automated titration
The product roadmap goes well beyond hardware. It includes:
Remote programming
Integration with wearables and HST
Remote and assisted titration
Ultimately automated titration with machine learning
This mirrors broader medtech trends: moving titration and follow-up out of the clinic and into the cloud.
For sleep medicine, the implications are significant: HGNS follow-up could shift from manually intensive ENT sleep labs toward hybrid or remote models—reducing a significant pain point post-implantation.
8. Commercialization: LivaNova is Prepared to Scale
They anticipate:
150 territories
400+ implanting ENTs
By 2030
This is a substantial commitment for a company that has never had a large U.S. sleep-focused sales force.
Bottom line: LivaNova is Serious—and Inspire Has Another Competitor
The presentation signals a coordinated and well-funded push into OSA anchored around four pillars:
A more versatile, anatomically flexible HGNS system (pHGNS)
A real RCT with broader patient inclusion (OSPREY)
Software-driven differentiation (PolySync)
A disciplined commercial strategy built on neuromodulation experience
For sleep medicine clinicians and surgeons, competition is good. If pHGNS expands eligibility, improves responder rates, or simplifies titration, it’s a great addition to treatment workflows.
For investors, LivaNova is signaling that OSA is not a side project—it’s the company’s new growth engine.
And for patients, more treatment options, greater eligibility, and a broader set of tools is a clear win. We look forward to seeing it in our clinics sooner than later.
Best, Chris & Robson.