0875 Sleep Disordered Breathing and Sleep Architecture in Children with Vagal Nerve Stimulation

Abstract Introduction This study aimed to characterize the effects of vagus nerve stimulation (VNS) on sleep architecture and sleep-disordered breathing using polysomnography (PSG) in children with drug-resistant epilepsy (DRE). Methods This was a retrospective study involving children with DRE/VNS who underwent PSG. We assessed the PSG differences between children with VNS/DRE and age, gender, BMI, and AHI-matched children without epilepsy. Obstructive sleep apnea (OSA) severity was categorized by obstructive apnea-hypopnea index as normal ( 1 event/hr), mild (1–4.9 events/h), moderate (5–9.9 events/h), or severe (≥ 10 events/h). Demographic data, VNS characteristics, sleep architecture, and distribution of respiratory events across sleep stages and body positions were collected and compared with matched-controls. Results Data from 28 children with VNS and 28 matched-controls were analyzed. In both groups, the median age was 12 years, 57.1% were female, and the BMI z-score was 1.1. Median AHI was 3.1 in the VNS group and 2.6 in the control group. The median age at VNS insertion was 7.5 years. The M106 was the most frequently used device model (51.9%). Among children with VNS, OSA was common: 28.6% had mild, 14.3% had moderate, and 21.4% had severe OSA. The VNS group spent less time in N1 sleep 3.8 (1.5–20.5) vs. 14.5 (8.5–25.5) minutes, p=0.017, more time in N2 sleep 270.0 (194.3–319.1) vs. 230.5 (183.5–238.7) minutes, p=0.039, and less time in REM sleep 42.0 (12.3–72.8) vs. 70.3 (56.5–89.8) minutes, p=0.006. The overall maximum CO₂ level was slightly higher in the control group 50.0 (49.0–51.5) vs. 48.0 (44.0–50.5) mmHg, p = 0.041. None of the VNS stimulation parameters correlated with AHI, and there were no significant differences between groups in the distribution of respiratory events across sleep stages or body positions. Conclusion Our findings suggest that VNS in children with DRE is associated with meaningful alterations in sleep architecture and a high burden of sleep-disordered breathing, underscoring the importance of routine screening for OSA in this population. Incorporating formal sleep evaluations into the care of children receiving VNS may help identify treatable contributors to morbidity and optimize overall clinical outcomes. Support (if any)