Obstructive Sleep Apnea Associated With Vagus Nerve Stimulation in Children With Drug Resistant Epilepsy: A Retrospective Case Series
Abstract
BACKGROUND
Obstructive sleep apnea (OSA) is a common condition in children with drug resistant epilepsy. Its association with vagus nerve stimulation (VNS) is well-documented in adults, but pediatric data remain scarce. VNS-induced OSA may negatively impact seizure control and quality of life. This study aims to define the incidence, characteristic features, mechanistic underpinnings, and management strategies of VNS-associated OSA in children.
METHODS
We conducted a retrospective case series of 14 children with drug resistant epilepsy who developed new-onset snoring following VNS implantation. All underwent polygraphy or polysomnography. We evaluated the temporal relationship between VNS stimulation and respiratory events, explored anatomical and functional mechanisms through drug-induced sleep endoscopy (DISE), and assessed therapeutic interventions including VNS parameter adjustments, Continuous Positive Airway Pressure, and surgical treatments.
RESULTS
OSA was identified in 11 of 14 patients (79%) ranging from mild to severe. A highly characteristic respiratory pattern emerged, consisting of rhythmic obstructive events tightly synchronized with VNS active stimulation cycles. DISE identified vocal cord adduction during VNS activation in 3 patients, indicating an active obstructive mechanism. Nighttime VNS parameter adjustments effectively resolved OSA in 67% of patients without worsening seizure control. Continuous Positive Airway Pressure showed limited efficacy, likely…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 14 participants or records.
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