[MS1-2A-4] Severe Obstructive Sleep Apnea Associated with Vagal Nerve Stimulation: Dramatic Improvement with VNS Setting Changes
Implanted Vagal nerve stimulator (VNS) could affect respiration during sleep and worsen obstructive sleep apnea (OSA) by increasing the numbers of apneas and hypopneas. We reported a 13 years old pediatric case with Lennox-Gastaut syndrome and other complicated medical conditions s/p VNS implantation. He is s/p adenotonsillectomy, with his most recent prior study (after surgery) showing mild OSA (obstructive Apnea–hypopnea index (AHI) 2.5, oxyhemoglobin saturation nadir 88%). Given interim worsening symptoms of sleep-disordered breathing, he was referred for evaluation of suspected obstructive sleep apnea. The following Polysomnography (PSG) showed severe OSA and frequent desaturation (obstructive AHI: 23.3 oxyhemoglobin saturation nadir 78%). Most of the obstructive events were associated with VNS artifacts. The VNS’s settings were then adjusted to reduce the influence on respiration and a repeated PSG was performed 4.5 months later, the results showed dramatic improvement of OSA (AHI:2.6, oxyhemoglobin saturation nadir 92%) and the residual hypopneas were no longer associated with VNS artifact.
This case presented the implanted VNS’s impaction on respiration, and demonstrate the successful reduction of OSA after adjustment of VNS’s setting. The changed parameters of the VNS’s setting in this case could be a worth reference for those who has similar medical conditions.
This case presented the implanted VNS’s impaction on respiration, and demonstrate the successful reduction of OSA after adjustment of VNS’s setting. The changed parameters of the VNS’s setting in this case could be a worth reference for those who has similar medical conditions.