Sleep disordered breathing in children receiving vagus nerve stimulation therapy

An Unusual Cause of Worsening Obstructive Sleep Apnea

“…Snoring (77.3%), night awakening (68.1%), and parasomnias (63.6%) were the most frequently reported symptoms. 4 The prevalence of OSA and NH in this cohort was 86.4% (n = 19) and 27.3% (n = 6), respectively. 4 The proposed mechanism of action for the resulting OSA as seen in our patient includes the stimulation of the left recurrent laryngeal nerve resulting in left vocal cord adduction, increased lateral laryngeal tone, and increased resistance of the upper airway.…”

“…4 The prevalence of OSA and NH in this cohort was 86.4% (n = 19) and 27.3% (n = 6), respectively. 4 The proposed mechanism of action for the resulting OSA as seen in our patient includes the stimulation of the left recurrent laryngeal nerve resulting in left vocal cord adduction, increased lateral laryngeal tone, and increased resistance of the upper airway. 1,4 Respiratory pattern changes such as increased respiratory rate, which was observed in our patient, decreased tidal volume, and nocturnal Sp o 2 has also been reported in children with VNS.…”

“…4 The proposed mechanism of action for the resulting OSA as seen in our patient includes the stimulation of the left recurrent laryngeal nerve resulting in left vocal cord adduction, increased lateral laryngeal tone, and increased resistance of the upper airway. 1,4 Respiratory pattern changes such as increased respiratory rate, which was observed in our patient, decreased tidal volume, and nocturnal Sp o 2 has also been reported in children with VNS. 6 Given that the vagal nerve innervates the brainstem’s respiratory control center and relays information from baroreceptors, chemoreceptors, and stretch receptors, VNS may also affect the control of breathing during sleep, thus contributing to the subsequent development of SDB.…”

“…To date, there is a published retrospective cross-sectional study of 22 children who underwent diagnostic PSG after VNS insertion. 4 The mean ± standard deviation (SD) age in years at the time of VNS insertion was 8.4 ± 4.0 years (male, 50%) and at the first PSG after VNS insertion was 10.6 ± 4.3 years. Snoring (77.3%), night awakening (68.1%), and parasomnias (63.6%) were the most frequently reported symptoms.…”

“…1 There are several known side effects of a VNS, which include dysphonia, neck pain, coughing, dyspnea, headache, and sleep-disordered breathing (SDB). 1 Given the increasing prescription of VNS for seizure control, 3,4 it is paramount for general pediatricians, pulmonologists, and neurologists to be aware of its associated risk of SDB. In addition, the optimal treatment for VNS-associated SDB is not well understood.…”