Hypoglossal Nerve Stimulation as a Treatment of Obstructive Sleep Apnea in Down Syndrome Patients: A Systematic Review and Meta-analysis
Hamza K. Alsalhi1, Yasmeen Jamal Alabdallat1, Ibrahim Alkhawaldeh2, Yousef Hawas3, Benyameen Y. Mosa4, Obada Abunar1, Toka Elboraay5, Adam M. Abdallah6, Ahmed Negida7
1The Hashemite University, 2Mutah University, 3Tanta University, 4Misr University for Science and Technology, 5Faculty of Zagazig, 6King Abdullah University Hospital, 7Virginia Commonwealth University
Objective:

To evaluate the efficacy and safety of Hypoglossal Nerve Stimulation (HNS) in treating Obstructive Sleep Apnea (OSA) in Down syndrome patients in all age groups.

Background:

HNS is a novel, well-tolerated, and effective treatment for patients with OSA. Down syndrome patients were found to be more susceptible to OSA with limited treatment options. Therefore, HNS can be a favorable suggested therapy for Down syndrome patients with OSA.

Design/Methods:

We thoroughly searched relevant clinical trials and observational studies in three databases: PubMed, Scopus, and Web of Science. We analyzed the extracted data by calculating each variable's mean and pooled standard deviation (SD) using the Rstudio 4.2.3. Our primary outcomes were AHI, ODI, and ESS, we also used the OSA-18 questionnaire to measure the quality of life before and after HNS implantation. To assess the risk of bias, we used the JBI, NIH, and ROBINS-I tools for case reports, case series, and clinical trials respectively.

Results:

Our meta-analysis included five case series, four case reports, and a single prospective clinical trial. With a total number of 82 patients, the results showed that the Apnea-Hypopnea Index (AHI) decreased significantly after the intervention, with a pre-intervention median of 25.6 (min: 21.02, max: 36.25) reduced to a post-intervention median of 3.9 (min: 2.8, max: 7.73). Oxygen saturation (SaO2) levels also improved, as the pre-intervention median of 81 (min: 77, max: 83.4) increased to a post-intervention median of 83 (min: 79.5, max: 84.6). Additionally, paired t-test of the OSA-18 scores between the baseline and the 6-month follow-up showed a statistically significant improvement (P=0.012; 95% CI: 0.2-1.65). These results collectively indicate a positive impact of the intervention on the study's parameters.

Conclusions:

HNS was found to be an effective and safe option for the treatment of OSA in Down syndrome, with minimal adverse events and significant improvement in AHI and OSA-18.

10.1212/WNL.0000000000205427