(1321) DISE Based Hypoglossal Nerve Stimulator Titration in Complex Pediatric Patients with Severe Obstructive Sleep Apnea

Introduction: Access to pediatric polysomnography (PSG) for hypoglossal nerve stimulator (HGNS) titration studies can be challenging. Further, depending on developmental status, limited patient tolerance of in-lab polysomnography for extended periods of time in order to obtain a sufficiently long HGNS titration study can prove challenging.

Methods: We report 3 cases of pediatric patients who underwent drug induced sleep endoscopy (DISE) based titration of their HGNS and a subsequent in-lab PSG. Two patients had trisomy 21, one patient had cerebral palsy. All three patients initially demonstrated a very moderate benefit of HGNS and limited tolerance of titration on their acclimation PSG, were taken to the operating room for drug induced sleep endoscopy and HGNS titration 3 months post activation.

Results: All three patients were effectively titrated via DISE and achieved a post-titration apnea hypopnea index < 5 as well as substantial reported improvements in sleep related quality of life.

Conclusions: Drug induced sleep endoscopy can be a useful tool for titrating HGNS therapy in complex pediatric patients, particularly when access to pediatric sleep studies is challenging or tolerance thereof is poor.