Spectrum of Polysomnographic Abnormalities in Children With Epilepsy

Kaleyias, Joseph; Cruz, Marcos; Goraya, Jatinder S.; Valencia, Ignacio; Khurana, Divya S.; Legido, Agustín; Kothare, Sanjeev V.

doi:10.1016/j.pediatrneurol.2008.06.002

Cited by 98 publications

(71 citation statements)

References 25 publications

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“…Sleep and sleep disorders have complex association and interactions with epilepsy. [25][26][27] Over 80% of children with epilepsy have snoring, apneas/hypopneas, and periodic limb movements, 28 and 30% of patient with drug resistant seizures have sleep apnea. 29 Malow et al studied the effect of treating OSA in 2 epileptic patients with VNS to determine if this decreased seizure activity in these patients.…”

Section: Question 5: Does Sleep Apnea Impact Seizure Control In Patiementioning

confidence: 99%

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

111

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Intermittent vagus nerve stimulation can reduce the frequency of seizures in patients with refractory epilepsy. Stimulation of vagus nerve afferent fi bers can also cause vocal cord dysfunction, laryngeal spasm, cough, dyspnea, nausea, and vomiting. Vagus nerve stimulation causes an increase in respiratory rate, decrease in respiratory amplitude, decrease in tidal volume, and decrease in oxygen saturation during periods of device activation. It usually does not cause an arousal, or a change in heart rate or blood pressure. Most patients have an increase in their apnea-hypopnea index (AHI). Patients with VNS can have central apneas, obstructive hypopneas, and obstructive apneas. These respiratory events can be reduced with changes in the vagus nerve stimulator operational parameters or with the use of CPAP. In summary, there are complex relationships between epilepsy and obstructive sleep apneas. In particular, patients with refractory epilepsy need assessment for undiagnosed and untreated obstructive sleep apnea before implantation of vagus nerve stimulator devices. Patients with vagus nerve stimulators often have an increase in apneic events after implantation, and these patients need screening for sleep apnea both before and after implantation. (VNS) to control refractory epilepsy in 1990. 1 Intermittent vagus nerve stimulation can reduce seizures by up to 50% in adult seizure patients and up to 90% in pediatric seizure patients. The FDA approved these devices for the treatment of refractory epilepsy in 1997 and for the treatment of refractory depression in 2005. VNS are currently under investigation for treatment of anxiety, obesity, bulimia, migraines, Alzheimer disease, chronic pain syndromes, obsessive-compulsive disorder, panic disorder, and posttraumatic stress disorder. 2 Vagus nerve stimulation can cause side effects involving the upper airway, lower respiratory tract, and upper gastrointestinal tract. These devices can decrease airfl ow, oxygen saturation, and respiratory amplitude during sleep. 3 Most patients with VNS have an increase in their apnea-hypopnea index (AHI) after implantation. 4 One-third of these patients develop mild obstructive sleep apnea post treatment, 4,5 and a minority of patients develop severe obstructive sleep apnea secondary to VNS therapy. 6 More than 50,000 patients have had VNS implants to date, and it is important for sleep medicine specialists to recognize the sleep disordered breathing and other respiratory complications related to VNS devices. We recently helped care for a patient who developed obstructive sleep apnea (OSA) after implantation of a VNS and then required discontinuation of the VNS. Our review of literature while attempting to answer some clinically relevant questions pertaining to this patient led to this review. This article focuses on six questions pertinent to the management of these patients and reviews the literature on sleep-related and respiratory complications associated with vagus nerve stimulators. mETHODSWe conducted a literature search with ...

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Section: Question 5: Does Sleep Apnea Impact Seizure Control In Patiementioning

confidence: 99%

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

111

View full text Add to dashboard Cite

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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. Some studies have focused on the impact of antiepileptic drugs (AEDs) on sleep quality.…”

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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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“…Several studies have reported that epilepsy and OSAS, when coexist, profoundly exacerbate each other's [16]. On the one hand, OSAS has been hypnotized to exacerbate seizure frequency by disrupting REM sleep [17], on the other hand, children with epilepsy report sleep deprivation as a significant seizures-precipitating factor and drug poor control.…”

Section: Discussionmentioning

confidence: 99%

Sleep Abnormalities and Sleep Breathing Disorders in Children with Drug- Resistant Catastrophic Epileptic Encephalopathy

Gaeta¹

2015

J Sleep Disord Ther

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Undiagnosed obstructive sleep apnoea is common in patients with medically refractory epilepsy. The aim of this study is to evaluate sleep alterations and the prevalence of Sleep Breathing Disorders (SBD) in a paediatric population with catastrophic epileptic encephalopathy. To diagnose SBD, polysomnography (PSG) was performed in eleven patients (nine males, two females), with ages ranging between 3 and 11 years old, with epileptic encephalopathy characterized by drug-resistant seizures, occurring both in sleeping and waking, mental retardation and cerebral palsy. All the patients presented alterations of the sleep architecture and were positive for SBD. In particular, seven patients presented a severe form of Obstructive Sleep Apnoea Syndrome (OSAS) with apnoea/ hypopnea index (AHI) greater than10/hr, two patients presented a moderate form with AHI between 5/hr and 10/hr, two patients presented a mild form with AHI lower than 4/hr. In conclusion, SBD and sleep disruption appeared to be in comorbidity with catastrophic epileptic encephalopathy. Their treatment might also have a positive impact in seizures control and quality of life.

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Spectrum of Polysomnographic Abnormalities in Children With Epilepsy

Cited by 98 publications

References 25 publications

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Insomnia and Epilepsy: A Questionnaire-Based Study

Sleep Abnormalities and Sleep Breathing Disorders in Children with Drug- Resistant Catastrophic Epileptic Encephalopathy

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