Pediatric Down Syndrome Post-Approval Study

Inclusion Criteria: 1. Patient has been diagnosed with Down syndrome; 2. Patient is 13-18 years of age; 3. Patient has been diagnosed with severe obstructive sleep apnea, with an AHI of ≥ 10 and ≤ 50 based on a recent (within 6 months of enrollment) qualified in-lab sleep study (PSG); 4. Patient has documented failure of, or intolerance to, positive airway pressure therapies (such as CPAP or BiPAP) despite attempts to improve compliance; 5. Patient is contraindicated for, or not effectively treated by, adenotonsillectomy; 6. Treatment of patient's OSA has followed standard of care in considering all other alternative/adjunctive therapies; 7. Patient, and their parents/guardians, is willing to have stimulation hardware permanently implanted, and be willing to participate in follow-up visits, postoperative in-lab sleep studies (PSGs), and questionnaire completion. Exclusion Criteria: 1. Patient's recent PSG (within 6 months of enrollment) reports central + mixed apneas \> 25% of the total apnea-hypopnea index (AHI); 2. Patient has any anatomical finding that would compromise the performance of upper airway stimulation, such as the presence of complete concentric collapse of the soft palate; 3. Patient has any condition or procedure that has compromised neurological control of the upper airway; 4. Patient, or their parent/guardian, is unable or does not have the necessary assistance to operate the patient remote; 5. Patient is pregnant or plans to become pregnant; 6. Patient has an implantable device that may be susceptible to unintended interaction with the Inspire system; 7. Patient will require magnetic resonance imaging (MRI) other than what is specified in the MR conditional labeling; 8. Patient has a terminal illness with life expectancy of less than 12 months; 9. Any other reason the investigator deems the patient is unfit for participation in the study.