Vagus nerve stimulator-induced apneas and hypopneas in a child with refractory seizures

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.