抗癫痫药物对睡眠结构的影响：一项初步研究。

Effects of antiepileptic drugs on sleep architecture: a pilot study.

作者信息

Legros Benjamin, Bazil Carl W

机构信息

Comprehensive Epilepsy Center, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.

出版信息

Sleep Med. 2003 Jan;4(1):51-5. doi: 10.1016/s1389-9457(02)00217-4.

DOI:10.1016/s1389-9457(02)00217-4

PMID:14592360

Abstract

OBJECTIVES

The effects of antiepileptic drugs (AEDs) on sleep architecture are not well understood, especially in patients with localization-related epilepsy, in whom seizures themselves can disrupt sleep. To clarify the effects of AEDs on sleep architecture, we performed a prospective study, looking at sleep architecture in patients with epilepsy admitted for video-EEG monitoring.

METHODS

Adult patients with localization-related epilepsy treated with a single AED and admitted between 10/1997 and 04/2001 were included. Control patients on no AEDs were also included. Both groups were withdrawn from other AEDs. Overnight polysomnography was recorded and was scored according to the standard method. Adult patients with localization-related epilepsy on no medication were also recorded and served as controls. Patients with no seizure during the recording and no seizure in the 24 h preceding the recording were analyzed in this paper. Patients with a seizure in the 24 h preceding the recording and patients with a seizure during the recording were analyzed separately.

RESULTS

A total of 72 nights were recorded in 39 patients, and patients taking each AED were compared to controls. We did not find any statistically significant effect of carbamazepine (CBZ). Phenytoin (PHT) disrupted sleep by increasing stage 1 sleep (PHT: 13.2+/-7.3%; control: 7.7+/-4.8%; P=0.008), and decreasing slow wave sleep (SWS) (PHT: 7.9+/-4.2%; control: 11.3+/-4.4%; P=0.03) and REM sleep (PHT: 13.9+/-6.2; control: 18.8+/-5.1; P=0.01). Valproic acid (VPA) disrupted sleep by increasing stage 1 sleep (VPA: 16.8+/-9.8%; control: 7.7+/-4.8%; P=0.007). Gabapentin (GBP) improved sleep by increasing SWS (GBP: 19.4+/-4.2%; control: 11.3+/-4.4%; P=0.0009). PHT and VPA disrupt sleep in the absence of seizures, while CBZ and lamotrigine have no significant effects. GBP improves sleep by increasing SWS.

CONCLUSIONS

AEDs have differing effects on sleep structure, which can be beneficial or detrimental. Consideration of these potential effects is important in maintaining optimal sleep in patients with epilepsy.

摘要

目的

抗癫痫药物（AEDs）对睡眠结构的影响尚未完全明确，尤其是在局灶性癫痫患者中，癫痫发作本身就会干扰睡眠。为阐明AEDs对睡眠结构的影响，我们进行了一项前瞻性研究，观察因视频脑电图监测而入院的癫痫患者的睡眠结构。

方法

纳入1997年10月至2001年4月期间接受单一AED治疗的局灶性癫痫成年患者。也纳入未服用AEDs的对照患者。两组均停用其他AEDs。记录整夜多导睡眠图，并按照标准方法进行评分。还记录了未服用药物的局灶性癫痫成年患者并作为对照。本文分析记录期间无癫痫发作且记录前24小时内无癫痫发作的患者。记录前24小时内有癫痫发作的患者和记录期间有癫痫发作的患者分别进行分析。

结果

39例患者共记录了72个夜晚，并将服用每种AED的患者与对照进行比较。我们未发现卡马西平（CBZ）有任何统计学上的显著影响。苯妥英（PHT）通过增加1期睡眠（PHT：13.2±7.3%；对照：7.7±4.8%；P = 0.008）、减少慢波睡眠（SWS）（PHT：7.9±4.2%；对照：11.3±4.4%；P = 0.03）和快速眼动睡眠（PHT：13.9±6.2；对照：18.8±5.1；P = 0.01）来干扰睡眠。丙戊酸（VPA）通过增加1期睡眠（VPA：16.8±9.8%；对照：7.7±4.8%；P = 0.007）来干扰睡眠。加巴喷丁（GBP）通过增加SWS（GBP：19.4±4.2%；对照：11.3±4.4%；P = 0.0009）来改善睡眠。PHT和VPA在无癫痫发作时干扰睡眠，而CBZ和拉莫三嗪无显著影响。GBP通过增加SWS来改善睡眠。