Hypoglossal nerve stimulation in adolescents with down syndrome and obstructive sleep apnea: A systematic review and meta-analysis

Abstract

ObjectiveTo evaluate the efficacy and adverse effects of hypoglossal nerve stimulation in adolescents with down syndrome and obstructive sleep apnea.MethodsA systematic search was conducted using PubMed, Web of Science, Embase, and Scopus databases. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search strategy used a combination of Medical Subject Headings and free words with “OR” and “AND.” Articles were screened to extract data reporting apnea-hypopnea index, quality of life, voltage, follow-up duration, and complications. All included participants were adolescents with down syndrome and obstructive sleep apnea.ResultsA total of 92 articles were identified, of which 9 articles met the inclusion criteria. A total of 106 patients were included. All the studies showed that patients receiving hypoglossal nerve stimulation experienced a significant decrease in apnea-hypopnea index (at least 50%). The pooled AHI was significantly lower in patients following treatment (mean AHI reduction 17.43 events/h, 95% confidence interval 13.98–20.88 events/h, P < 0.001) after 2 case reports were excluded. The pooled OSA-18 were significantly decreased in 88 patients after treatment (mean OSA-18 reduction 1.67, 95% confidence interval 1.27–2.08, P < 0.001) after excluding 5 studies. Four investigations examined the necessity to optimize stimulation voltage for arousal during treatment. The most common complication was pain or discomfort in the tongue or mouth. Most studies had relatively short patient follow-up periods, with the most extended follow-up being 44–58 months.ConclusionHypoglossal nerve stimulation significantly reduces apnea-hypopnea index and improves the quality of life; and thus, could be a potential alternative therapy for obstructive sleep apnea in adolescents with down syndrome. The adolescent's age, potential complications, adverse events, long-term efficacy, and comfort, needs to be considered while performing hypoglossal nerve stimulation.

Medical Treatment of Obstructive Sleep Apnea in Children

“…In a meta-analysis of nine articles involving 106 adolescents with Down syndrome and OSA, there was an improvement in the AHI by at least 50% when patients were treated with hypoglossal nerve stimulation. Participants also showed improvements in the OSA-18 (a validated, disease-specific quality of life instrument for OSA) and in daytime sleepiness measured with Epworth Sleepiness Scale questionnaires [104].…”

A Multifaceted Approach to Seizure Management in a Patient With Down Syndrome, Obstructive Sleep Apnea, and Hypothyroidism: A Case Report

“…Nonetheless, the high prevalence of undetected sleep disorders in adults with DS emphasizes the importance of comprehensive sleep assessment [ 12 ]. Alternatives to CPAP therapy, such as hypoglossal nerve stimulation, have been suggested and are well-tolerated in adolescents with DS [ 13 ], indicating the need to explore various treatment options.…”

Beyond Hypoglossal Hype: Social Media Perspectives on the Inspire Upper Airway Stimulation System

“…The Inspire ® Upper Airway Stimulation (UAS) device has been a focal point of discussion in sleep apnea and sleep surgery literature, as hypoglossal nerve stimulation has gained traction as a popular option for surgical management of OSA [25][26][27]. The device has been commonly advertised on platforms such as television, radio, and social media, the latter of which physicians have assumed a proactive role, with 32.2% of all posts related to the UAS device being written by physicians.…”