Expanding Alternatives to CPAP: Hypoglossal Nerve Stimulation for Sleep-Disordered Breathing in Children With Down Syndrome

Obstructive sleep apnea (OSA) is common in children with Down syndrome and often proves difficult to treat. Many patients continue to experience clinically significant disease even after adenotonsillectomy. Continuous positive airway pressure (CPAP) can improve breathing, but many families struggle with long-term tolerance. When standard treatment options fail, clinicians have limited alternatives.

To address this gap, our team at Children’s Wisconsin developed the Alternatives to CPAP Program, which emphasizes careful evaluation and individualized treatment planning. Our team assesses children with persistent sleep apnea through a multidisciplinary process, which may include drug-induced sleep endoscopy. By directly evaluating airway collapse during sleep, we can identify anatomic contributors and match patients with the most appropriate surgical or non-surgical options.

The Alternatives to CPAP Program recently introduced hypoglossal nerve stimulation using the Inspire system for a small, carefully selected group of adolescents with Down syndrome. The FDA has approved the device for patients age 13 and older with severe OSA who cannot tolerate CPAP and meet defined anatomic and physiologic criteria. During sleep, the system stimulates the hypoglossal nerve to support airway patency without relying on external airway pressure.

Children’s Wisconsin became the first center in the Midwest to implant the latest Inspire V system in a pediatric patient with Down syndrome. The first patient our team treated with Inspire V showed meaningful improvement in nighttime breathing without reliance on CPAP. These early results are promising and highlight the potential role of hypoglossal nerve stimulation for patients with few remaining treatment options.

Our team applies this technology deliberately. Rather than positioning Inspire as a replacement for other therapies, we incorporate it as one option within a broader Alternatives to CPAP framework. A multidisciplinary team guides patient selection, and structured follow-up includes device adjustment and ongoing monitoring to support safety and effectiveness.

As our team gains more experience, we will continue to evaluate which patients benefit most from hypoglossal nerve stimulation and learn how to most effectively integrate the technology into long-term care. For families who have struggled with existing therapies, the availability of an additional, carefully applied option marks an important step toward improving sleep health and quality of life.

Qualifications for Inspire Therapy

• Age 13 or older

• Diagnosed with severe obstructive sleep apnea (between 10 and 50 events per hour)

• Not effectively treated by adenotonsillectomy

• Inability to tolerate or failed CPAP use