Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, Washington.
Division of Neurology, Seattle Children's Hospital, Seattle, Washington.
J Clin Sleep Med. 2022 Aug 1;18(8):1973-1981. doi: 10.5664/jcsm.10050.
The vagal nerve stimulator (VNS) is a nonpharmacological treatment for refractory epilepsy. A side effect of the VNS is sleep-disordered breathing. The purpose of this study was to demonstrate how a surface electrode placed over the VNS lead can help distinguish whether sleep-disordered breathing is due to VNS discharge.
Seven pediatric patients (aged 7.7 ± 2.2 years) with a VNS underwent a polysomnogram with an additional surface electrode on the left anterolateral neck to detect VNS discharge. The VNS-associated apnea-hypopnea index was calculated by determining the number of hypopneas and apneas occurring during VNS discharge. We evaluated the veracity of the VNS electrode by comparing signal duration and total number to those expected by programmed settings. We compared these findings to chin electromyogram signal change.
Three patients had an obstructive pattern with VNS discharge, and 3 had an increase in respiratory rate without gas exchange abnormalities, including 1 with both patterns; 1 patient experienced no respiratory abnormalities. The mean obstructive apnea-hypopnea index was 8.2 ± 8.3 events/h. The mean VNS-associated apnea-hypopnea index was 4.8 ± 6.2 events/h and accounted for 46.9 ± 30.2% of the total obstructive apnea-hypopnea index. The additional electrode captured a statistically high percentage of expected discharges (94.7 ± 6.5%) compared to chin electromyogram (36.1 ± 35.8%; < .05).
We demonstrated that a surface electrode on the VNS lead can temporally coregister VNS discharges and enabled us to attribute sleep-disordered breathing to VNS stimulation in 4 patients. We propose that this sensor be standard procedure in patients with VNS undergoing polysomnogram.
Chan JHM, DelRosso LM, Ruth C, Wrede JE. A surface electrode adjacent to vagal nerve stimulator lead can aid in characterizing vagal nerve stimulator-mediated pediatric sleep-disordered breathing: a case series of 7 patients. 2022;18(8):1973-1981.
迷走神经刺激器（VNS）是治疗耐药性癫痫的非药物治疗方法。VNS 的副作用是睡眠呼吸障碍。本研究的目的是证明放置在 VNS 导联上的表面电极如何帮助区分睡眠呼吸障碍是否是由于 VNS 放电引起的。
7 名接受 VNS 的儿科患者（年龄 7.7 ± 2.2 岁）进行了多导睡眠图检查，并在左前外侧颈部放置了一个额外的表面电极以检测 VNS 放电。通过确定 VNS 放电期间发生的呼吸暂停和低通气次数来计算 VNS 相关的呼吸暂停-低通气指数。我们通过比较信号持续时间和总数与程控设置预期值来评估 VNS 电极的准确性。我们将这些发现与颏肌肌电图信号变化进行了比较。
3 名患者在 VNS 放电时出现阻塞性模式，3 名患者呼吸频率增加但无气体交换异常，包括 1 名患者同时存在两种模式；1 名患者无呼吸异常。平均阻塞性呼吸暂停-低通气指数为 8.2 ± 8.3 次/小时。平均 VNS 相关呼吸暂停-低通气指数为 4.8 ± 6.2 次/小时，占总阻塞性呼吸暂停-低通气指数的 46.9 ± 30.2%。与颏肌肌电图相比，附加电极捕获的预期放电比例统计上较高（94.7 ± 6.5%比 36.1 ± 35.8%；<.05）。
我们证明了 VNS 导联上的表面电极可以对 VNS 放电进行时间配准，并使我们能够在 4 名患者中将睡眠呼吸障碍归因于 VNS 刺激。我们建议在接受多导睡眠图检查的 VNS 患者中，将这种传感器作为标准程序。
Chan JHM、DelRosso LM、Ruth C、Wrede JE。VNS 导联旁的表面电极可帮助识别迷走神经刺激器介导的儿科睡眠呼吸障碍：7 例患者的病例系列研究。 2022；18（8）：1973-1981。
