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Hypoglossal Nerve Stimulation in Adolescents With Down Syndrome and Obstructive Sleep Apnea

Gillian R Diercks1,2, Carissa Wentland3,4, Donald Keamy1,2,5

  • 1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.

JAMA Otolaryngology-- Head & Neck Surgery
|November 4, 2017
PubMed

Insights

Hypoglossal nerve stimulation is a safe and effective treatment for children with Down syndrome (DS) and obstructive sleep apnea (OSA). This therapy significantly reduced apnea events and improved quality of life in adolescents with DS.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Genetics

Background:

  • Obstructive sleep apnea (OSA) affects up to 60% of children with Down syndrome (DS).
  • Persistent OSA in children with DS often leads to poor tolerance of positive airway pressure devices or tracheotomy.
  • Hypoglossal nerve stimulation offers a potential solution for upper airway obstruction.

Purpose of the Study:

  • To evaluate the safety and efficacy of hypoglossal nerve stimulation in children with Down syndrome.

Main Methods:

  • A case series involving 6 adolescents (12-18 years) with DS and severe OSA post-adenotonsillectomy.
  • Implantation of the Inspire hypoglossal nerve stimulator.
  • Monitoring for adverse events, adherence, and efficacy via apnea-hypopnea index (AHI) and OSA-18 quality-of-life scores.

Main Results:

  • Hypoglossal nerve stimulator therapy was well-tolerated, with device use ranging from 5.6 to 10.0 hours/night.
  • Significant reduction in AHI (56%-85%), with 4 children achieving <5 events/h and 2 achieving <10 events/h.
  • Clinically significant improvement in quality of life as measured by the OSA-18 instrument.

Conclusions:

  • Hypoglossal nerve stimulation is a safe and effective treatment option for children with DS and refractory OSA.
  • This therapy is suitable for patients with DS who cannot tolerate positive pressure airway devices.
  • It represents a promising therapeutic advancement for managing severe OSA in this population.
Abstract

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