0862 POLYSOMNOGRAPHIC CHARACTERISICS OF PEDIATRIC DOWNS SYNDROME PATIENTS BEFORE AND AFTER HYPOGLOSSAL NERVE STIMULATOR IMPANT

Abstract

Introduction: Obstructive sleep apnea (OSA) affects 50-60% of patients with Down syndrome. OSA persists in 50% of patients after adenotonsillectomy and these patients often do not tolerate CPAP. The hypoglossal nerve stimulator is proposed as an alternative treatment for these patients. There have been no previous reports of the polysomnography (PSG) and device titration characteristics these patients Methods: Six pediatric patients between ages 11 and 18 years with Down syndrome were enrolled for a safety and efficacy trial with the hypoglossal nerve stimulator. Patients underwent preoperative PSG and post operative PSG with device titration at 1,2,6, and 12 months after implantation. The characteristics of these studies are reviewed. Results: 6 patients had a preoperative AHI between 10 and 50 (Mean 25.96 +/- 12.94 SD). At final voltage levels., AHI was reduced by 51.8-88.7% with a mean reduction of 22.03 +/- 12.67 SD. Titration to the optimal voltage was achieved in all children using a similar technique to CPAP titration. The similarity to CPAP titration allowed sleep staff to quickly master device titration. Unlike adults, these patients were titrated to a single voltage instead of a range. This restriction required titration adjustment until at least the 3rd post op study in all patients. Final voltage settings were determined by the efficacy of the device at relieving obstruction but limited by arousals and discomfort at higher voltage setting. This threshold was complicated by challenges in the study population's ability to reliably report their sensation threshold. One patient had severe central apnea when the device was activated post op. This central apnea resolved on subsequent titrations. Conclusion: The hypoglossal nerve stimulator has been safe and effective in this limited, first of its kind, application in pediatric down syndrome patients. The titration technique was rapidly adopted and understood by sleep staff given similarities to CPAP titration. The adult titration technique had to be modified to suit the study population resulting in more in lab effort at titration. The device has been well tolerated and utilized daily by these first six patients.