{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T14:10:02Z","timestamp":1736518202361,"version":"3.32.0"},"reference-count":5,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:sec id=\"ab-obr240005-4\"><jats:title>Importance<\/jats:title><jats:p>Upper airway stimulation (UAS) was recently approved to treat persistent obstructive sleep apnea in pediatric patients with Down syndrome. Appropriate titration of the UAS implantable device is essential to achieve optimal outcomes, but standardized titration protocols for young patients are lacking.<\/jats:p><\/jats:sec><jats:sec id=\"ab-obr240005-5\"><jats:title>Objective<\/jats:title><jats:p>To develop and share a UAS titration protocol for pediatric patients with Down syndrome.<\/jats:p><\/jats:sec><jats:sec id=\"ab-obr240005-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This small cohort study of pediatric patients with Down syndrome presents a standardized UAS stimulation titration protocol for conducting postimplantation polysomnograms. The protocol was developed through a multidisciplinary collaboration at a tertiary children\u2019s hospital with a dedicated pediatric polysomnogram laboratory. The initial titration polysomnogram was performed on the night of device activation, with subsequent titration polysomnograms performed at 1 month, 2 to 3 months, 6 months, and 12 months after implantation. The initial titration goal is acclimation, promoting AHI optimization in later polysomnograms. Pediatric patients with Down syndrome and persistent obstructive sleep apnea who have undergone UAS titration from June 2022 to January 2024 participated in this study.<\/jats:p><\/jats:sec><jats:sec id=\"ab-obr240005-7\"><jats:title>Exposure<\/jats:title><jats:p>A novel standardized UAS titration polysomnogram protocol.<\/jats:p><\/jats:sec><jats:sec id=\"ab-obr240005-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The main outcomes were apnea-hypopnea index (AHI) change and nightly device use in hours.<\/jats:p><\/jats:sec><jats:sec id=\"ab-obr240005-9\"><jats:title>Results<\/jats:title><jats:p>This study included 5 pediatric patients with Down syndrome who have undergone UAS implantation. Three patients were male, and 4 identified as White. The median (range) age at implantation was 15 years (12-20 years), and the median (range) preoperative AHI was 20.1 (15.6-38.8). The median (range) incoming voltage for a 1-month postimplant UAS titration polysomnogram was 1.7 V (0.4-1.7 V). All 5 patients completed UAS titration polysomnograms at the aforementioned postoperative time course; all patients also experienced an AHI reduction from baseline and adequate tolerance of UAS (ie, nightly device use of more than 6 hours). A titration protocol for UAS in pediatric patients with Down syndrome, a sample polysomnogram report form, and general information for sleep technologists are provided.<\/jats:p><\/jats:sec><jats:sec id=\"ab-obr240005-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this study, a standardized UAS protocol for device titration during polysomnogram promoting acclimation and optimized AHI reduction demonstrated UAS efficacy in pediatric patients with Down syndrome. The protocol can be used as a model for other institutions creating programs for UAS titration in pediatric patients with Down syndrome. As more pediatric patients undergo UAS device implants, protocols can be refined to ensure optimal outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2024.3701","type":"journal-article","created":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T15:33:05Z","timestamp":1730388785000},"page":"78","source":"Crossref","is-referenced-by-count":0,"title":["Titration Protocol for Upper Airway Stimulation in Pediatric Patients With Down Syndrome"],"prefix":"10.1001","volume":"151","author":[{"given":"Robert M.","family":"Frederick","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Eastern Virginia Medical School, Norfolk"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina M.","family":"Baldassari","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eastern Virginia Medical School, Norfolk"},{"name":"Department of Pediatric Sleep Medicine, Children\u2019s Hospital of the King\u2019s Daughters, Norfolk, Virginia"},{"name":"Deputy Editor, JAMA Otolaryngology\u2013Head & Neck Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","reference":[{"key":"obr240005r1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.ijporl.2016.09.037","article-title":"The safety and efficacy of pediatric lingual tonsillectomy.","volume":"91","author":"DeMarcantonio","year":"2016","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"6","key":"obr240005r2","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1001\/jamaoto.2022.0455","article-title":"Evaluation of upper airway stimulation for adolescents with Down syndrome and obstructive sleep apnea.","volume":"148","author":"Yu","year":"2022","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"4","key":"obr240005r4","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1002\/ohn.633","article-title":"Pediatric Down syndrome upper airway stimulation: patient selection and post-implantation optimization.","volume":"170","author":"Chieffe","year":"2024","journal-title":"Otolaryngol Head Neck Surg"},{"key":"obr240005r5","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1093\/sleep\/zsaa279","article-title":"Post-implant care pathway: lessons learned and recommendations after 5 years of clinical implementation of hypoglossal nerve stimulation therapy.","volume":"44","author":"Soose","year":"2021","journal-title":"Sleep"},{"first-page":"34","volume-title":"Inspire Upper Airways Stimulation System Implant Manual","year":"2023","key":"obr240005r3"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2825437\/jamaotolaryngology_frederick_2024_br_240005_1735578774.92455.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T16:02:46Z","timestamp":1736438566000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2825437"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,1]]},"references-count":5,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2024.3701","relation":{},"ISSN":["2168-6181"],"issn-type":[{"type":"print","value":"2168-6181"}],"subject":[],"published":{"date-parts":[[2025,1,1]]}}}