Vagus Nerve Stimulator–Associated Sleep Disordered Breathing: Identification, Treatment, and Outcomes in a Pediatric Patient

Abstract

Vagus nerve stimulator (VNS)-associated sleep disordered breathing (SDB) is a poorly understood side effect of VNS treatment. We present a patient with VNS-associated SDB who underwent sleep laboratory VNS titration, evaluation by drug-induced sleep endoscopy, and treatment including adenotonsillectomy and positive airway pressure therapy. This case is unique as it is the first to document, in real time, the inverse correlation of VNS current with airflow. This case offers unique insights into mechanisms and treatment of VNS-associated SDB, and a novel approach in its management. Most importantly, this case highlights the need for collaboration between physicians managing epilepsy with VNS and those managing sleep.

Effects of anti‐seizure therapies on sleep in patients with epilepsy: A literature review

“…Early screening of sleep‐disordered breathing before as well as after VNS implantation should be considered as clinical routines. A drug‐induced sleep endoscopy may be useful in evaluating respiratory and laryngeal patterns 61 . Adjusting device parameters such as lowering stimulus intensity or frequency, switching the device off during sleep helps control respiratory symptoms and prevent exacerbation of OSAHS in most patients; whereas some others may require positive airway pressure 62 .…”

“…A drug-induced sleep endoscopy may be useful in evaluating respiratory and laryngeal patterns. 61 Adjusting device parameters such as lowering stimulus intensity or frequency, switching the device off during sleep helps control respiratory symptoms and prevent exacerbation of OSAHS in most patients; whereas some others may require positive airway pressure. 62 A careful VNS titration under PSG monitoring is recommended.…”