Sleep-related breathing disorder in children with vagal nerve stimulators

Pediatr Neurol. 2008 Feb;38(2):99-103. doi: 10.1016/j.pediatrneurol.2007.09.014.


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 apnea-hypopnea 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.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Body Mass Index
  • Child
  • Electric Stimulation Therapy / adverse effects*
  • Female
  • Humans
  • Male
  • Polysomnography
  • Retrospective Studies
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / etiology*
  • Sleep Apnea Syndromes / physiopathology
  • Sleep Apnea, Obstructive / etiology
  • Sleep Apnea, Obstructive / physiopathology
  • Vagus Nerve / physiology*