Obstructive Sleep Apnea Common Following Vagus Nerve Stimulation, Regardless of Sex

Melissa L. Bernbaum, MD

Findings from a meta-analysis of 10 studies showed that obstructive sleep apnea (OSA) is a common adverse event following vagus nerve stimulation (VNS), with no differences based on sex. Investigators concluded that routine screening for OSA following VNS implantation may be a reasonable choice.¹

Prior research has suggested that VNS can cause an increase in respiratory rate, decrease in respiratory amplitude, decrease in tidal volume, and decrease in oxygen saturation during periods of device activation. Presented at the 2023 SLEEP Annual Meeting, held June 3-7, in Indianapolis, Indiana, pooled rates of OSA in the meta-analysis, which comprised of 7 retrospective and 3 prospective studies totaling 306 patients, were 27.3% (95% CI, 15.1-41.5).

In the analysis, senior investigator Melissa L. Bernbaum, MD, director, Epilepsy of Medicine, Huntington Hospital, and colleagues, used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Two reviewers article and a third settled disagreements. Following Freeman-Tukey transformation, generic inverse variance method with random effects model was used for the meta-analysis.

In a subgroup analysis, there were no significant difference in OSA rates between the pediatric (22.1%; 95% CI, 8.2-40.5) and adult (31.9%; 95% CI, 18.9-47.5) populations following VNS implantation (P = .39). Of note, investigators observed significant heterogeneity in the pooled analysis (I2 = 100%; P <.00001), but no inter-subgroup heterogeneity (I2 = 0%).

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VNS, which entails using a device to stimulate the vagus nerve, has been approved to treat epilepsy and depression, as well as for rehabilitative purposes for poststroke patients. These devices are surgically implanted under the skin of the chest; however, there are newer, noninvasive VNS devices that do not require surgery. Current research has examined the potential benefits of the therapy for rheumatoid arthritis, inflammatory bowel disease, bipolar disorder, obesity, and Alzheimer disease.

Following VNS, most patients have shown to have an increase in their apnea-hypopnea index, with some reports suggesting that one-third of patients can develop OSA.² Research has also suggested that a minority of patients develop severe OSA secondary to VNS therapy. VNS, a common adjunct therapy for refractory epilepsy, has been linked to delayed arrhythmias, laryngopharyngeal dysfunction, and tonsillar pain mimicking glossopharyngeal neuralgia. OSA can cause sleep fragmentation and hypoxia, potentially worsening seizures.³

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REFERENCES
1. Saleem M, Santhumayor B, Hasan E, Kolesnik M, Bernbaum M. Obstructive sleep apnea following vagus nerve stimulatory implantation: a meta-analysis. Presented at: 2023 SLEEP Annual Meeting; June 3-7; Indianapolis, Indiana. Abstract 0541
2. Marzec M, Edwards J, Sagher O, Fromes G, Malow BA. Effects of vagus nerve stimulation on sleep-related breathing in epilepsy patients. Epilepsia. 2003;44:930-5.
3. Oh DM, Johnson J, Shah B, Bhat S, Nuoman R, Ming X. Treatment of vagus nerve stimulator-induced sleep-disordered breathing: a case series. Epilepsy & Behav. 2019;12:100325. doi:10.1016/j.ebr.2019.100325