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Published on: December 6, 2016
Neurostimulation for Pediatric Obstructive Sleep Apnea
Doug Chieffe1, Christopher Hartnick2
1Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
Insights
Most children with Down syndrome (DS) have obstructive sleep apnea (OSA). Hypoglossal nerve stimulation is a new treatment option for DS patients with residual OSA, but care pathways need adaptation.
Area of Science:
- Pediatric Pulmonology
- Neurology
- Genetics
Background:
- Obstructive sleep apnea (OSA) affects up to 80% of children with Down syndrome (DS).
- Adenotonsillectomy provides OSA resolution in only 16%–30% of these children.
- Hypoglossal nerve stimulation (HNS) is FDA-approved for DS children with residual OSA.
Purpose of the Study:
- To review the current understanding of HNS for pediatric OSA in Down syndrome.
- To discuss the adaptation of established adult HNS care pathways for this complex pediatric population.
Main Methods:
- Review of existing literature on HNS in adults and children with DS.
- Analysis of challenges in translating adult HNS care pathways to pediatric DS patients.
Main Results:
- HNS is a proven therapy for adult OSA with established care pathways.
- Pediatric DS patients present unique challenges (e.g., craniofacial differences, comorbidities) impacting HNS therapy.
- Direct transfer of adult care pathways is not feasible for children with DS.
Conclusions:
- Hypoglossal nerve stimulation offers a promising therapeutic option for children with Down syndrome and obstructive sleep apnea.
- Specialized care pathways are necessary to optimize HNS outcomes in this vulnerable pediatric population.
Abstract:
Up to 80% of children with Down syndrome (DS) are affected by obstructive sleep apnea (OSA), and only 16% to 30% will have resolution of their OSA with adenotonsillectomy. Hypoglossal nerve stimulation is a well-established therapy for adults with OSA and was recently approved by the Food and Drug Administration for use in children with DS and residual OSA. There is robust experience with this therapy in adults that has led to well-established care pathways. However, given the challenges inherent to caring for a complex pediatric population, these pathways are not directly transferrable to children with DS.
