Obstructive Sleep Apnea Associated With Vagus Nerve Stimulation in Children With Drug Resistant Epilepsy: A Retrospective Case Series
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Updated: Jan 25, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Nuria Lamagrande-Casanova1, Francisca Romero-Adújar1, Azucena Lloris1
1Department of Pediatric Neurology, Hospital Universitario Niño Jesús, Madrid, Spain.
Insights
Vagus nerve stimulation (VNS) frequently causes obstructive sleep apnea (OSA) in children with epilepsy. Adjusting nighttime VNS settings effectively treated OSA in most patients, improving seizure control and quality of life.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Epilepsy Research
Background:
- Obstructive sleep apnea (OSA) is common in children with drug-resistant epilepsy.
- Vagus nerve stimulation (VNS) is used for epilepsy but its effect on pediatric OSA is understudied.
- VNS-induced OSA can worsen seizure control and quality of life.
Purpose of the Study:
- To determine the incidence and characteristics of VNS-associated OSA in children.
- To investigate the mechanisms underlying VNS-induced OSA.
- To evaluate management strategies for VNS-associated OSA.
Main Methods:
- Retrospective case series of 14 children with epilepsy and new-onset snoring post-VNS.
- Polygraphy/polysomnography to diagnose and characterize OSA.
- Drug-induced sleep endoscopy (DISE) to explore obstructive mechanisms.
- Assessment of VNS parameter adjustments, CPAP, and surgery.
Main Results:
- OSA identified in 79% of patients (11/14), ranging from mild to severe.
- Characteristic respiratory events synchronized with VNS stimulation cycles.
- DISE revealed vocal cord adduction during VNS in 3 patients.
- Nighttime VNS adjustments resolved OSA in 67% without impacting seizure control.
- CPAP had limited efficacy due to active vocal cord adduction.
Conclusions:
- VNS-associated OSA is a frequent complication in pediatric epilepsy patients.
- Systematic sleep evaluation is crucial for children undergoing VNS therapy.
- DISE is valuable, but VNS adjustment, especially overnight, is an effective management strategy.
- Timely OSA treatment can improve epilepsy outcomes and quality of life.
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.
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