Inspire hypoglossal nerve stimulator
Inspire criteria::
- >18yo or 13-18yo with Down's Syndrome
- BMI<35
- AHI 15-65/hr
- CPAP unsuccessful
- No severe neuromuscular disease

- No other sleep disorders, eg narcolepsy
- DISE shows AP collapse

Patient is a 58yo male who suffers from severe OSA manifesting as excessive daytime somnolence, sleeping up to 15 hours per day, cognitive impairment, and inability to maintain full-time employment over the past 12 years. He was unable to tolerate CPAP despite trialling 3 different masks due to severe mental health issues and anxiety. He then trailed a mandibular advancement device which he was also unable to tolerate. He has an AHI of 45.5 (as per WatchPAT study), ESS of 6, BMI of 29. Drug induced sleep endoscopy showed multilevel obstruction with complete velar collapse in the supine position, partial lateral oropharyngeal collapse, tongue base obstruction, and epiglottic obstruction. He was discussed in the sleep MDT, and hypoglossal nerve stimulator was deemed appropriate.

His past medical history includes anxiety and depression, and a hiatal hernia. He is a never smoker. He drinks 9.6 units of alcohol per week on average and is trying to cut down.