The sleep disorder commonly affecting people with Down syndrome

Sleep apnea is common among individuals with Down syndrome. In fact, 50% to 75% of children with Down syndrome have sleep apnea compared to about 4% of children without the disability. And 80% of adults with Down syndrome have sleep apnea compared to 10% of adults without the disability.

Sleep apnea occurs when the throat muscles relax and block the airway, causing lapses in breathing throughout the night. When your brain senses this decrease in oxygen and increase in carbon dioxide in your blood, it arouses you to a lighter stage of sleep. This reengages the muscles and reopens the breathing space. As the cycle repeats all night, deep, restful sleep stages aren’t possible. Chronic sleep apnea and sleep deprivation can lead to severe mental and physical illnesses.

People with Down syndrome are at an increased risk of sleep apnea for several reasons:

• Decreased muscular tone. This allows the muscles in the back of the throat to relax more than normal during sleep which can collapse the airway.
• Larger than average tongues, which can take up more space in the throat, impairing the airway.
• More likely to be overweight. There is a correlation between body weight and sleep apnea severity.

Many patients with Down syndrome undergo procedures to treat sleep apnea as a child, including removing the tonsils and adenoids. Unfortunately, further treatment is often needed. It’s also difficult to get children with special needs to adapt to using a CPAP machine with a mask on their face at night, and therefore, many patients are going untreated for sleep apnea.

Inspire therapy is a good option for patients with Down syndrome since it doesn’t require a mask yet provides the same stimulation through an implant. The device sends a gentle stimulus to the nerve controlling the muscles of the tongue and back of the throat, pulling the structures away from the breathing space so the airway isn’t blocked.

Candidates for Inspire therapy include individuals over the age of 18 – over the age of 13 for those with Down syndrome – with moderate or severe obstructive sleep apnea who cannot tolerate a CPAP.

Device placement is performed on an outpatient basis and takes about 60 minutes. Two small incisions are made under the chin and on the chest just below the clavicle. Recovery is minimal. Most people are back to 90% of normal activities within a day or two of the procedure.

Management of obstructive sleep apnea is multidisciplinary, involving airway surgeons and sleep medicine physicians who can provide you the full breadth of treatment options, including Inspire therapy.

Dr. Michael Layland is an otolaryngologist affiliated with Advocate Health Care. In 2017, he partnered with Dr. Yelena Tumashova to establish the Inspire program at Advocate Lutheran General Hospital – one of the first in Illinois.

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