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Hypoglossal Nerve Stimulation Therapy for Pediatric Obstructive Sleep Apnea: A Meta-Analysis
Ji Ho Choi1, Soo Kyoung Park2, Jae Hoon Cho3
1Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170, Jomaru-ro, Bucheon 14584, Republic of Korea.
Insights
Hypoglossal nerve stimulation effectively treats pediatric obstructive sleep apnea (OSA) in patients unresponsive to standard therapies. This safe and valuable alternative shows consistent results across diverse pediatric patient groups.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Otolaryngology
Background:
- Obstructive sleep apnea (OSA) in children poses significant health risks.
- Standard therapies for pediatric OSA are not universally effective.
- Alternative treatments are needed for refractory pediatric OSA cases.
Purpose of the Study:
- To evaluate the efficacy of hypoglossal nerve stimulation (HNS) for pediatric OSA.
- To assess the consistency of HNS outcomes in different pediatric patient groups.
- To identify HNS as a potential alternative to conventional treatments for pediatric OSA.
Main Methods:
- Systematic literature search of PubMed, EMBASE, Cochrane Library, and Web of Science up to July 2025.
- Inclusion of studies with objective polysomnographic data (apnea-hypopnea index [AHI]) for pre- and post-intervention comparison.
- Meta-analysis using ratio of means (ROM) and a fixed-effects model to quantify treatment effect.
Main Results:
- Nine studies with 140 pediatric subjects, primarily adolescents with Down syndrome, were included.
- Significant reduction in AHI observed, with an overall ROM of 0.57 (95% CI: 0.49-0.65).
- High uniformity of therapeutic benefit across cohorts (I² = 16%, p = 0.30) with no significant publication bias.
Conclusions:
- Hypoglossal nerve stimulation is a safe and effective treatment for pediatric OSA.
- HNS offers a valuable alternative for children with OSA unresponsive to standard therapies.
- Consistent positive outcomes suggest broad applicability in pediatric OSA management.
Abstract:
Background/Objectives: This study evaluates the efficacy of hypoglossal nerve stimulation as an alternative intervention for pediatric patients with obstructive sleep apnea (OSA) unresponsive to standard therapies and examines the uniformity of therapeutic outcomes across different patient cohorts. Methods: An extensive systematic search was performed across four principal databases (PubMed, EMBASE, Cochrane Library, and Web of Science) utilizing keywords associated with pediatric OSA and hypoglossal nerve stimulation, encompassing studies up to July 2025 that provided objective polysomnographic metrics (e.g., apnea-hypopnea index [AHI] values) to enable the quantitative assessment of pre- and post-intervention effects in children. The primary outcome measured was the ratio of means (ROM), determined from pre-post data in single-group studies, with summary estimates obtained using the fixed-effects model. Results: The systematic review included nine eligible studies with a total of 140 pediatric subjects, the majority of whom were adolescents with Down syndrome. AHI meta-analysis outcomes indicated a marked improvement in OSA severity, yielding an overall ROM of 0.57 [95% confidence interval: 0.49-0.65]. The therapeutic benefit demonstrated a high degree of uniformity across cohorts, as indicated by minimal statistical heterogeneity (I2 = 16%, p = 0.30). Funnel plot assessment showed no statistically significant evidence of systematic publication bias. Conclusions: Current evidence suggests that hypoglossal nerve stimulation therapy is a safe, effective, and valuable alternative for pediatric OSA patients who do not respond to conventional therapies.
