Abstract：
BACKGROUND: Hypoglossal nerve stimulation (HGNS) is an effective therapy for carefully selected pediatric patients with Down syndrome (DS) and obstructive sleep apnea (OSA), but optimization of device settings has been focused on stimulation settings. The potential benefits of sensing lead setting optimization have not been investigated. We describe a series of three cases of HGNS in children with DS where optimization of both the stimulation lead and sensing lead settings, as well as utilization of drug-induced sleep endoscopy (DISE), when indicated, was more effective than stimulation lead optimization alone.
METHODS: Using our novel titration algorithm, among the three identified pediatric patients with DS in whom HGNS initially failed to reduce the apnea-hypopnea index (AHI), two patients in whom sleep studies were characterized as hypopnea-dominant were assigned to advanced titration (optimization of stimulation settings and sensing lead settings). The third patient, with an obstructive apnea-dominant sleep study, was referred for interrogated DISE. Advanced titration included adjustment of both stimulation settings and sensing lead settings.
RESULTS: Application of the advanced titration algorithm, tailored to obstructive apnea- versus hypopnea-dominant sleep patterns, resulted in approximately 50% or greater reduction in AHI in all three patients. \"Normal to mild OSA\" AHI (AHI <5) was achieved in two patients.
CONCLUSIONS: A novel diagnostic and therapeutic titration algorithm for the Inspire HGNS system significantly reduced AHI in three pediatric patients with DS and OSA who had failed to respond to the standard device titration that focused solely on stimulation settings.
METHODS: 4 Laryngoscope, 2024.
METHODS: Using our novel titration algorithm, among the three identified pediatric patients with DS in whom HGNS initially failed to reduce the apnea-hypopnea index (AHI), two patients in whom sleep studies were characterized as hypopnea-dominant were assigned to advanced titration (optimization of stimulation settings and sensing lead settings). The third patient, with an obstructive apnea-dominant sleep study, was referred for interrogated DISE. Advanced titration included adjustment of both stimulation settings and sensing lead settings.
RESULTS: Application of the advanced titration algorithm, tailored to obstructive apnea- versus hypopnea-dominant sleep patterns, resulted in approximately 50% or greater reduction in AHI in all three patients. \"Normal to mild OSA\" AHI (AHI <5) was achieved in two patients.
CONCLUSIONS: A novel diagnostic and therapeutic titration algorithm for the Inspire HGNS system significantly reduced AHI in three pediatric patients with DS and OSA who had failed to respond to the standard device titration that focused solely on stimulation settings.
METHODS: 4 Laryngoscope, 2024.
摘要：
背景：舌下神经刺激（HGNS）是精心选择的唐氏综合征（DS）和阻塞性睡眠呼吸暂停（OSA）儿科患者的有效疗法，但是设备设置的优化一直集中在刺激设置上。尚未研究过传感引线设置优化的潜在益处。我们描述了DS儿童的一系列三例HGNS，其中优化了刺激引线和感应引线设置，以及药物诱导的睡眠内窥镜检查（DISE）的利用，当指示时，比单独的刺激铅优化更有效。
方法：使用我们新颖的滴定算法，在三位确定的DS儿科患者中，HGNS最初未能降低呼吸暂停低通气指数（AHI），2例睡眠研究以呼吸不足为主的患者被分配到高级滴定组(优化刺激设置和传感导联设置).第三个病人,一项阻塞性呼吸暂停占优势的睡眠研究，被转介接受审讯的DISE。高级滴定包括调节刺激设置和传感引线设置。
结果：高级滴定算法的应用，适合阻塞性呼吸暂停与低通气主导的睡眠模式，导致所有3例患者的AHI降低约50%或更多。两名患者达到“正常至轻度OSA”AHI（AHI<5）。
结论：InspireHGNS系统的一种新的诊断和治疗滴定算法显著降低了3名DS和OSA患儿的AHI，这些患儿对仅关注刺激设置的标准设备滴定没有反应。
方法：4喉镜，2024.
方法：使用我们新颖的滴定算法，在三位确定的DS儿科患者中，HGNS最初未能降低呼吸暂停低通气指数（AHI），2例睡眠研究以呼吸不足为主的患者被分配到高级滴定组(优化刺激设置和传感导联设置).第三个病人,一项阻塞性呼吸暂停占优势的睡眠研究，被转介接受审讯的DISE。高级滴定包括调节刺激设置和传感引线设置。
结果：高级滴定算法的应用，适合阻塞性呼吸暂停与低通气主导的睡眠模式，导致所有3例患者的AHI降低约50%或更多。两名患者达到“正常至轻度OSA”AHI（AHI<5）。
结论：InspireHGNS系统的一种新的诊断和治疗滴定算法显著降低了3名DS和OSA患儿的AHI，这些患儿对仅关注刺激设置的标准设备滴定没有反应。
方法：4喉镜，2024.
