Effect of Neuromodulation on Sleep in Patients with Epilepsy – Systematic Review and Meta-analysis
Abstract number :
2.04
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2022
Submission ID :
2204728
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Sihyeong Park, MD – University of Toledo; Vinh Pham, MD – Department of Neurology – University of Toledo; Ajaz Sheikh, MD – Department of Neurology – University of Toledo
Rationale: The objective of this study was to review the effect of vagus nervus stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS) on sleep in patients with epilepsy.
Methods: The PubMed and Embase databases were comprehensively assessed and searched for studies that focused on changes in sleep in patients with epilepsy who were treated with neuromodulation (Figure 1). Modalities of interest included in this study were VNS, DBS, and RNS. A random effects model was used to estimate pooled mean difference of the selected outcomes with 95 percent confidence intervals (CIs), and the study heterogeneity was analyzed.
Results: Five studies1-5 were identified with 107 post-VNS cases and 116 cases in the control group. Pooled mean difference of apnea hypopnea index (or respiratory event index) was 3.61 (95% CI=[0.50; 6.71], p-value=0.0322) (Figure 2). Three studies with total of 55 patients reported the percentage of REM sleep on polysomnography (PSG) performed pre- and post-VNS. Pooled mean difference of REM sleep percentage was 1.58 (95% CI=[-20.48; 13.36], p-value=0.4610). Three studies with total of 55 patients reported the percentage of N3 sleep on PSG obtained pre- and post-VNS. Pooled mean difference of N3 sleep percentage was 1.58 (95% CI=[ −1.76; 4.92], p-value=0.1783). Two studies compared total sleep time pre- and post-VNS, and there was no statistically significant difference. Same studies compared sleep latency, one of which showed that there was no difference, while the other study reported that a significant decrease in sleep latency was observed after the initiation of VNS therapy. One retrospective study6 assessed quality of sleep using ten-point response scale. There was no significant difference in sleep quality after DBS implantation. Another study demonstrated that arousals occurred 3.3 times more frequently during DBS stimulation period compared to nonstimulation period.7 There was one study that evaluated for the effect of RNS on sleep after implantation. Their observation was that the arousals consistently preceded stimulations,8 suggesting that the sleep disruption is not directly caused by responsive neurostimulation.
Conclusions: Our systematic review shows that implantation of VNS is associated with increased apnea-hypopnea index. This is in accordance with what has been reported previously. Mean differences in N3 sleep percentage and REM sleep percentage were not statistically significant. Further high quality studies are needed on DBS and especially RNS, which was more recently introduced. However, it is imperative that the sleep-related breathing disorders are addressed before neuromodulation can be considered for treatment of epilepsy.
Funding: None
Neurophysiology