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Abstract Introduction Obstructive Sleep Apnea (OSA) is characterized by recurrent partial or complete blockage of the upper airway during sleep, leading to disruptions in breathing and intermittent oxygen desaturation, putting patients with epilepsy at risk for seizure exacerbations. However, literature about the development or progression of OSA in patients with a vagus nerve stimulator (VNS) refractory epilepsy is limited. Report of case(s) Case of a 42-year-old female with history of right lobe temporal epilepsy since childhood, temporal lobe surgery for epilepsy, currently on VNS who complained of snoring and daytime sleepiness. An Epworth Sleepiness Scale was obtained with a score of 18/24 (high). Physical examination revealed mallampati score of II, BMI: 24.62 kg/m², 139 lb weight, 14-inch neck circumference, and a STOP-Bang sleep score of 2/8 (low-risk). During the initial polysomnography (PSG), the patient exhibited mild to moderate OSA, with associated hypoxemia and disruption in sleep architecture, as reflected by the baseline apnea/hypopnea index (AHI) of 13.5/hr (normal: 5/hr). The REM AHI (AASM) was 12.3/hr, and the respiratory events and desaturation pattern exhibited an atypically periodic nature, occurring approximately every 3.6 minutes with fixed respiratory events lasting around 29-30 seconds. This periodicity was likely associated with the activation of the VNS implant. Conclusion To our knowledge, this case is novel and important in raising awareness of screening for sleep-related disorders, given the limited research about VNS leading to such manifestations. What is significant about this case is that routine tools typically used did not provide sufficient clarity for diagnosing this patient. Instead, a thorough evaluation was required where there are no clear guidelines to evaluate possible VNS-induced sleep-related disorders. The mechanisms involved are complex and diverse. Some proposed causes include respiratory disturbances with changes in airflow, primarily attributable to vocal cord paresis, supraglottic spasm, laryngeal muscle stimulation, or alterations to the brainstem's respiratory center and relay of information, among other possible mechanisms. Further studies are necessary to understand these manifestations, especially in underserved regions like the Puerto Rican and Hispanic populations, where access to sleep studies and research is limited. Support (if any)
Cardona-Quiñones et al. (Sat,) studied this question.