Mansukhani, Meghna P.

The treatment of epilepsy with vagus nerve stimulation can inadvertently cause obstructive and central sleep apnea (CSA). The mechanism for CSA seen in patients with a vagus nerve stimulator (VNS) is not fully known. We describe the case of a 13-year-old girl in whom VNS activation induced tachypnea and post-hyperventilation central apnea. Following adjustment of VNS settings, the post-hyperventilation CSA resolved. Polysomnography may assist with management when patients with epilepsy develop sleep disruption after VNS placement.

Obstructive and central sleep apnea have been associated with increased risk of adverse cardiovascular events and mortality. Sympathetic dysregulation occurring as a result of the respiratory disturbance is thought to play a role in this increased risk. Sleep apnea increases the risk of arrhythmias, myocardial ischemia/infarction, stroke, and heart failure, all of which may increase mortality risk. A higher incidence of nocturnal arrhythmias, cardiac ischemia, and sudden death has been noted in subjects with sleep-disordered breathing (SDB). In this review, the association between SDB and each of these conditions is discussed, as well as the potential mechanisms underlying these risks and the effects of treatment of SDB. Particular emphasis is placed on the relationship between SDB and nocturnal atrial and ventricular arrhythmias, myocardial ischemia/infarction and sudden death.