title: Sleep-related breathing disorder in children with vagal nerve stimulators.
abstract: The effects of vagal nerve stimulation on sleep-related breathing have not been well-described in children. Vagal nerve stimulation was reported to cause decreases in airflow during sleep, although most studies reported this condition to be clinically insignificant. We present a retrospective case series of nine children who underwent polysomnography after vagal nerve-stimulator placement. All children, except for one, had sleep-disordered breathing after stimulator implantation. We describe in further detail a child who manifested severe, obstructive sleep apnea postimplantation, with apneas occurring regularly and consistently with stimulator activity, resulting in an elevated apnea-hypopnea index of 37 per hour. Polysomnography was repeated with the stimulator turned off, and revealed complete resolution of the stimulator-related sleep apnea. With the vagal nerve stimulator back on, continuous positive airway pressure treatment was effective in normalizing the apnea-hypopnea index. This study demonstrates that severe and clinically significant disturbances in sleep-related breathing may occur with vagal nerve stimulators. Obstructive apneas of this severity, related to vagal nerve stimulators, were not previously described in pediatric patients. This effect on sleep-related breathing warrants further investigation and care in managing pediatric patients.
authors.affiliation: Department of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Tauyee
authors.initials: T
authors.lastname: Hsieh
authors.forename: Maida
authors.initials: M
authors.lastname: Chen
authors.forename: Amber
authors.initials: A
authors.lastname: McAfee
authors.forename: Yemiserach
authors.initials: Y
authors.lastname: Kifle
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D004599:Electric Stimulation Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000503:physiopathology; D014630:Vagus Nerve / Q000502:physiology*