Upper airway hypoglossal nerve stimulation is safe and effective in adolescence. Down’s syndrome Severe persistence Obstructive sleep apnea (OSA) Early studies suggest that those who develop after adenosyl resection and cannot tolerate positive airway pressure.
In a phase I trial, 42 adolescents received a surgically implanted device that moved the tongue forward during sleep. The results of the one-year follow-up showed that 66% responded “well” to treatment and had a decrease in apnea-hypopnea index (AHI) of at least 50%.
“My parents came back to us and said that not only did my child get better sleep, but my child seemed to get better during the day,” said Pediatric Otorhinolaryngology and Pediatric Airways, Voice, and Swallowing. Dr. Christopher Hartnick, MD, Principal Investigator, Head of the Department, said. Boston’s Massachusetts Ophthalmology and Otorhinolaryngology Center Medscape Medical News.
The survey results are Published online April 21 JAMA Otorhinolaryngology – Head and Neck Surgery.
Limited options
Upper respiratory tract simulations have previously been shown to be effective in adults with OSA, but so far this process has not been evaluated in children.
The device used in the current study “stimulates the hypoglossal nerve to stick out the tongue and open the airways during inspiration during sleep,” the researchers point out.
“Sublingual nerve stimulation is particularly suitable for patients with down syndrome because it can enhance neuromuscular airway tone and reduce anatomical obstruction at the base of the tongue, which is a common site of residual occlusion in children with down syndrome. It could be a cure, “they add.
“This study was born out of a frustration that children with Down Syndrome suffering from sleep apnea do not have effective treatment options,” Hartnick said in a news release.
A total of 42 adolescents (67% male, average age 15 years) with Down syndrome and persistent severe OSA after hypoglossal nerve stimulator transplantation. Everything was tracked for 12 months.
Surgery was safe and the most common adverse event was temporary tongue discomfort in 5 patients (12%). Researchers say this usually resolved in a few weeks.
High response, compliance rate
The results showed a high response rate and adherence to treatment. The average duration of night treatment was 9 hours, with 40 children (95.2%) using the device for at least 4 hours each night.
Implants were also effective, with an average reduction in AHI of 12.9 events per hour (95% CI, –17.0 to –8.7 events per hour).
Almost two-thirds of children had at least a 50% reduction in AHI, and about three-quarters had less than 10 12-month follow-up AHI events per hour.
Polysomnography and parental quality of life results also showed significant improvements 12 months after transplantation, including improvements in sleep and daily function, behavior, and language.
“Sleep apnea is one of the most common conditions I work with patients with Down’s disease and their families,” said Brian Scottko, a collaborator on Down’s disease at Massachusetts General Hospital in Boston. I am. release.
“In the past, many of our patients have run out of treatment options and their health and well-being have diminished. Now, treatment with hypoglossal nerve stimulants treats apnea and maximizes brain health. There may be an effective and safe way to turn it into for people with down syndrome, “Scotko added.
Hartnick and Skotko received a $ 4 million five-year grant from the National Institutes of Health to assess whether upper airway stimulation helps cognition in children with Down syndrome.
Breakthrough research
Co-author Invitation commentary They said they “praise” researchers for their “breakthrough” study, which showed a response to upper airway stimulation similar to that achieved in children with Down syndrome and adults with OSA.
“They have established the safety of the procedure, but future research is needed to optimize the results of the implants,” said Dr. Norman Friedman and Catherine Green Medicine in Otorhinolaryngology-Head and Neck Surgery. The doctor writes. Aurora Medical University, Aurora.
“Further assessment of patient selection and systematic preoperative identification of potential barriers that may affect treatment success are unique to this population, which is different from the adult cohort that has received implants to date. It helps to improve long-term outcomes and success, “they add.
This study was funded by Inspire Medical Systems Inc. InspireMedicalSystems Inc provided eight devices for research, but otherwise did not play a role in its design and implementation. The LuMind IDSC Down Syndrome Foundation also funded this study. Hartnick and the editor do not disclose the relevant financial relationship. A complete list of disclosures for other researchers is available in the original article.
JAMAOtolaryngol Head neck surge. Published online on April 21, 2022. overview, editorial
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