The therapeutic dilemma of vagus nerve stimulator-induced sleep disordered breathing

Upadhyay, Hinaesh; Bhat, Sushanth; Gupta, Divya; Mulvey, Martha; Ming, Sue X.

doi:10.4103/1817-1737.180025

Cited by 12 publications

(7 citation statements)

References 16 publications

(23 reference statements)

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“…This subject could not tolerate the lower VNS setting as her seizures were exacerbated. The prior study of this case was reported previously without detailed calculation of AHI [2].…”

Section: Case Resultsmentioning

confidence: 97%

“…Our results aligns with literature that report minimal effectiveness of PAP in eliminating SDB during VNS stimulation. [1], [2], [9], [11] Tonsillectomy and adenotonsillectomy are the first line of treatment for OSA in pediatric populations but has shown variable levels of success in VNS-induced sleep apnea. [11], [15], [17] This suggests that airway splint or positive airway pressure may not overcome the inhibitory action of vagal nerve on respiration in our subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Changing the VNS settings is a reasonable solution for VNS-induced SDB, although it must be balanced with seizure control. [1], [2], [9], [17] However, determining ideal VNS parameters for each individual subject while maintaining therapeutic levels of stimulation is challenging. Three of our subjects showed improvement in their VNS-induced SDB after titrations of their specific VNS settings.…”

Section: Discussionmentioning

confidence: 99%

“…While treatment of primary OSA with positive airway pressure in patients with epilepsy can reduce seizure frequency, [15] the association of VNS and therefore sleep disordered breathing (SDB) deserves a closer look, especially since several cases have been described in a recent review [16] and there is no established treatment. [1], [2], [17], [18] We report 4 subjects who experienced marked SDB during VNS activation and discuss the dilemma of VNS titration.…”

Section: Introductionmentioning

confidence: 99%

“…Vagus nerve stimulator (VNS) has become a common adjunct therapy for individuals with drug-resistant epilepsy [1], [2]. However, its complications include delayed arrhythmias, laryngopharyngeal dysfunction, tonsillar pain mimicking glossopharyngeal neuralgia, and sleep disordered breathing (SDB) [3].…”

Section: Introductionmentioning

confidence: 99%

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Treatment of vagus nerve stimulator-induced sleep-disordered breathing: A case series

Johnson

Shah³

et al. 2019

Epilepsy & Behavior Reports

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Objective Vagus nerve stimulation (VNS) is a treatment option for patients with drug-resistant seizures, but it is also associated with sleep-disordered breathing (SDB). We present four patients with VNS who underwent polysomnography (PSG) concurrently with VNS stimulation monitoring and adjustment, and positive airway pressure (PAP) treatment. We demonstrate the importance of sleep apnea screening prior to VNS placement and the dilemma of optimizing VNS settings. Background VNS is a common adjunct therapy for refractory epilepsy. Despite its low side effect profile, complications of VNS include delayed arrhythmias, laryngopharyngeal dysfunction, obstructive sleep apnea, and tonsillar pain mimicking glossopharyngeal neuralgia. Risk of developing or exacerbating existing obstructive sleep apnea (OSA) limits the VNS settings, as there appears to be a dose dependent effect. OSA can further cause sleep fragmentation and cause hypoxia, potentially worsening seizures. Methods Four patients with drug-resistant epilepsy with VNS underwent PSG with concurrent VNS leads to monitor correlation of SDB and VNS. AHI was calculated to quantify SDB, and it was scored as non-VNS related when the VNS was off, and VNS-induced when the onset of SDB corresponded to VNS activation. Subsequent PAP and VNS adjustment was performed to treat the SDB episodes. Results Three out of four patients had non-VNS associated SDB, which improved with PAP treatment. All four patients had VNS-induced SDB episodes but none improved with PAP. The VNS-induced SDB events decreased in a dose dependent manner, when VNS was adjusted down and disappeared when turned off completely. Conclusion Our case series provides further evidence of VNS-induced SDB secondary to VNS. PAP treatment alone is ineffective for VNS-induced SDB. Screening for OSA before VNS implant is crucial; further research is needed to establish optimal VNS parameters for prevention andminimization of VNS-induced SDB along with other possible treatments.

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“…This subject could not tolerate the lower VNS setting as her seizures were exacerbated. The prior study of this case was reported previously without detailed calculation of AHI [2].…”

Section: Case Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Treatment of vagus nerve stimulator-induced sleep-disordered breathing: A case series

Johnson

Shah³

et al. 2019

Epilepsy & Behavior Reports

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Interaktion zwischen schlafbezogenen Atemstörungen und Epilepsie

Lanz

2018

Z. Epileptol.

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Sleep Disorders in Epilepsy: Current Trends and Future Perspectives

Grayson

DeWolfe

2018

Curr Sleep Medicine Rep

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Purpose of Review Sleep complaints are common in people with epilepsy (PWE). We aim to highlight the updated evidence regarding comorbid sleep disorders and epilepsy and the impact of epilepsy and its treatments on sleep. Recent Findings Up to two thirds of PWE report sleep disturbances which may signal presence of a comorbid sleep disorder, including insomnia, arousal parasomnias, excessive daytime sleepiness, obstructive sleep apnea, or restless legs syndrome. Uncontrolled seizures contribute to poor sleep quality, while presence of epilepsy (with or without seizures) and antiepileptic drugs is associated with changes in sleep architecture. Chronic intracranial EEG monitoring with implanted devices reveals a nocturnal peak for interictal epileptiform activity. Epilepsy surgery outcomes suggest better seizure control may improve sleep architecture and quality. Summary Screening for and treating sleep disorders may lead to improved seizure control and quality of life in PWE. Epilepsy surgery and implanted devices to treat refractory epilepsy provide new insights into the relationship between sleep and epilepsy.

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The therapeutic dilemma of vagus nerve stimulator-induced sleep disordered breathing

Cited by 12 publications

References 16 publications

Treatment of vagus nerve stimulator-induced sleep-disordered breathing: A case series

Treatment of vagus nerve stimulator-induced sleep-disordered breathing: A case series

Interaktion zwischen schlafbezogenen Atemstörungen und Epilepsie

Sleep Disorders in Epilepsy: Current Trends and Future Perspectives

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