Identification and treatment of obstructive sleep apnea in adults and children with epilepsy: a prospective pilot study

Malow, Beth A.; Weatherwax, Kevin; Chervin, Ronald D.; Hoban, Timothy F.; Marzec, Mary L.; Martin, Cory; Binns, Lizabeth

doi:10.1016/j.sleep.2003.06.004

Cited by 132 publications

(82 citation statements)

References 24 publications

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“…In addition, one of the patients could not tolerate the CPAP, and the other used it sporadically. 7 Therefore, CPAP can treat respiratory complications associated with VNS but did not reduce seizure activity in this small study. Malow et al also randomized 35 subjects with seizures and OSA to sham vs. therapeutic CPAP for 10 weeks.…”

Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 62%

“…[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%

“…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. If a study did not have the average patient age specifi cally stated in the article, we calculated the average patient age from the data published on individual patients in the study.…”

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%

See 4 more Smart Citations

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: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Question 4: Does Intermittent Vagus Nerve Stimulation Increamentioning

confidence: 99%

See 3 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

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Management of Medical Comorbidity Associated with Epilepsy

Singh

2015

The Treatment of Epilepsy

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Sleep disorders, epilepsy, and autism

Malow

2004

Ment. Retard. Dev. Disabil. Res. Rev.

Self Cite

113

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The purpose of this review article is to describe the clinical data linking autism with sleep and epilepsy and to discuss the impact of treating sleep disorders in children with autism either with or without coexisting epileptic seizures. Studies are presented to support the view that sleep is abnormal in individuals with autistic spectrum disorders. Epilepsy and sleep have reciprocal relationships, with sleep facilitating seizures and seizures adversely affecting sleep architecture. The hypothesis put forth is that identifying and treating sleep disorders, which are potentially caused by or contributed to by autism, may impact favorably on seizure control and on daytime behavior. The article concludes with some practical suggestions for the evaluation and treatment of sleep disorders in this population of children with autism.

show abstract

Identification and treatment of obstructive sleep apnea in adults and children with epilepsy: a prospective pilot study

Cited by 132 publications

References 24 publications

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Management of Medical Comorbidity Associated with Epilepsy

Sleep disorders, epilepsy, and autism

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