0541 Obstructive Sleep Apnea Following Vagus Nerve Stimulator Implantation: A Meta-Analysis

Abstract

Introduction Vagus nerve stimulation (VNS) treatment for patients with intractable epilepsy has been shown to effectively lower seizure frequency and improve quality of life. However, due to stimulation of the vagus nerve, alterations in both central regulation of breathing and laryngeal muscle stimulation can precipitate obstructive sleep apnea (OSA). While there have been case reports describing OSA following VNS implantation, there has yet to be a detailed evaluation of this complication in a large cohort of VNS patients. The objective of this meta-analysis was to determine OSA rates in patients following VNS implantation. Methods English full-text articles were searched for on Pubmed, Scopus, and Embase databases. Articles had to follow patients before and after VNS implantation; report apnea-hypopnea index (AHI), respiratory disturbance index (RDI), or OSA rates following VNS implantation; be from a clinical trial, cohort, or case-control study. Two reviewers reviewed articles and a third settled disagreements. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies were used. Following Freeman-Tukey transformation, the generic inverse variance method with random effects model was used for meta-analysis. Results Ten studies, seven retrospective and three prospective, representing a cohort of 306 patients were included in this study. Pooled OSA rates following VNS implantation were 27.3%, 95% CI: 15.1 - 41.5%. Subgroup analysis found no difference in rates between studies of pediatric populations (22.1%, 95% CI: 8.2 - 40.5%) and adult populations (31.9%, 95% CI: 18.9 - 47.5%) following VNS implantation (P = 0.39). There was significant heterogeneity in pooled analysis (P < 0.00001, I2 = 100%), but no inter-subgroup heterogeneity (I2 = 0%). Conclusion Obstructive sleep apnea is a common adverse effect following VNS treatment and patients should be monitored following implantation. There are no differences in OSA rates between pediatric and adult populations. Routine screening for OSA following VNS implantation may be a reasonable choice. Support (if any) No institutional or NIH funding was received for this project