Obstructive Sleep Apnea Associated With Vagus Nerve Stimulation in Children With Drug Resistant Epilepsy: A Retrospective Case Series.

BACKGROUND

Obstructive sleep apnea (OSA) is a common condition in children with drug resistant epilepsy. Its association with vagus nerve stimulation (VNS) is well-documented in adults, but pediatric data remain scarce. VNS-induced OSA may negatively impact seizure control and quality of life. This study aims to define the incidence, characteristic features, mechanistic underpinnings, and management strategies of VNS-associated OSA in children.

METHODS

We conducted a retrospective case series of 14 children with drug resistant epilepsy who developed new-onset snoring following VNS implantation. All underwent polygraphy or polysomnography. We evaluated the temporal relationship between VNS stimulation and respiratory events, explored anatomical and functional mechanisms through drug-induced sleep endoscopy (DISE), and assessed therapeutic interventions including VNS parameter adjustments, Continuous Positive Airway Pressure, and surgical treatments.

RESULTS

OSA was identified in 11 of 14 patients (79%) ranging from mild to severe. A highly characteristic respiratory pattern emerged, consisting of rhythmic obstructive events tightly synchronized with VNS active stimulation cycles. DISE identified vocal cord adduction during VNS activation in 3 patients, indicating an active obstructive mechanism. Nighttime VNS parameter adjustments effectively resolved OSA in 67% of patients without worsening seizure control. Continuous Positive Airway Pressure showed limited efficacy, likely due to active vocal cord adduction.

CONCLUSIONS

VNS-associated OSA is a frequent and under-recognized complication in children with epilepsy. Its distinctive polysomnographic signature and demonstrable laryngeal mechanism highlight the need for systematic sleep evaluation in VNS-treated children. DISE provides high diagnostic yield, but when unavailable, targeted VNS adjustment-particularly overnight modulation-offers an effective and practical management strategy. Early identification and treatment of OSA may contribute to improved seizure outcomes and overall quality of life.