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Volume 15 No. 10
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Accepted Papers

Case Reports

Case of an In-Laboratory Vagal Nerve Stimulator Titration for Vagal Nerve Stimulator-Induced Pediatric Obstructive Sleep Apnea

Jeremy H.M. Chan, MD1; James W. Owens, MD, PhD1; Joanna E. Wrede, MD1,2
1Division of Neurology, Seattle Children’s Hospital, Seattle, Washington; 2Division of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, Seattle, Washington

We present the case of a 12-year-old girl with medically refractory epilepsy and a vagal nerve stimulator (VNS), who experienced severe obstructive sleep apnea (OSA) with respiratory events closely matching her VNS settings. We demonstrated a real-time decrease in OSA through an in-laboratory VNS titration study, decreasing her VNS frequency from 20 Hz to 10 Hz. We were able to demonstrate a baseline level of OSA by turning off the VNS. We then effectively treated her residual OSA with continuous positive airway pressure (CPAP). Novel to our case is that this in-laboratory VNS titration did not result in any subsequent increase in seizure frequency. After 5 months, her seizure frequency had decreased. Our case demonstrates that in-laboratory VNS titration can be an efficient tool for optimizing treatment of VNS-induced OSA and assert that polysomnography before VNS placement is important for guiding future care.


Chan J, Owens JW, Wrede JE. Case of an in-laboratory vagal nerve stimulator titration for vagal nerve stimulator-induced pediatric obstructive sleep apnea. J Clin Sleep Med. 2019;15(10):1539–1542.

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