Adults with Down syndrome and obstructive sleep apnea treated with hypoglossal nerve stimulation

We aimed to examine the feasibility, adherence to therapy, and efficacy of hypoglossal nerve stimulation in adults with Down syndrome and obstructive sleep apnea.

Adults patients with Down syndrome who met criteria for hypoglossal nerve stimulation were prospectively enrolled. Objective adherence was extracted from a cloud-based compliance database. Preoperative sleep studies were compared to follow-up testing performed no sooner than 3 months after device activation.

Eleven adults with Down syndrome underwent implantation of hypoglossal nerve stimulation between May 2021 and July 2024. Median age was 27 years (interquartile range 26, 33), body mass index 28.5 kg/m² (26.5, 32.4), 27% were female, and patients had severe obstructive sleep apnea (apnea-hypopnea index 40 events/h, 28.4, 42.9). All patients were successfully implanted on an outpatient basis with no postoperative complications or readmissions and activated on schedule at 1 month after surgery. Adherence data show nightly usage longer than 4 hours was 100% and 96% of nights and a median of 9.2 and 8.5 hours/night in the first 30 and 90 days, respectively. Seven patients have undergone follow-up testing and the median entire-night apnea-hypopnea index was reduced by 76%. All patients experienced a > 50% decrease in apnea-hypopnea index and to less than 15 events/h. Median time spent below 88% improved from 2.0% (0.3, 5.0) to 0.2% (0, 0.6), and oxygenation nadir improved from 79.0% (75.5, 85) to 88.0% (86.5, 91).

In this small initial cohort, hypoglossal nerve stimulation appears to be a safe, well-tolerated, and efficacious treatment option for adults with Down syndrome with moderate-to-severe obstructive sleep apnea and positive airway pressure therapy intolerance.

Huyett P, Santoro SL, Oreskovic NM, Skotko BG. Adults with Down syndrome and obstructive sleep apnea treated with hypoglossal nerve stimulation. J Clin Sleep Med. 2025;21(4):619-625.