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Effects of Vagus Nerve Stimulation on Sleep‐related Breathing in Epilepsy Patients
Author(s) -
Marzec Mary,
Edwards Jonathan,
Sagher Oren,
Fromes Gail,
Malow Beth A.
Publication year - 2003
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1046/j.1528-1157.2003.56202.x
Subject(s) - medicine , epilepsy , vagus nerve stimulation , obstructive sleep apnea , anesthesia , continuous positive airway pressure , vagus nerve , hypopnea , positive airway pressure , apnea , stimulation , polysomnography , psychiatry
Summary: Purpose: To describe the effects of vagus nerve stimulation (VNS) on sleep‐related breathing in a sample of 16 epilepsy patients. Methods: Sixteen adults with medically refractory epilepsy (nine men, seven women, ages 21–58 years) underwent baseline polysomnograms (PSGs). Three months after VNS therapy was initiated, PSGs were repeated. In addition, patient 7 had a study with esophageal pressure monitoring, and patient 1 had a continuous positive airway pressure (CPAP) trial. Results: Baseline PSGs: One of 16 patients had an apnea–hypopnea index (AHI) >5 (6.8). Treatment PSGs: Five of 16 patients had treatment AHIs >5. Respiratory events were more frequent during periods with VNS activation (on‐time) than without VNS activation (off‐time; p = 0.016 ). Follow‐up studies: Esophageal pressure monitoring in patient 7 showed crescendos in esophageal pressure during VNS activation, supporting an obstructive pattern. The CPAP trial of patient 1 showed that all respiratory events were associated with VNS stimulation at low CPAP levels. They were resolved at higher CPAP levels. Conclusions: Treatment with VNS affects respiration during sleep and should be used with care, particularly in patients with preexisting obstructive sleep apnea. The AHI after VNS treatment remained <5 in the majority of patients and was only mildly elevated (<12) in five patients. In one patient, CPAP resolved VNS‐related respiratory events.