Effects of vagus nerve stimulation on respiration during sleep

Malow, Beth A.; Edwards, Jonathan; Marzec, Mary L.; Sagher, Oren; Fromes, Gail

doi:10.1212/wnl.55.10.1450

Cited by 183 publications

(127 citation statements)

References 17 publications

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“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In these studies, the number of patients included ranged from 1 to 60. Of these 15 articles, 4 involved only pediatric patients, 8,12,13,17 7 involved only adult patients, 4,5,10,11,[14][15][16] and 4 studies involved both adult and pediatric patients. 3,6,7,9 The patient ages ranged from 3 to70 years.…”

Section: Methodsmentioning

confidence: 99%

“…18 A programming wand that communicates with the generator using radio frequency signals can be used to vary the output current, frequency, pulse width, and stimulation off and on time. 2 Additionally, a 50 gauss bar magnet provided by the manufacturer was reported in 8 studies [4][5][6][7]10,[14][15][16] and oxygen saturation was reported in 6. [4][5][6]10,15,16 …”

Section: Methodsmentioning

confidence: 99%

“…Eight case reports and small case series totaling 36 patients (Table 3) [4][5][6][7]10,[14][15][16][17] show that VNS increases the AHI, which usually improves after discontinuation of the VNS. Marzec et al studied 16 adult patients with VNS to determine if there was a change in AHI and oxygen saturation during sleep with VNS activation.…”

Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 99%

“…Airflow obstruction and obstructive events related to vagal nerve stimulation are highest at a device setting of 30 Hz, are less at 20 Hz, and are virtually nonexistent at 10 Hz. 5 Both lowering the frequency and increasing the cycle time have been recommended by the manufacturer to prevent worsening of OSA during VNS therapy. Although it is not recommended by the manufacturer, in addition to reprogramming the VNS, temporarily deactivating the VNS using the magnet could be considered during a portion of the diagnostic study to estimate the severity of any underlying sleep disordered breathing that a patient has independent of the VNS.…”

Section: Question 6: How Should Patients With Vagus Nerve Stimulatorsmentioning

confidence: 99%

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Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

111

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Intermittent vagus nerve stimulation can reduce the frequency of seizures in patients with refractory epilepsy. Stimulation of vagus nerve afferent fi bers can also cause vocal cord dysfunction, laryngeal spasm, cough, dyspnea, nausea, and vomiting. Vagus nerve stimulation causes an increase in respiratory rate, decrease in respiratory amplitude, decrease in tidal volume, and decrease in oxygen saturation during periods of device activation. It usually does not cause an arousal, or a change in heart rate or blood pressure. Most patients have an increase in their apnea-hypopnea index (AHI). Patients with VNS can have central apneas, obstructive hypopneas, and obstructive apneas. These respiratory events can be reduced with changes in the vagus nerve stimulator operational parameters or with the use of CPAP. In summary, there are complex relationships between epilepsy and obstructive sleep apneas. In particular, patients with refractory epilepsy need assessment for undiagnosed and untreated obstructive sleep apnea before implantation of vagus nerve stimulator devices. Patients with vagus nerve stimulators often have an increase in apneic events after implantation, and these patients need screening for sleep apnea both before and after implantation. (VNS) to control refractory epilepsy in 1990. 1 Intermittent vagus nerve stimulation can reduce seizures by up to 50% in adult seizure patients and up to 90% in pediatric seizure patients. The FDA approved these devices for the treatment of refractory epilepsy in 1997 and for the treatment of refractory depression in 2005. VNS are currently under investigation for treatment of anxiety, obesity, bulimia, migraines, Alzheimer disease, chronic pain syndromes, obsessive-compulsive disorder, panic disorder, and posttraumatic stress disorder. 2 Vagus nerve stimulation can cause side effects involving the upper airway, lower respiratory tract, and upper gastrointestinal tract. These devices can decrease airfl ow, oxygen saturation, and respiratory amplitude during sleep. 3 Most patients with VNS have an increase in their apnea-hypopnea index (AHI) after implantation. 4 One-third of these patients develop mild obstructive sleep apnea post treatment, 4,5 and a minority of patients develop severe obstructive sleep apnea secondary to VNS therapy. 6 More than 50,000 patients have had VNS implants to date, and it is important for sleep medicine specialists to recognize the sleep disordered breathing and other respiratory complications related to VNS devices. We recently helped care for a patient who developed obstructive sleep apnea (OSA) after implantation of a VNS and then required discontinuation of the VNS. Our review of literature while attempting to answer some clinically relevant questions pertaining to this patient led to this review. This article focuses on six questions pertinent to the management of these patients and reviews the literature on sleep-related and respiratory complications associated with vagus nerve stimulators. mETHODSWe conducted a literature search with ...

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 99%

Section: Question 6: How Should Patients With Vagus Nerve Stimulatorsmentioning

confidence: 99%

See 2 more Smart Citations

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

111

View full text Add to dashboard Cite

show abstract

“…The common respiratory side effects of chronic vagal stimulation include dyspnea on exertion, altered breathing patterns (gasping), snoring during sleep, decreased airflow, and heightened respiratory effort during sleep. [40][41][42] In addition, one-third of patients with refractory epilepsy may have baseline obstructive sleep apnea (OSA). 43 A combination of respiratory side effects of chronic vagal nerve stimulation, residual anesthetic effects, and concomitant OSA may increase the risk of postoperative respiratory compromise.…”

Section: Magnetic Resonance Imaging Safetymentioning

confidence: 99%