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

Hinesh Upadhyay, Sushanth Bhat, Divya Gupta, Martha Mulvey, Sue Ming

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Intermittent vagus nerve stimulation (VNS) can reduce the frequency of seizures in patients with refractory epilepsy, but can affect respiration in sleep. Untreated obstructive sleep apnea (OSA) can worsen seizure frequency. Unfortunately, OSA and VNS-induced sleep disordered breathing (SDB) may occur in the same patient, leading to a therapeutic dilemma. We report a pediatric patient in whom OSA improved after tonsillectomy, but coexistent VNS-induced SDB persisted. With decrease in VNS output current, patient's SDB improved, but seizure activity exacerbated, which required a return to the original settings. Continuous positive airway pressure titration was attempted, which showed only a partial improvement in apnea-hypopnea index. This case illustrates the need for clinicians to balance seizure control and SDB in patients with VNS.

Original languageEnglish (US)
Pages (from-to)151-154
Number of pages4
JournalAnnals of Thoracic Medicine
Volume11
Issue number2
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Keywords

  • Epilepsy
  • obstructive sleep apnea
  • seizure
  • vagus nerve stimulator

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