ASPO018 - Upper Airway Stimulation for Adolescents with Down Syndrome and Obstructive Sleep Apnea
Saturday, April 30, 2022
10:30 AM – 11:05 AM CT
Location: Landmark C
Phoebe K. Yu, MD MPH1, Matthew J. Stenerson, MS1, Stacey Ishman, MD2, Nikhila Raol, MD, MPH3, Ryan J. Soose, MD4, Allison Tobey, MD4, Cristina Baldassari, MD5, Raj C. Dedhia, MD, MSCR6, Thomas B. Kinane, MD7, Donald G. Keamy, MD MPH1, Brian G. Skotko, MD, MPP7, Christopher J. Hartnick, MD, MS1;
1Otolaryngology, Massachusetts Eye & Ear, Cambridge, MA, 2Otolaryngology, Cincinnati Children’s Hosp. Med. Ctr., Cincinnati, OH, 3Otolaryngology, Children's Healthcare of Atlanta, Atlanta, GA, 4Otolaryngology, Univ. of Pittsburgh Med. Ctr., Pittsburgh, PA, 5Otolaryngology, Eastern Virginia Med. Ctr., Norfolk, VA, 6Otolaryngology, Univ. of Pennsylvania, Philadelphia, PA, 7Pediatrics, Massachusetts Gen. Hosp., Boston, MA.
Introduction: Patients with Down syndrome (DS) have a high incidence of persistent obstructive sleep apnea (OSA) and limited treatment options. Upper airway hypoglossal stimulation has shown efficacy for OSA in adults, but has not yet been evaluated in pediatric populations. Our objective is to describe the safety and efficacy of upper airway stimulation for adolescent patients with DS and severe OSA.
Methods: Using a multicenter, prospective, single-arm, cohort design, 42 adolescent patients with DS and persistent, severe OSA (apnea-hypopnea index > 10 events/hour after adenotonsillectomy and positive airway pressure intolerance) underwent upper airway stimulation. Polysomnographic and quality of life outcomes were assessed at 1, 2, 6, and 12 months postoperatively. The prespecified primary outcomes were safety and the change in apnea-hypopnea index from baseline to 12 months postoperatively.
Results: There was a mean decrease in AHI of 12.9 (95% CI -17.0, -8.7; p<0.0001). Using a therapy response definition of a 50% decrease in AHI, the 12-month response rate was 65.9%, and 73.2% of patients had a 12-month AHI under 10. The most common complication was temporary tongue or oral discomfort, which occurred in 11.9% patients. The reoperation rate was 4.8%. There was a mean improvement in the OSA-18 total score of 34.8 (95% CI -42.1, -27.5; p<0.0001) and in the Epworth Sleepiness Scale of 5.1 (95% CI -7.4, -2.8; p<0.0001). The average nightly therapy use was 8.96 hours with 95.2% of patients using the device at least 4 hours a night.
Conclusion: Upper airway stimulation was able to be safely performed for 42 adolescents who had DS and persistent severe OSA after adenotonsillectomy with CPAP intolerance. There was an acceptable adverse event profile with high rates of therapy response and quality of life improvement