Impact of vagus nerve stimulation on sleep-related breathing disorders in adults with epilepsy

Salvadé, Aude; Ryvlin, Philippe; Rossetti, Andrea O.

doi:10.1016/j.yebeh.2017.10.040

Cited by 34 publications

(31 citation statements)

References 34 publications

(70 reference statements)

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“…A few small series have reported newly diagnosed or worse obstructive sleep apnea (OSA) in patients after VNS therapy initiation. In two studies of 18 and 23 patients, 22-58% had newly diagnosed OSA and 50% had worsening of preexisting OSA [54,55]. It can be improved with device adjustment and/or continuous positive airway pressure therapy.…”

Section: Efficacy and Tolerabilitymentioning

confidence: 99%

Comparison and Selection of Current Implantable Anti-Epileptic Devices

2019

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Implantable neural stimulators represent an advanced treatment adjunct to medication for pharmacoresistant epilepsy and alternative for patients that are not good candidates for resective surgery. Three treatment modalities are currently FDA-approved: vagus nerve stimulation, responsive neurostimulation, and deep brain stimulation. These devices were originally trialed in very similar patient populations with focal epilepsy, but head-to-head comparison trials have not been performed. As such, device selection may be challenging due to large overlaps in clinical indications and efficacy. Here we will review the data reported in the original pivotal clinical trials as well as long-term experience with these technologies. We will highlight differences in their features and mechanisms of action which may help optimize device selection on a case-by-case basis.

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Section: Efficacy and Tolerabilitymentioning

confidence: 99%

Comparison and Selection of Current Implantable Anti-Epileptic Devices

2019

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“…cbVNS had to be discontinued due to the development of sleep apnea in one patient. Sleep apnea was noted previously in the literature during VNS and can be treated or ameliorated by decreasing stimuli intensity or the number of stimulation cycles (17, 18). Sleep apnea was noted late in the cbVNS phase in this patient in the present series.…”

Section: Discussionmentioning

confidence: 96%

Impact of Cardiac-Based Vagus Nerve Stimulation Closed-Loop Stimulation on the Seizure Outcome of Patients With Generalized Epilepsy: A Prospective, Individual-Control Study

Cukiert¹,

Cukiert²,

Mariani³

et al. 2021

Neuromodulation: Technology at the Neural Interface

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“…Several factors might contribute to an increased prevalence of OSA in epilepsy, including a higher rate of metabolic syndrome favored by reduced exercise and weight-gaining ASMs such as valproate [41]. Vagus nerve stimulation (VNS) also appears to trigger or aggravate OSA in 28-57% of patients [42][43][44], possibly through a stimulation-induced left vocal cord adduction [43]. This issue can be usually controlled by adjusting VNS therapy or OSA treatment [44].…”

Section: Description Of Findingsmentioning

confidence: 99%

Expert Opinion: Managing sleep disturbances in people with epilepsy

Nobili

Beniczky

Eriksson

et al. 2021

Epilepsy & Behavior

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Poor sleep and daytime sleepiness are common in people with epilepsy. Sleep disorders can disrupt seizure control and in turn sleep and vigilance problems can be exacerbated by seizures and by antiepileptic treatments. Nevertheless, these aspects are frequently overlooked in clinical practice and a clear agreement on the evidence-based guidelines for managing common sleep disorders in people with epilepsy is lacking. Recently, recommendations to standardize the diagnostic pathway for evaluating patients with sleep-related epilepsies and comorbid sleep disorders have been presented. To build on these, we adopted the Delphi method to establish a consensus within a group of experts and we provide practical recommendations for identifying and managing poor night-time sleep and daytime sleepiness in people with epilepsy. We recommend that a comprehensive clinical history of sleep habits and sleep hygiene should be always obtained from all people with epilepsy and their bed partners. A psychoeducational approach to inform patients about habits or practices that may negatively influence their sleep or their vigilance levels should be used, and strategies for avoiding these should be applied. In case of a suspected comorbid sleep disorder an appropriate diagnostic investigation should be performed. Moreover, the possible presence of sleep fragmentation induced by sleep-related seizures should be ruled out. Finally, the dose and timing of antiepileptic medications and other co-medications should be optimized to improve nocturnal sleep and avoid daytime sedation.

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Impact of vagus nerve stimulation on sleep-related breathing disorders in adults with epilepsy

Abstract: Despite the relatively modest clinical impact on epilepsy, in view of the associated cardiovascular risk factor development, easy treatment, and the relatively high SAS prevalence, routine screening for SAS before and after VNS implantation may represent a reasonable practice.

Cited by 34 publications

References 34 publications

Comparison and Selection of Current Implantable Anti-Epileptic Devices

Comparison and Selection of Current Implantable Anti-Epileptic Devices

Impact of Cardiac-Based Vagus Nerve Stimulation Closed-Loop Stimulation on the Seizure Outcome of Patients With Generalized Epilepsy: A Prospective, Individual-Control Study

Expert Opinion: Managing sleep disturbances in people with epilepsy

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