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Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea in down syndrome patients: A systematic review and meta-analysis

Year 2024, Volume: 41 Issue: 2, 407 - 416, 19.05.2024

Abstract

Obstructive sleep apnea (OSA) is highly prevalent in individuals with Down syndrome (DS), affecting more than 50% of this population during childhood and reaching up to 100% in adulthood. This disorder poses significant clinical consequences, including impaired cognitive function, developmental delay, and cardiovascular complications. To address this, direct hypoglossal nerve stimulation (HNS) has been approved as a treatment modality for OSA. Recent studies have shown a significant positive correlation between HNS voltage and post-apnea-hypopnea index (AHI) levels in DS and non-DS patients. However, concerns regarding the reliability of some findings have been raised, emphasizing the need for further research to underline the usefulness of HNS in treating OSA in DS patients. This meta-analysis provides a comprehensive review and analysis of the available case reports, case series, and cohort studies to evaluate the safety and efficacy of HNS in treating OSA in Down syndrome patients.

References

  • Tsou AY, Bulova P, Capone G, Chicoine B, Gelaro B, Harville TO, et al.; Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup. Medical Care of Adults With Down Syndrome: A Clinical Guideline. JAMA. 2020 Oct 20;324(15):1543-1556.
  • Sankri-Tarbichi AG. Obstructive sleep apnea-hypopnea syndrome: Etiology and diagnosis. Avicenna J Med. 2012 Jan;2(1):3-8.
  • Shott SR, Amin R, Chini B, Heubi C, Hotze S, Akers R. Obstructive sleep apnea: Should all children with Down syndrome be tested? Arch Otolaryngol Head Neck Surg. 2006 Apr;132(4):432-6.
  • Trois MS, Capone GT, Lutz JA, Melendres MC, Schwartz AR, Collop NA, Marcus CL. Obstructive sleep apnea in adults with Down syndrome. J Clin Sleep Med. 2009 Aug 15;5(4):317-23.
  • Bull MJ; Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics. 2011 Aug;128(2):393-406.
  • Macchini F, Leva E, Torricelli M, Valadè A. Treating acid reflux disease in patients with Down syndrome: pharmacological and physiological approaches. Clin Exp Gastroenterol. 2011;4:19-22.
  • Ikizoglu NB, Kiyan E, Polat B, Ay P, Karadag B, Ersu R. Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome? Pediatr Pulmonol. 2019 Oct;54(10):1541-1546.
  • Woodson BT, Strohl KP, Soose RJ, Gillespie MB, Maurer JT, de Vries N, et al. Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes. Otolaryngol Head Neck Surg. 2018 Jul;159(1):194-202.
  • Fleury Curado T, Oliven A, Sennes LU, Polotsky VY, Eisele D, Schwartz AR. Neurostimulation Treatment of OSA. Chest. 2018 Dec;154(6):1435-1447.
  • Scheffler P, Eitan D, Drewek R, Gnagi S. Hypoglossal Nerve Stimulation as Treatment for Obstructive Apnea in a Patient with a Pharyngeal Flap. Laryngoscope. 2023 Sep;133(9):2428-2429.
  • Trois MS, Capone GT, Lutz JA, Melendres MC, Schwartz AR, Collop NA, et al. Obstructive sleep apnea in adults with Down syndrome. J Clin Sleep Med. 2009 Aug 15;5(4):317-23.
  • Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71.
  • Albakri K, Abdelwahab OA, Gabra MD, Nafady MH, Alabdallat YJ, Soliman A, et al. Characteristics of sudden hearing loss after different COVID-19 vaccinations: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2023 Dec;280(12):5167-5176.
  • Antonarakis SE, Skotko BG, Rafii MS, Strydom A, Pape SE, Bianchi DW, et al. Down syndrome. Nat Rev Dis Primers. 2020 Feb 6;6(1):9.
  • Simpson R, Oyekan AA, Ehsan Z, Ingram DG. Obstructive sleep apnea in patients with Down syndrome: current perspectives. Nat Sci Sleep. 2018;10:287–93.
  • Liu P, Kong W, Fang C, Zhu K, Dai X, Meng X. Hypoglossal nerve stimulation in adolescents with down syndrome and obstructive sleep apnea: A systematic review and meta-analysis. Front Neurol. 2022;13:1037926.
  • Greco T, Zangrillo A, Biondi-Zoccai G, Landoni G. Meta-analysis: pitfalls and hints. Heart Lung Vessel. 2013;5(4):219–25.
  • Baptista PM, Prieto-Matos C, Alegre-Esteban M, Urrestarazu-Bolumburu E, Alcade Navarrete J. Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in Spain: Implementation Strategy and Early Results in a Tertiary Care Center. Indian J Otolaryngol Head Neck Surg. 2022 Jun;74(2):158–65.
  • Strollo PJ, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014 Jan 9;370(2):139–49.
  • Van de Heyning PH, Badr MS, Baskin JZ, Cramer Bornemann MA, De Backer WA, Dotan Y, et al. Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope. 2012 Jul;122(7):1626–33.
  • Zhu Z, Hofauer B, Wirth M, Heiser C. Long-term changes of stimulation intensities in hypoglossal nerve stimulation. J Clin Sleep Med. 2020 Oct 15;16(10):1775–80.
  • Diercks GR, Keamy D, Kinane TB, Skotko B, Schwartz A, Grealish E, et al. Hypoglossal Nerve Stimulator Implantation in an Adolescent With Down Syndrome and Sleep Apnea. Pediatrics. 2016 May;137(5):e20153663.
  • Relating oxygen partial pressure, saturation and content: the haemoglobin-oxygen dissociation curve - PubMed (Internet). (cited 2023 Dec 12). Available from: https://pubmed.ncbi.nlm.nih.gov/26632351/
  • Hafen BB, Sharma S. Oxygen Saturation. In: StatPearls (Internet) (Internet). StatPearls Publishing; 2022 (cited 2023 Dec 14). Available from: https://www.ncbi.nlm.nih.gov/books/NBK525974/
  • Incerti Parenti S, Fiordelli A, Bartolucci ML, Martina S, D’Antò V, Alessandri-Bonetti G. Diagnostic accuracy of screening questionnaires for obstructive sleep apnea in children: A systematic review and meta-analysis. Sleep Med Rev. 2021 Jun;57:101464.
  • Kompelli AR, Ni JS, Nguyen SA, Lentsch EJ, Neskey DM, Meyer TA. The outcomes of hypoglossal nerve stimulation in the management of OSA: A systematic review and meta-analysis. World J Otorhinolaryngol Head Neck Surg. 2018 Sep 25;5(1):41–8.
  • Steffen A, Baptista P, Ebner EM, Jeschke S, König IR, Bruchhage KL. Insomnia affects patient-reported outcome in sleep apnea treated with hypoglossal nerve stimulation. Laryngoscope Investig Otolaryngol. 2022 Jun;7(3):877–84.
Year 2024, Volume: 41 Issue: 2, 407 - 416, 19.05.2024

Abstract

References

  • Tsou AY, Bulova P, Capone G, Chicoine B, Gelaro B, Harville TO, et al.; Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup. Medical Care of Adults With Down Syndrome: A Clinical Guideline. JAMA. 2020 Oct 20;324(15):1543-1556.
  • Sankri-Tarbichi AG. Obstructive sleep apnea-hypopnea syndrome: Etiology and diagnosis. Avicenna J Med. 2012 Jan;2(1):3-8.
  • Shott SR, Amin R, Chini B, Heubi C, Hotze S, Akers R. Obstructive sleep apnea: Should all children with Down syndrome be tested? Arch Otolaryngol Head Neck Surg. 2006 Apr;132(4):432-6.
  • Trois MS, Capone GT, Lutz JA, Melendres MC, Schwartz AR, Collop NA, Marcus CL. Obstructive sleep apnea in adults with Down syndrome. J Clin Sleep Med. 2009 Aug 15;5(4):317-23.
  • Bull MJ; Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics. 2011 Aug;128(2):393-406.
  • Macchini F, Leva E, Torricelli M, Valadè A. Treating acid reflux disease in patients with Down syndrome: pharmacological and physiological approaches. Clin Exp Gastroenterol. 2011;4:19-22.
  • Ikizoglu NB, Kiyan E, Polat B, Ay P, Karadag B, Ersu R. Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome? Pediatr Pulmonol. 2019 Oct;54(10):1541-1546.
  • Woodson BT, Strohl KP, Soose RJ, Gillespie MB, Maurer JT, de Vries N, et al. Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes. Otolaryngol Head Neck Surg. 2018 Jul;159(1):194-202.
  • Fleury Curado T, Oliven A, Sennes LU, Polotsky VY, Eisele D, Schwartz AR. Neurostimulation Treatment of OSA. Chest. 2018 Dec;154(6):1435-1447.
  • Scheffler P, Eitan D, Drewek R, Gnagi S. Hypoglossal Nerve Stimulation as Treatment for Obstructive Apnea in a Patient with a Pharyngeal Flap. Laryngoscope. 2023 Sep;133(9):2428-2429.
  • Trois MS, Capone GT, Lutz JA, Melendres MC, Schwartz AR, Collop NA, et al. Obstructive sleep apnea in adults with Down syndrome. J Clin Sleep Med. 2009 Aug 15;5(4):317-23.
  • Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71.
  • Albakri K, Abdelwahab OA, Gabra MD, Nafady MH, Alabdallat YJ, Soliman A, et al. Characteristics of sudden hearing loss after different COVID-19 vaccinations: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2023 Dec;280(12):5167-5176.
  • Antonarakis SE, Skotko BG, Rafii MS, Strydom A, Pape SE, Bianchi DW, et al. Down syndrome. Nat Rev Dis Primers. 2020 Feb 6;6(1):9.
  • Simpson R, Oyekan AA, Ehsan Z, Ingram DG. Obstructive sleep apnea in patients with Down syndrome: current perspectives. Nat Sci Sleep. 2018;10:287–93.
  • Liu P, Kong W, Fang C, Zhu K, Dai X, Meng X. Hypoglossal nerve stimulation in adolescents with down syndrome and obstructive sleep apnea: A systematic review and meta-analysis. Front Neurol. 2022;13:1037926.
  • Greco T, Zangrillo A, Biondi-Zoccai G, Landoni G. Meta-analysis: pitfalls and hints. Heart Lung Vessel. 2013;5(4):219–25.
  • Baptista PM, Prieto-Matos C, Alegre-Esteban M, Urrestarazu-Bolumburu E, Alcade Navarrete J. Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in Spain: Implementation Strategy and Early Results in a Tertiary Care Center. Indian J Otolaryngol Head Neck Surg. 2022 Jun;74(2):158–65.
  • Strollo PJ, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014 Jan 9;370(2):139–49.
  • Van de Heyning PH, Badr MS, Baskin JZ, Cramer Bornemann MA, De Backer WA, Dotan Y, et al. Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope. 2012 Jul;122(7):1626–33.
  • Zhu Z, Hofauer B, Wirth M, Heiser C. Long-term changes of stimulation intensities in hypoglossal nerve stimulation. J Clin Sleep Med. 2020 Oct 15;16(10):1775–80.
  • Diercks GR, Keamy D, Kinane TB, Skotko B, Schwartz A, Grealish E, et al. Hypoglossal Nerve Stimulator Implantation in an Adolescent With Down Syndrome and Sleep Apnea. Pediatrics. 2016 May;137(5):e20153663.
  • Relating oxygen partial pressure, saturation and content: the haemoglobin-oxygen dissociation curve - PubMed (Internet). (cited 2023 Dec 12). Available from: https://pubmed.ncbi.nlm.nih.gov/26632351/
  • Hafen BB, Sharma S. Oxygen Saturation. In: StatPearls (Internet) (Internet). StatPearls Publishing; 2022 (cited 2023 Dec 14). Available from: https://www.ncbi.nlm.nih.gov/books/NBK525974/
  • Incerti Parenti S, Fiordelli A, Bartolucci ML, Martina S, D’Antò V, Alessandri-Bonetti G. Diagnostic accuracy of screening questionnaires for obstructive sleep apnea in children: A systematic review and meta-analysis. Sleep Med Rev. 2021 Jun;57:101464.
  • Kompelli AR, Ni JS, Nguyen SA, Lentsch EJ, Neskey DM, Meyer TA. The outcomes of hypoglossal nerve stimulation in the management of OSA: A systematic review and meta-analysis. World J Otorhinolaryngol Head Neck Surg. 2018 Sep 25;5(1):41–8.
  • Steffen A, Baptista P, Ebner EM, Jeschke S, König IR, Bruchhage KL. Insomnia affects patient-reported outcome in sleep apnea treated with hypoglossal nerve stimulation. Laryngoscope Investig Otolaryngol. 2022 Jun;7(3):877–84.
There are 27 citations in total.

Details

Primary Language English
Subjects Brain and Nerve Surgery (Neurosurgery)
Journal Section Review Articles
Authors

Yasmeen Jamal Alabdallat 0000-0001-6855-3718

Hamza Khaled Alsalhi 0000-0001-6635-1821

Benyameen Yacoub Mosa 0009-0000-1799-3852

Yousef Hawas 0000-0003-0361-4609

Toka Elboraay 0000-0001-9606-4196

Ibraheem M. Alkhawaldeh 0000-0002-0187-1583

Jaber H. Jaradat 0000-0002-6488-4664

Obada Ahmad Abunar 0000-0003-1778-5281

Adam M. Abdallah 0000-0003-0503-1669

Zaid Kamal 0009-0000-9724-5204

Publication Date May 19, 2024
Submission Date February 17, 2024
Acceptance Date April 18, 2024
Published in Issue Year 2024 Volume: 41 Issue: 2

Cite

APA Alabdallat, Y. J., Alsalhi, H. K., Mosa, B. Y., Hawas, Y., et al. (2024). Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea in down syndrome patients: A systematic review and meta-analysis. Journal of Experimental and Clinical Medicine, 41(2), 407-416.
AMA Alabdallat YJ, Alsalhi HK, Mosa BY, Hawas Y, Elboraay T, Alkhawaldeh IM, Jaradat JH, Abunar OA, Abdallah AM, Kamal Z. Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea in down syndrome patients: A systematic review and meta-analysis. J. Exp. Clin. Med. May 2024;41(2):407-416.
Chicago Alabdallat, Yasmeen Jamal, Hamza Khaled Alsalhi, Benyameen Yacoub Mosa, Yousef Hawas, Toka Elboraay, Ibraheem M. Alkhawaldeh, Jaber H. Jaradat, Obada Ahmad Abunar, Adam M. Abdallah, and Zaid Kamal. “Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea in down Syndrome Patients: A Systematic Review and Meta-Analysis”. Journal of Experimental and Clinical Medicine 41, no. 2 (May 2024): 407-16.
EndNote Alabdallat YJ, Alsalhi HK, Mosa BY, Hawas Y, Elboraay T, Alkhawaldeh IM, Jaradat JH, Abunar OA, Abdallah AM, Kamal Z (May 1, 2024) Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea in down syndrome patients: A systematic review and meta-analysis. Journal of Experimental and Clinical Medicine 41 2 407–416.
IEEE Y. J. Alabdallat, “Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea in down syndrome patients: A systematic review and meta-analysis”, J. Exp. Clin. Med., vol. 41, no. 2, pp. 407–416, 2024.
ISNAD Alabdallat, Yasmeen Jamal et al. “Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea in down Syndrome Patients: A Systematic Review and Meta-Analysis”. Journal of Experimental and Clinical Medicine 41/2 (May 2024), 407-416.
JAMA Alabdallat YJ, Alsalhi HK, Mosa BY, Hawas Y, Elboraay T, Alkhawaldeh IM, Jaradat JH, Abunar OA, Abdallah AM, Kamal Z. Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea in down syndrome patients: A systematic review and meta-analysis. J. Exp. Clin. Med. 2024;41:407–416.
MLA Alabdallat, Yasmeen Jamal et al. “Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea in down Syndrome Patients: A Systematic Review and Meta-Analysis”. Journal of Experimental and Clinical Medicine, vol. 41, no. 2, 2024, pp. 407-16.
Vancouver Alabdallat YJ, Alsalhi HK, Mosa BY, Hawas Y, Elboraay T, Alkhawaldeh IM, Jaradat JH, Abunar OA, Abdallah AM, Kamal Z. Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea in down syndrome patients: A systematic review and meta-analysis. J. Exp. Clin. Med. 2024;41(2):407-16.