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Successful upper airway stimulation therapy in an adult Down syndrome patient with severe obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Short Communication
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Abstract

Purpose

The aim of this study was to report on the successful application of upper airway stimulation (UAS) therapy in an adult Down syndrome (DS) patient with severe obstructive sleep apnea (OSA) and continuous positive airway pressure (CPAP) intolerance.

Methods

Baseline polysomnography (PSG) in a 23-year-old male OSA patient (body mass index (BMI) 24.4 kg/m2) revealed an apnea/hypopnea index (AHI) of 61.5 events/h and oxygen desaturation index (ODI) of 39.7 events/h. Based on the clinical examination, PSG and drug-induced sleep endoscopy, the patient fulfilled the formal inclusion criteria for UAS therapy: AHI between 15 and 65 events/h, BMI < 32 kg/m2, and no complete concentric collapse at the level of the velopharynx.

Results

Implantation of the hypoglossal nerve stimulator in the adult patient with DS resulted in a substantial subjective as well as objective improvement of OSA (63 to 81% decrease in AHI and 77% decrease in ODI), translating into an overall satisfactory outcome.

Conclusion

Research on the long-term effectiveness of UAS therapy in a larger group of patients with DS is needed. However, based on the available literature and our presented case, respiration-synchronized electrostimulation of the hypoglossal nerve using UAS therapy may have a potential value in well-selected OSA patients with DS who are non-compliant to CPAP therapy.

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Funding

Olivier Vanderveken holds a Senior Clinical Investigator Fellowship from the Research Foundation—Flanders (FWO)—2016–2021. Marijke Dieltjens holds a Postdoctoral fellowship at Research Foundation—Flanders (FWO)—12H4516N.

Author information

Author notes

  1. Eli Van de Perck and Jolien Beyers contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium

    Eli Van de Perck, Jolien Beyers, Marijke Dieltjens, Sara Op de Beeck, Paul Van de Heyning, An Boudewyns & Olivier M. Vanderveken

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium

    Eli Van de Perck, Jolien Beyers, Marijke Dieltjens, Sara Op de Beeck, Paul Van de Heyning, An Boudewyns & Olivier M. Vanderveken

  3. Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium

    Johan Verbraecken & Olivier M. Vanderveken

  4. Department of Pulmonology, Antwerp University Hospital, Edegem, Antwerp, Belgium

    Johan Verbraecken

  5. Department of ENT, Head and Neck Surgery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium

    Olivier M. Vanderveken

Authors
  1. Eli Van de Perck
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  2. Jolien Beyers
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  3. Marijke Dieltjens
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  4. Sara Op de Beeck
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  5. Johan Verbraecken
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  6. Paul Van de Heyning
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  7. An Boudewyns
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  8. Olivier M. Vanderveken
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Corresponding author

Correspondence to Olivier M. Vanderveken.

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Conflict of interest

Olivier Vanderveken has the following potential conflicts of interest: research support and lecture fees from Inspire Medical Systems, research grant from and consultancy for Philips Respironics, research grant and lecture fees from Somnomed, consultancy for Nyxoah, consultancy for Galvani, research support from ReVent, research support from Nightbalance. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Patient consent statement

The patient guardian has consented to the submission of the paper for submission to the journal.

Additional information

Comment

This case highlights the potential for hypoglossal nerve stimulation in treating patients with Down’s syndrome, who may otherwise have difficulty tolerating CPAP and other therapeutic modalities. This patient’s response suggests that hypoglossal stimulation can overcome defects in upper airway anatomy and neuromuscular control commonly found in this condition.

Alan R. Schwartz

Baltimore, USA

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Van de Perck, E., Beyers, J., Dieltjens, M. et al. Successful upper airway stimulation therapy in an adult Down syndrome patient with severe obstructive sleep apnea. Sleep Breath 23, 879–883 (2019). https://doi.org/10.1007/s11325-018-1752-1

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  • DOI: https://doi.org/10.1007/s11325-018-1752-1

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