Last updated on June 2018

A Pilot Study to Evaluate the Hypoglossal Nerve Stimulator in Adolescents With Down Syndrome and Obstructive Sleep Apnea

Brief description of study

Obstructive sleep apnea (OSA) affects up to 1% of the general pediatric population and is associated with adverse behavior and quality of life, as well as long term cardiopulmonary system complications. Trisomy 21 (Down Syndrome) is the most common chromosomal disorder, with a incidence of approximately 1 per 660-800 births. Patients with Down Syndrome have a higher incidence of OSA than the general pediatric population, with rates of 30-60%, resulting in increased morbidity and decreased quality of life for affected individuals. In children, adenotonsillectomy (T&A) is often a contributing factor to OSA, and adenotonsillectomy is a first line treatment. Children with Down Syndrome often undergo T&A for obstructive sleep apnea, however 30-50% will have persistent obstructive sleep patterns requiring continuous positive pressure airway support (CPAP) or tracheotomy. Persistent obstruction is attributed to anatomic and physiologic differences in this population, including reduced muscular tone, macroglossia, maxillary hypoplasia, and lingual tonsil hypertrophy. This pilot study is designed to determine if the Inspire Upper Airway Simulation System, Model 3024 IPG, and any subsequent iteration thereof that are approved under P130008 for the treatment of obstructive sleep apnea, which has already been approved for use in adults with OSA, can be safely implanted and used in adolescents and young adults with Down Syndrome.

Detailed Study Description

The study will be a multi-center, prospective, single-arm study conducted under a common implant and follow-up protocol. Twenty-one adolescents and young adults (10-21 years of age) with Down Syndrome with moderate to severe obstructive sleep apnea after adenotonsillectomy will be identified through a Multi-Disciplinary clinic for patients with Trisomy 21 at Massachusetts General Hospital's Hospital for Children, University Hospitals Rainbow Babies and Children's Hospital, Henrietta Egleston Hospital for Children, Cincinnati Children's Hospital, and Children's Hospital of Pittsburgh. Patients and their parents will be screened by a senior pulmonologist and pediatrician for medical clearance and willingness to participate. Subjects will then undergo preoperative evaluation with an in-lab polysomnogram (PSG), evaluation by a pediatric otolaryngology surgeon, and drug induced sleep endoscopy (DISE) to ensure all inclusion and exclusion criteria are met. Subjects meeting eligibility criteria will then be implanted with the Inspire Upper Airway Simulation System, Model 3024 IPG, and any subsequent iteration thereof that are approved under P130008 for the treatment of obstructive sleep apnea, a hypoglossal nerve stimulator, after informed consent. Surgery will be performed by senior pediatric otolaryngologists who have completed a training program for the Inspire system. Subjects will then adhere to a follow-up schedule. The device will be activated and settings titrated during an in-lab sleep study 1 month postoperatively. Quality of life surveys and device interrogation will be conducted at timed intervals. Subjects will then undergo in-lab polysomnography at 2 months, 6 months, and 12-months, then on an annual basis, and the device titrated as needed. All personnel adjusting device parameters will be trained in programming the Inspire system. For this pilot study, we will evaluate safety and efficacy over the first year after device implantation.

Clinical Study Identifier: NCT02344108

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Nikhila Raol, MD

Henrietta Egleston Hospital for Children
Atlanta, GA United States
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Christopher Hartnick, MD

Massachusetts Eye and Ear
Boston, MA United States
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Stacey Ishman, MD, MPH

Cincinnati Children's Hospital
Cincinnati, OH United States
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Carissa Wentland, DO

University Hospitals Rainbow Babies and Children's Hospital
Cleveland, OH United States
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Allison Tobey, MD

Children's Hospital of Pittsburgh
Pittsburgh, PA United States
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Anna Messner, MD

Stanford Children's Hospital/Lucile Packard Children's Hospital Stanford
Palo Alto, CA United States
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David Zopf, MD

C.S. Mott Children's Hospital (part of the University of Michigan Health System)
Ann Arbor, MI United States
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Derek Lam, MD

Oregon Health and Science University
Portland, OR United States
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Lisa Elden, Md

Children's Hospital of Philadelphia
Philadelphia, PA United States
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Ron Mitchell, MD

University of Texas Southwestern Medical Center
Dallas, TX United States
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Mary Musso Musso, MD

Texas Children's Hospital
Houston, TX United States
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Cristina Baldassari, MD

Children's Hospital of The King's Daughter
Norfolk, VA United States
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Sanjay Parikh, MD

Seattle Children's Hospital
Seattle, WA United States
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