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Optimizing Inspire Hypoglossal Nerve Stimulator Settings in Pediatric Obstructive Sleep Apnea
Kathryn S Marcus1, Danielle R Larrow1, Kevin S Gipson2
1Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.
The Laryngoscope
|June 26, 2024
Summary
Optimizing both stimulation and sensing leads for hypoglossal nerve stimulation (HGNS) significantly improved obstructive sleep apnea (OSA) in children with Down syndrome (DS). This advanced titration, including drug-induced sleep endoscopy when needed, proved more effective than stimulation settings alone.
Area of Science:
- Otolaryngology
- Sleep Medicine
- Pediatric Pulmonology
Background:
- Hypoglossal nerve stimulation (HGNS) is an established treatment for obstructive sleep apnea (OSA) in pediatric patients with Down syndrome (DS).
- Current optimization strategies primarily focus on stimulation lead settings.
- The impact of sensing lead optimization on HGNS efficacy in this population remains under-investigated.
Purpose of the Study:
- To evaluate the effectiveness of an advanced titration algorithm for HGNS in pediatric patients with DS and OSA.
- To determine if optimizing both stimulation and sensing lead settings, alongside drug-induced sleep endoscopy (DISE) when indicated, improves outcomes compared to stimulation-only optimization.
Main Methods:
- A novel titration algorithm was applied to three pediatric patients with DS and OSA who initially did not respond to standard HGNS titration.
- Two patients with hypopnea-dominant sleep studies underwent advanced titration, optimizing both stimulation and sensing lead settings.
- One patient with an apnea-dominant study was evaluated with interrogated DISE, followed by advanced titration.
Main Results:
- The advanced titration algorithm resulted in a ≥50% reduction in the apnea-hypopnea index (AHI) for all three patients.
- Two patients achieved normal to mild OSA severity (AHI <5) after the advanced titration.
- The tailored approach, considering apnea-dominant versus hypopnea-dominant patterns, demonstrated significant efficacy.
Conclusions:
- A novel diagnostic and therapeutic titration algorithm for the Inspire HGNS system significantly improved AHI in pediatric patients with DS and OSA.
- This advanced titration, incorporating sensing lead optimization and DISE when necessary, is more effective than standard stimulation-only titration for non-responders.
- Optimizing both stimulation and sensing leads offers a promising strategy for HGNS therapy in challenging pediatric OSA cases.
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