Sleep-related breathing disorder in children with vagal nerve stimulators

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 apneahypopnea 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. (c) 2008 by Elsevier Inc. All rights reserved.