Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
J Clin Sleep Med. 2011 Aug 15;7(4):401-7. doi: 10.5664/JCSM.1204.
Intermittent vagus nerve stimulation can reduce the frequency of seizures in patients with refractory epilepsy. Stimulation of vagus nerve afferent fibers can also cause vocal cord dysfunction, laryngeal spasm, cough, dyspnea, nausea, and vomiting. Vagus nerve stimulation causes an increase in respiratory rate, decrease in respiratory amplitude, decrease in tidal volume, and decrease in oxygen saturation during periods of device activation. It usually does not cause an arousal, or a change in heart rate or blood pressure. Most patients have an increase in their apnea-hypopnea index (AHI). Patients with VNS can have central apneas, obstructive hypopneas, and obstructive apneas. These respiratory events can be reduced with changes in the vagus nerve stimulator operational parameters or with the use of CPAP. In summary, there are complex relationships between epilepsy and obstructive sleep apneas. In particular, patients with refractory epilepsy need assessment for undiagnosed and untreated obstructive sleep apnea before implantation of vagus nerve stimulator devices. Patients with vagus nerve stimulators often have an increase in apneic events after implantation, and these patients need screening for sleep apnea both before and after implantation.
间歇性迷走神经刺激可以减少耐药性癫痫患者的癫痫发作频率。刺激迷走神经传入纤维也可能导致声带功能障碍、喉痉挛、咳嗽、呼吸困难、恶心和呕吐。迷走神经刺激在设备激活期间会导致呼吸频率增加、呼吸幅度减小、潮气量减小和血氧饱和度降低。它通常不会引起觉醒，也不会改变心率或血压。大多数患者的呼吸暂停-低通气指数（AHI）增加。接受 VNS 的患者可能会出现中枢性呼吸暂停、阻塞性低通气和阻塞性呼吸暂停。这些呼吸事件可以通过改变迷走神经刺激器的操作参数或使用 CPAP 来减少。总之，癫痫和阻塞性睡眠呼吸暂停之间存在复杂的关系。特别是，在植入迷走神经刺激器装置之前，需要对耐药性癫痫患者进行未诊断和未经治疗的阻塞性睡眠呼吸暂停的评估。植入迷走神经刺激器后的患者常出现呼吸暂停事件增加，这些患者在植入前后都需要进行睡眠呼吸暂停筛查。
