title: Laryngeal motility alteration: A missing link between sleep apnea and vagus nerve stimulation for epilepsy.
abstract: This study aimed to evaluate the prevalence and the relationship of sleep breathing disorders (SBDs) and laryngeal motility alterations in patients with drug-resistant epilepsy after vagus nerve stimulator (VNS) implantation. Twenty-three consecutive patients with medically refractory epilepsy underwent out-of-center sleep testing before and after VNS implantation. Eighteen eligible subjects underwent endoscopic laryngeal examination post-VNS implantation. Statistical analysis was carried out to assess an association between laryngeal motility alterations and the onset/worsening of SBDs. After VNS implantation, 11 patients showed a new-onset mild/moderate SBD. Half of the patients already affected by obstructive sleep apnea (OSA) showed worsening of SBD. All of the patients with a new-onset OSA had a laryngeal pattern with left vocal cord adduction (LVCA) during VNS stimulation. The association between VNS-induced LVCA and SBD was statistically significant. This study suggests an association between VNS and SBD, hinting to a pivotal role of laryngeal motility alterations. The relationship between SBD and VNS-induced LVCA supports the need to routinely investigate sleep respiratory and laryngeal motility patterns before and after VNS implantation.
authors.affiliation: Epilepsy Center - Sleep Medicine Center, San Paolo Hospital, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Zambrelli
authors.affiliation: Department of Otolaryngology, San Paolo Hospital, Milan, Italy.|Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Saibene
authors.affiliation: Epilepsy Center - Sleep Medicine Center, San Paolo Hospital, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Furia
authors.affiliation: Epilepsy Center - Sleep Medicine Center, San Paolo Hospital, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiesa
authors.affiliation: Epilepsy Center - Sleep Medicine Center, San Paolo Hospital, Milan, Italy.|Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Aglaia
authors.initials: A
authors.lastname: Vignoli
authors.affiliation: Department of Otolaryngology, San Paolo Hospital, Milan, Italy.|Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Pipolo
authors.affiliation: Department of Otolaryngology, San Paolo Hospital, Milan, Italy.|Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Felisati
authors.affiliation: Epilepsy Center - Sleep Medicine Center, San Paolo Hospital, Milan, Italy.|Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Canevini
mesh_terms: D000328:Adult; D000368:Aged; D004827:Epilepsy / Q000628:therapy*; D015154:Esophageal Motility Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000209:etiology*; D018709:Statistics, Nonparametric; D055536:Vagus Nerve Stimulation / Q000009:adverse effects*; D014827:Vocal Cords / Q000503:physiopathology*
keywords: Drug-resistant epilepsy; Sleep breathing disorders; Vocal cord dysfunction