The prevalence of vagus nerve stimulator-induced sleep disordered breathing in children with refractory Epilepsy: A retrospective cohort study.

Rationale: Vagus nerve stimulators (VNS) can reduce seizure burden in children but may result in sleep-disordered breathing (SDB). Our objectives were to assess the prevalence of SDB in children with epilepsy using polysomnography (PSG) before and after VNS implantation as well to explore management strategies for VNS-induced SDB.

Methods: A retrospective cohort study was conducted (May 2019 to September 2024) of children aged 0-18 years old with refractory epilepsy and VNS insertion at The Hospital for Sick Children, Toronto, Canada. All included children underwent level 1 baseline PSG evaluation within 1 year prior to VNS insertion. Once VNS was inserted, a repeat PSG was conducted within 18 months. Paired t-tests and Wilcoxon-matched-pair tests compared respiratory variables from PSGs before and after VNS insertion.

Results: Twenty-seven children with a mean (SD) age of 8.8 (4.2) years were included. Prior to VNS insertion, 5 (19 %) children had mild obstructive sleep apnea (OSA), 1 (4 %) child had moderate OSA, no child had severe OSA, 2 (7 %) children had central sleep apnea (CSA), and 1 (4 %) child had nocturnal hypoventilation. After VNS insertion, 9 (33 %) children experienced worsened SDB, with most progressing from having no OSA to developing mild OSA. Management strategies for VNS-induced SDB included conservative management, alteration of VNS settings, adenotonsillectomy, and continuous positive airway pressure therapy.

Conclusions: The severity of OSA may increase in children with epilepsy treated with VNS. All children being considered for VNS should be routinely screened for symptoms of SDB. Various management strategies can be used for VNS-induced SDB are available.