Obstructive sleep apnea and sudden unexpected death in epilepsy in unselected patients with epilepsy: are they associated?

Phabphal, Kanitpong; Koonalintip, Prut; Sithinamsuwan, Pasiri; Wongsritrang, Krongthong; Amornpojnimman, Thanyalak; Ekpitakdamrong, Nichanan; Geater, Alan

doi:10.1007/s11325-021-02307-1

Cited by 8 publications

(2 citation statements)

References 30 publications

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“…Obstructive sleep apnea may be associated with sudden unexpected death in epilepsy patients (SUDEP) risk in patients with refractory epilepsy ( McCarter et al, 2018 ), although conflicting data exists ( Cheng, 2021 ; Phabphal et al, 2021 ). Lack of heart rate variability during sleep apneas in patients with TLE has been proposed as an indirect marker of SUDEP ( Nayak et al, 2017 ).…”

Section: Resultsmentioning

confidence: 99%

Sleep and Temporal Lobe Epilepsy – Associations, Mechanisms and Treatment Implications

Garg

Charlesworth

Shukla

2022

Front. Hum. Neurosci.

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In this systematic review, we aim to describe the association between temporal lobe epilepsy (TLE) and sleep, with bidirectional links in mechanisms and therapeutic aspects. Sleep stages may variably impact seizure occurrence, secondary generalization and the development, frequency and distribution of interictal epileptiform discharges. Conversely, epilepsy affects sleep micro- and macroarchitecture. TLE, the most frequent form of drug resistant epilepsy (DRE), shares an enduring relationship with sleep, with some intriguing potential mechanisms specific to anatomic localization, linking the two. Sleep characteristics of TLE may also inform localizing properties in persons with DRE, since seizures arising from the temporal lobe seem to be more common during wakefulness, compared to seizures of extratemporal origin. Polysomnographic studies indicate that persons with TLE may experience excessive daytime somnolence, disrupted sleep architecture, increased wake after sleep onset, frequent shifts in sleep stages, lower sleep efficiency, decreased rapid eye movement (REM) sleep, and possibly, increased incidence of sleep apnea. Limited literature suggests that effective epilepsy surgery may remedy many of these objective and subjective sleep-related concerns, via multipronged effects, apart from reduced seizure frequency. Additionally, sleep abnormalities also seem to influence memory, language and cognitive-executive function in both medically controlled and refractory TLE. Another aspect of the relationship pertains to anti-seizure medications (ASMs), which may contribute significantly to sleep characteristics and abnormalities in persons with TLE. Literature focused on specific aspects of TLE and sleep is limited, and heterogeneous. Future investigations are essential to understand the pathogenetic mechanisms linking sleep abnormalities on epilepsy outcomes in the important sub-population of TLE.

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Section: Resultsmentioning

confidence: 99%

Sleep and Temporal Lobe Epilepsy – Associations, Mechanisms and Treatment Implications

Garg

Charlesworth

Shukla

2022

Front. Hum. Neurosci.

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“…Patients with OSA experience disruption of the autonomic system during sleep (Adlakha and Shepard, 1998 ), which may be further imbalanced by seizures. While no direct correlation between OSA and SUDEP has been identified, higher revised SUDEP-7 scores [presence of seizures in the past 12 months—especially generalized tonic clonic seizures (GTCS), longer duration of epilepsy, increased number of ASMs, and lower IQ/more cognitive impairment]—are associated with probable SUDEP (Phabphal et al, 2021 ). OSA decreases the amount of time a person spends asleep each night, potentially leading to further sleep deprivation.…”

Section: Sleep Impairment Sleep-disordered Breathing (Sdb) and Epilepsymentioning

confidence: 99%

The role of sleep state and time of day in modulating breathing in epilepsy: implications for sudden unexpected death in epilepsy

Joyal

Kreitlow

Buchanan

2022

Front. Neural Circuits

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Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death among patients with refractory epilepsy. While the exact etiology of SUDEP is unknown, mounting evidence implicates respiratory dysfunction as a precipitating factor in cases of seizure-induced death. Dysregulation of breathing can occur in epilepsy patients during and after seizures as well as interictally, with many epilepsy patients exhibiting sleep-disordered breathing (SDB), such as obstructive sleep apnea (OSA). The majority of SUDEP cases occur during the night, with the victim found prone in or near a bed. As breathing is modulated in both a time-of-day and sleep state-dependent manner, it is relevant to examine the added burden of nocturnal seizures on respiratory function. This review explores the current state of understanding of the relationship between respiratory function, sleep state and time of day, and epilepsy. We highlight sleep as a particularly vulnerable period for individuals with epilepsy and press that this topic warrants further investigation in order to develop therapeutic interventions to mitigate the risk of SUDEP.

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Epilepsy and sleep

Mora-Muñóz

Grigg-Damberger

Foldvary‐Schaefer

2023

Encyclopedia of Sleep and Circadian Rhythms

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Obstructive sleep apnea and sudden unexpected death in epilepsy in unselected patients with epilepsy: are they associated?

Cited by 8 publications

References 30 publications

Sleep and Temporal Lobe Epilepsy – Associations, Mechanisms and Treatment Implications

Sleep and Temporal Lobe Epilepsy – Associations, Mechanisms and Treatment Implications

The role of sleep state and time of day in modulating breathing in epilepsy: implications for sudden unexpected death in epilepsy

Epilepsy and sleep

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