Epilepsy and Obstructive Sleep Apnea

Höllinger, Peter; Khatami, Ramin; Gugger, Matthias; Heß, Christian; Bassetti, Claudio L.

doi:10.1159/000092306

Cited by 97 publications

(44 citation statements)

References 38 publications

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“…A maioria dos artigos revisados refere a SAOS como uma possível causa de refratariedade de CE, assim como alguns trabalhos sugerem controle de CE refratárias em pacientes com o referido transtorno ao utilizarem CPAP [1][2][3]7,14 Existe somente um trabalho que sugere uma relação inversa, ou seja, que CE e descargas interictais afetam controle da via aérea superior em pacientes predispostos levando a SAOS 8 . Há ainda outro estudo tipo relato de caso sobre a ocorrência de CE do lobo frontal em criança com SAOS prévia ao utilizar o CPAP 9 .…”

Section: Discussionunclassified

“…Höllinger et al (2006) 1 , apresentam uma revisão sobre a prevalência de SAOS em pacientes com epilepsia (PCE): 5 a 63%, sendo as mais altas naqueles com epilepsia farmacorresistente ou encaminhados a centro de Estudo do Sono, e as mais baixas, em amostras não selecionadas. Há também a particularidade dessa prevalência aumentar com a idade 1,3 . 4 , a síndrome da apneia obstrutiva do sono (SAOS) é caracterizada por episódios repetitivos de apneia completa ou parcial (hipopnéia) por obstrução das vias aéreas superiores que ocorre durante o sono.…”

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“…Verifica-se relação importante entre SED e SAOS com refratariedade das CE. A SAOS normalmente é subdiagnosticada em pacientes do sexo masculino e mais velhos com epilepsia e com CE noturnas 1 . Além disso, muitas vezes a SAOS não é considerada como um possível fator da cadeia causal de algumas doenças como demência, AVC e epilepsia 18 8 .…”

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Relação da epilepsia com a síndrome de apneia obstrutiva do sono: revisão

Venturi

Valois

Pontes

et al. 2010

J. epilepsy clin. neurophysiol.

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RESUMOObjetivos: Avaliar principalmente a relação entre síndrome da apneia obstrutiva do sono (SAOS) e crises epilépticas (CE) Sono-2005. Resultados: Obtidos 19 artigos (um em alemão, excluído) sendo 1 artigo de revisão, 2 editoriais, 5 relatos de caso, 1 série de casos, 4 transversais, 1 ensaio clínico piloto, 2 longitudinais experimentais sem controle, 1 longitudinal/avaliação polissonográfica em dois momentos, 1 de acurácia. Conclusão: A SAOS é subnotificada na população epiléptica farmacorresistente e nos pacientes com sonolência excessiva diurna (pode ser consequência da SAOS) bem como nos que serão submetidos a estimulação do nervo vago (pode exacerbar SAOS em pacientes com SAOS pré-existente) para fim de controle de CE. Os dados dessa revisão levantam a hipótese da relação importante entre SAOS e CE, pois alguns estudos sugerem a relação mútua entre os dois fatores, apesar de não haver significância estatística. Existe uma relação inversa em um relato de caso de lobectomia frontal esquerda com resolução de CE e da apneia, levando a sugestão de que descargas epilépticas interictais extensas bem como a CE em si no sono pudessem alterar o controle das vias aéreas superiores. A revisão estabelece também a necessidade da realização de novos estudos com análise multivariada e, idealmente, prospectivos e com controles, com amostra maior, observacionais ou de intervenção, com continuous positive airway pressure (CPAP) para a conclusão mais fundamentada metodologicamente.Unitermos: Apneia obstrutiva do sono, epilepsia, sonolência excessiva diurna. ABSTRACTThe relation between epilepsy and obstructive sleep apnea syndrome: Review Objectives: Mainly to evaluate the relationship between obstructive sleep apnea (OSA) and seizure.

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Section: Discussionunclassified

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Relação da epilepsia com a síndrome de apneia obstrutiva do sono: revisão

Venturi

Valois

Pontes

et al. 2010

J. epilepsy clin. neurophysiol.

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“…[1][2][3][4][5] Polysomnogram studies of patients with epilepsy have shown disrupted sleep with increased sleep onset latency, increased number of nocturnal awakenings, and altered sleep architecture. [6][7][8][9] Despite the increasing recognition of sleep disturbances as predictors of quality of life in these patients, 1,[10][11][12] insomnia in epilepsy has been poorly investigated.…”

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confidence: 99%

Insomnia and Epilepsy: A Questionnaire-Based Study

Vendrame

Yang

Jackson

et al. 2013

Journal of Clinical Sleep Medicine

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Study Objectives: Although disturbed sleep has been frequently reported in patients with seizures, little is known about insomnia and epilepsy. The aims of this study were (1) to analyze the prevalence and degree of insomnia in patients with epilepsy, (2) to examine the clinical features and correlates of insomnia in these patients, and (3) to evaluate the impact of poor sleep on their quality of life. Methods: One hundred-fi fty-two patients with epilepsy (mean age 46 years) completed the following questionnaires: Insomnia Severity Index, Pittsburgh Sleep Quality Index, Beck Depression Inventory-II, Quality of Life in Epilepsy Inventory-31. Patients with other known sleep disorders, including obstructive sleep apnea, were excluded from the study. Regression analysis was conducted for adjusting for age, years since epilepsy onset, number of antiepileptic drugs, comorbidities, and depression scores.Results: More than half of the participants (55%) suffered from insomnia and more than 70% were "poor sleepers." Insomnia and poor sleep quality were signifi cantly correlated with the number of antiepileptic medications and scores of depressive symptoms. After controlling for covariates, insomnia and poor sleep quality were signifi cant predictors of lower quality of life. Conclusion: These results suggest that insomnia and poor sleep are common in patients with epilepsy and may adversely impact quality of life. Further studies should examine whether improvements in sleep can improve seizure control and quality of life of these patients.

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“…25 Several studies have also shown an improvement of seizure control after treatment of concomitant OSA. 22,[26][27][28][29] In a recent pilot study in patients with refractory epilepsy and OSA, a receiving sham treatment became seizure-free. 27 Epilepsy and antiepileptic drugs may also aggravate OSA.…”

Section: Interaction Of Sleep and Seizuresmentioning

confidence: 99%

Epilepsy and Sleep Disorders

Walker¹,

Eriksson²

2011

US Neurology

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Throughout the ages, sleep has been considered akin to death; indeed, Homer referred to sleep as the 'brother of death'. However, the advent of electroecephalography (EEG) has expelled this misconception and sleep is now recognized as consisting of active brain states during which many biologic processes occur, such as synaptic plasticity and memory consolidation.1 Sleep can be broadly divided into rapid eye movement (REM) sleep and non-REM (NREM) sleep. These sleep states cycle over 90 minutes throughout the night. NREM can be subdivided into light (stages I/II) and deep (stages III/IV) sleep (see Figure 1). Temporal Association of Epilepsy with SleepPerhaps the best established relationship between epilepsy syndromes and sleep is in idiopathic generalized epilepsy syndromes, in which seizures occur shortly after waking. This is especially evident in the myoclonic jerks and tonic-clonic seizures in juvenile myoclonic epilepsy. 3 It is also striking that, in some people, seizures can occur exclusively at night, an observation mentioned in ancient texts. Indeed, Aristotle stated that "the beginning of this malady (epilepsy) takes place with many during sleep, and their subsequent habitual seizures occur in sleep, not in waking hours". 4 Later studies from the 19th and early 20th centuries determined that 20 % of patients with epilepsy have nocturnal seizures only. 5,6 Importantly, the occurrence of seizures predominantly during sleep is a characteristic of specific epilepsy syndromes. In particular, nocturnal seizures are typical of frontal lobe epilepsy, in which seizures usually cluster and can occur many times in a night. 7 Nocturnal seizures occur throughout all stages of NREM sleep and are distributed proportionately, so that they occur more frequently during light stages rather than deep stages (see Figure 2).Similarly, seizures in benign focal epilepsy with centrotemporal spikes (BECTS) show a predilection for sleep or drowsiness. 10 Although temporal lobe epilepsy does not show this diurnal variation, if temporal lobe seizures occur during the night, they are more likely to be secondary generalized. 7,9 Certain epileptic encephalopathies also show marked diurnal variation in seizure manifestation and electrographic activity. This is a particular feature of electrical status epilepticus during sleep (ESES), which is characterized by spike and wave discharges in 85-100% of NREM Table 1). 34 Nocturnal Frontal Lobe Epilepsy and Non-rapid Eye Movement Parasomnia Diagnosis and Differential DiagnosisNocturnal frontal lobe seizures can manifest as paroxysmal arousals, which consist of brief, sudden eye opening, head raising or sitting up in bed, a frightened expression and, sometimes, vocalization; or nocturnal paroxysmal dystonia, which involves dystonic posturing and hypermotor (complex motor) phenomena, and episodic nocturnal wanderings, which are longer in duration (one to three minutes), with associated stereotyped Figure 3). 41 Nevertheless, even with access to good-quality video-EEG telemetry, the d...

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Epilepsy and Obstructive Sleep Apnea

Cited by 97 publications

References 38 publications

Relação da epilepsia com a síndrome de apneia obstrutiva do sono: revisão

Relação da epilepsia com a síndrome de apneia obstrutiva do sono: revisão

Insomnia and Epilepsy: A Questionnaire-Based Study

Epilepsy and Sleep Disorders

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