Salvadé Aude, Ryvlin Philippe, Rossetti Andrea O
Service de neurologie, Département des neurosciences cliniques, CHUV, Lausanne, Switzerland; University of Lausanne, Lausanne, Switzerland.
Service de neurologie, Département des neurosciences cliniques, CHUV, Lausanne, Switzerland; University of Lausanne, Lausanne, Switzerland.
Epilepsy Behav. 2018 Feb;79:126-129. doi: 10.1016/j.yebeh.2017.10.040. Epub 2017 Dec 26.
Vagus nerve stimulation (VNS) can induce a sleep apnea syndrome (SAS), which in turn can worsen seizure control and represents a cardiovascular risk factor. Epidemiology of VNS-induced SAS has received little attention to date. The purpose of this study was to estimate the VNS-induced SAS prevalence and to explore clinical variables potentially correlating with its development.
We analyzed the computerized medical records of 18 consecutive adults treated for refractory epilepsy with VNS, implanted between May 2008 and October 2015. Patients underwent sleep polygraphy or polysomnography before and after VNS implantation. Between patients with and without SAS, we compared variables related to epilepsy type and device parameters.
Two patients had SAS and were treated before implantation; one improved after VNS, the other worsened. Four other patients developed SAS after VNS: induced/aggravated SAS occurred in 5/18 patients (prevalence: 27.8%). Only 2 of them had symptoms: one complained of important snoring, the other reported seizure worsening. All 5 patients were successfully treated by combinations of continuous positive airway pressure (cPAP), positional therapy, or VNS parameters modification. There was no statistically significant difference between potential predictors.
Despite the relatively modest clinical impact on epilepsy, in view of the associated cardiovascular risk factor development, easy treatment, and the relatively high SAS prevalence, routine screening for SAS before and after VNS implantation may represent a reasonable practice.
迷走神经刺激（VNS）可诱发睡眠呼吸暂停综合征（SAS），这反过来会使癫痫控制恶化，并代表一种心血管危险因素。迄今为止，VNS诱发的SAS的流行病学很少受到关注。本研究的目的是估计VNS诱发的SAS的患病率，并探索与其发生可能相关的临床变量。
我们分析了2008年5月至2015年10月期间连续18例接受VNS治疗难治性癫痫的成年患者的计算机化病历。患者在VNS植入前后接受睡眠多导图或多导睡眠图检查。在有和没有SAS的患者之间，我们比较了与癫痫类型和设备参数相关的变量。
两名患者在植入前就患有SAS并接受了治疗；一名患者在VNS治疗后病情改善，另一名患者病情恶化。另外四名患者在VNS治疗后出现了SAS：5/18例患者发生了诱发/加重的SAS（患病率：27.8%）。其中只有2例有症状：一名患者抱怨严重打鼾，另一名患者报告癫痫发作恶化。所有5例患者均通过持续气道正压通气（cPAP）、体位治疗或VNS参数调整成功治疗。潜在预测因素之间没有统计学上的显著差异。
尽管对癫痫的临床影响相对较小，但鉴于相关心血管危险因素的发展、易于治疗以及SAS患病率相对较高，在VNS植入前后对SAS进行常规筛查可能是一种合理的做法。
