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

Study objectives: To examine the feasibility, adherence to therapy, and efficacy of hypoglossal nerve stimulation (HGNS) in adults with Down syndrome (DS) with obstructive sleep apnea.

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

Results: Eleven adults with DS underwent implantation of HGNS between May 2021 and July 2024. Median age was 27 years old (interquartile range 26, 33), BMI 28.5kg/m² (26.5, 32.4), 27% were female, and had severe OSA (apnea-hypopnea index (AHI) 40/hr, (28.4, 42.9)). All patients were successfully implanted on an outpatient basis with no post-operative 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 AHI was reduced by 76%. All patients experienced a >50% decrease in AHI and to less than 15/hr. 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).

Conclusions: In this small initial cohort, HGNS appears to be a safe, well-tolerated and efficacious treatment option for adults with DS with moderate-severe obstructive sleep apnea and positive airway pressure therapy intolerance.