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Vagus nerve stimulation may induce obstructive sleep apnea : a case report
Frontal lobe epilepsy is relatively common and often presents with nocturnal seizures. Vagus nerve stimulation can be an alternative treatment for refractory patients. The left vagus nerve is stimulated using an implanted device at the level of the neck. Obstructive sleep apnea may impair seizure control.
Report a case of obstructive sleep apnea secondary to vagus nerve stimulation for epilepsy treatment.
We report a 29-year old male patient with a diagnosis of frontal lobe epilepsy under treatment with vagus nerve stimulation that was referred to the sleep medicine outpatient clinic due to snoring and daytime sleepiness. His epilepsy started during childhood. Vagus nerve stimulation was indicated due to inadequate control of seizures with clobazan and lamotrigine. After stimulator implantation, the patient observed better control of the number of seizures but noticed intermittent hoarseness. Six months after cervical electrode implantation the number of seizures had increased again. The patient noticed daytime sleepiness and snoring. Polysomnography was requested to investigate possible obstructive sleep apnea.
Polysomnography revealed obstructive respiratory events at regular intervals and with a similar duration in all events. An electrocardiogram artifact was also noticed during respiratory events. AHI was 27,0 hour .
A few cases of vagus nerve stimulation inducing OSA have been reported. Obstructive events are caused by vagus nerve stimulation of upper airway muscles. Reduction of stimulus intensity, switching the device off or CPAP may be necessary to control obstructive respiratory events.
Obstructive sleep apnea may be a side effect of vagus nerve stimulation that may affect seizure control.
seizures, sleep apnea, VNS, vagus nerve stimulation
Relato de Caso
FMUSP - Sao Paulo - Brasil
Thais Cano, Marcela Yanagimori, Viviane Vieira Passini, Mariana Delgado Fernandes, Bruno Sergio Vasconcellos, Cassio Batista Lacerda, Camila Bae Uneda, Geraldo Lorenzi Filho, Pedro Rodrigues Genta