Need for a standardized technique of nap EEG recordings: results of a national online survey in Italy

Abstract

The aim of this study is to report current clinical practice for sleep induction in Italian epilepsy centers. We administered an online-structured survey between March and November 2017 and collected data from pediatric and adult neurophysiologists belonging to 73 epilepsy centers. The preferred time for EEG recording is variable, depending on daily schedule of each laboratory. To facilitate spontaneous sleep during nap EEGs, almost all centers require sleep deprivation before the examination, with partial loss preferred to total deprivation in most centers (58/73 vs 12/73, p < 0.001). Other non-pharmacological procedures include breast/bottle feeding or listening to music (encouraged in most centers). Pharmacological sleep induction is performed in 40% of laboratories, more commonly in children than in adults (27/60 vs 7/42, p = 0.003). Melatonin is the most frequently prescribed drug to facilitate spontaneous sleep (one third of participating centers). Our study highlights the great heterogeneity among Italian epilepsy centers in current clinical practice for sleep EEG recordings. Expert consensus for sleep induction procedure is warranted.

Melatonin versus Sleep Deprivation for Sleep Induction in Nap Electroencephalography: Protocol for a Prospective Randomized Crossover Trial in Children and Young Adults with Epilepsy

“…Despite the necessity of attaining sleep during EEG recordings, there are to date no guidelines or recommendations addressing strategies for sleep induction [ 5 ]. The clinical practice among neurophysiology centers worldwide is substantially disparate both in terms of methods and applications [ 8 ].…”

“…Hence, more rigorous studies are needed to gather conclusions and inform clinical practice in the field. In a quite recent survey conducted in neurophysiology centers in Italy [ 5 ], it emerged that the most common strategies for sleep induction are represented by sleep deprivation and melatonin administration. In this context, our study protocol was designed to compare these two methods in a specific subset of pediatric epileptic outpatients.…”

“…As routine nap EEGs are mainly performed during daytime hours, sleep is usually achieved either by sleep deprivation or pharmacological agents [ 4 , 5 ]. Sleep deprivation is usually partial, but it can be extremely burdensome for patients and families, especially in children with neurodevelopmental disorders or behavioral problems [ 6 ].…”

“…In a quite recent survey aiming at describing the strategies adopted in everyday clinical practice for sleep induction in different pediatric and adult epilepsy centers in Italy, it emerged that melatonin is the most commonly used drug for sleep induction [ 5 ]. However, there is no consensus on the timing and doses of melatonin to be administered for EEG recordings.…”