Affiliations: Department of Internal Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, USA | Department of Pediatrics, Texas Tech University Health
Sciences Center, Lubbock, TX, USA
Note: [] Corresponding author: Rishi Raj, M.D., Department of Internal
Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Stop
9410, Lubbock, TX 79430, USA. Tel.: +1 806 743 3155; Fax: +1 806 743 3148;
E-mail: rishi.raj@ttuhsc.edu
Abstract: Vagal nerve stimulators (VNS) can decrease seizure frequency in
pediatric patients with refractory seizure disorders. However, vagal nerve
stimulation can cause apneas and hypopneas during sleep, especially in patients
with undiagnosed obstructive sleep apnea. We currently care for a young boy
with cerebral palsy and refractory seizures. His mother noted intermittent
noisy breathing and pauses in breathing at night following VNS implantation. An
overnight sleep study revealed very abnormal sleep architecture and an
apnea-hypopnea event rate of nine per h (18 per h when supine). After a review
of the management options, the VNS was disabled. A repeat sleep study
demonstrated improved sleep architecture and a reduced number of apneas and
hypopneas (overall and supine event rate 1.7 per h). Management options in
these patients include changing the VNS parameters, the use of positive airway
pressure therapy, and discontinuing the VNS device.
