For some adolescents with Down syndrome, neither surgery to remove the tonsils nor a CPAP machine provides a workable solution for obstructive sleep apnea. Children's Hospital Los Angeles offers another option: the Inspire hypoglossal nerve stimulation device, which helps keep the airway open during sleep.
CHLA otolaryngologist Debra Don, MD, and pulmonologist Sally Ward, MD, have partnered to offer the treatment to eligible adolescents with Down syndrome since July 2025.
"Between 50% and 80% of children with Down syndrome have sleep apnea," Dr. Ward says. Several anatomical factors contribute to their increased risk, including a smaller airway, decreased muscle tone, and a larger tongue that can block the airway during sleep.
Untreated sleep apnea in these children can contribute to fatigue, difficulty concentrating, behavioral challenges, and long-term health risks, including stroke, heart disease, and dementia.
It's important for families to understand the risks for a child with Down syndrome who has untreated obstructive sleep apnea."
Debra Don, MD, otolaryngologist, CHLA
"Reducing the severity of this condition can dramatically improve quality of life," Dr. Ward adds.
Who is eligible for the Inspire device?
Surgically removing adenoid and tonsillar tissue can help some children suffering from sleep apnea, but not all. A CPAP machine can support breathing at night, but roughly half of individuals with Down syndrome have trouble tolerating the mask or using it consistently.
The Inspire device is approved by the Food and Drug Administration for adolescents with Down syndrome who:
- are 13 or older
- meet the weight requirements for the device to be implanted
- failed to see improvement after adenotonsillectomy surgery
- cannot tolerate CPAP
- can tolerate the sleep endoscopy and sleep studies required for treatment
How the Inspire device works
The Inspire device is implanted surgically during a three-hour procedure.
"A small battery or generator is surgically implanted in the chest," Dr. Don explains. "Separately, a small, cuff-shaped electrode is surgically inserted into the neck and placed around the hypoglossal nerve, which is responsible for moving the tongue. This electrode is then connected to the generator in the chest."
The patient can usually return home the day after the procedure. Six weeks later, the device is turned on for the first time.
Parents are given a remote, which is used to activate the device at night when the teen is going to sleep and deactivate it in the morning.
During sleep, the device senses the teen's breathing and sends a signal to the electrode to activate the hypoglossal nerve. This moves the tongue forward while also opening the palate, preventing blockage of the airway and breathing difficulty.
The electrical signal is mild enough to not wake the individual. "We also use sleep studies after implanting the device to determine the right level of electrical signal to activate their hypoglossal nerve," Dr. Don says.
"We can also set the electrical stimulation to gradually increase over the first 20 minutes of sleep so the teen can get used to the feeling," Dr. Ward adds. "And there's a way to pause the device for 15 minutes if the teen needs to get up in the night."
To ensure the device isn't accidentally left on during the day, it will turn itself off automatically after 10 hours of use. The battery lasts 10 to 11 years, and replacing it requires a simple surgical procedure involving one small incision.
Improving breathing during sleep
The device can decrease the number of breathing-related events during sleep by 50% to 70%, Dr. Ward says.
"The kids for whom we've implanted the device have had very positive experiences," Dr. Don says.
For other clinicians considering offering this treatment, Drs. Ward and Don emphasize the importance of collaboration. "There's a lot of coordination involved between Pulmonology and Otolaryngology, and we work closely with the company to help answer any technical questions families have," Dr. Ward explains.
The team welcomes referrals for sleep apnea evaluations. "We're happy to see any patient with Down syndrome at any point in their journey," Dr. Ward says. "It's one of our passions."
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