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From the Michael S. Aldrich Sleep Disorders Laboratory and the Epilepsy Program, Clinical Neurophysiology Section, Department of Neurology, University of Michigan Medical School, Ann Arbor.
Address correspondence and reprint requests to Dr. Beth A. Malow, Michael S. Aldrich Sleep Disorders Laboratory, UH Room 8D-8702, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0117; e-mail: bmalow{at}umich.edu
Background: — Given that vagal afferents project to brainstem regions that promote alertness, the authors tested the hypothesis that vagus nerve stimulation (VNS) would improve daytime sleepiness in patients with epilepsy.
Methods: — Sixteen subjects with medically refractory seizures underwent polysomnography and multiple sleep latency tests (MSLT) and completed the Epworth Sleepiness Scale (ESS), a measure of subjective daytime sleepiness, before and after 3 months of VNS. Most subjects (>80%) were maintained on constant doses of antiepileptic medications.
Results: — In the 15 subjects who completed baseline and treatment MSLT, the mean sleep latency (MSL) improved from 6.4 ± 4.1 minutes to 9.8 ± 5.8 minutes (± SD; p = 0.033), indicating reduced daytime sleepiness. All subjects with stimulus intensities of 
1.5 mA showed improved MSL. In the 16 subjects who completed baseline and treatment ESS, the mean ESS score decreased from 7.2 ± 4.4 to 5.6 ± 4.5 points (p = 0.049). Improvements in MSLT and ESS were not correlated with reduction in seizure frequency. Sleep-onset REM periods occurred more frequently in treatment naps as compared to baseline naps (p < 0.008; Cochran-Mantel-Haenszel test). The amount of REM sleep or other sleep stages recorded on overnight polysomnography did not change with VNS treatment.
Conclusions: — Treatment with VNS at low stimulus intensities improves daytime sleepiness, even in subjects without reductions in seizure frequency. Daytime REM sleep is enhanced with VNS. These findings support the role of VNS in activating cholinergic and other brain regions that promote alertness.
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