Nunes Magda Lahorgue, Ferri Raffaele, Arzimanoglou Alexis, Curzi Lilia, Appel Carla C, Costa da Costa Jaderson
Division of Neurology Hospital São Lucas, School of Medicine, PUCRS, Porto Alegre RS, Brazil.
J Child Neurol. 2003 Nov;18(11):763-6. doi: 10.1177/08830738030180110601.
Although it is currently known that sleep can influence epilepsy and epilepsy can influence sleep organization, few data have been published on this mutual interaction concerning the pediatric population. The objective of this study was to verify the eventual presence of sleep alterations in children with partial refractory epilepsy. Seventeen patients with partial refractory epilepsy were submitted to whole-night polysomnography as part of their epilepsy investigation. Polysomnographic recordings were performed on a digital video-electroencephalography (EEG) system and consisted of the registration of EEG (24 channels), electro-oculogram, electromyogram, electrocardiogram, and nasal airflow and abdominal respiratory movements. Sleep stages were visually scored following standard criteria, and ictal events were classified according to the international classification of seizures. The patients were also subdivided into two subgroups based on the presence or absence of ictal episodes during the recording night. The results concerning sleep organization were compared with those obtained from a normal control group. The analysis of the sleep parameters showed a reduction of total time in bed and total sleep time in both subgroups of epileptic children; there was a higher number of stage shifts per hour in the control group than in both epileptic subgroups. The percentage of stage 2 shifts is significantly reduced in patients with epilepsy and seizures during the night and the percentage of stage 3 to 4 shifts is increased. Nonsignificant differences are evident for the number of awakenings per hour and the percentage of stage 1 shifts. The percentage of rapid eye movement (REM) sleep is reduced, and first REM latency is increased in both epileptic subgroups, compared with normal controls, without statistical significance. Nine of 17 patients had seizures during the polysomnographic recording; nocturnal ictal events occurred mostly during non-REM sleep stage 2. Our results show that patients with partial refractory epilepsies have only mild sleep structure abnormalities, and this can be considered as an effect of the epileptic syndrome per se or as a result of the chronic antiepilepsy drug treatment.
虽然目前已知睡眠可影响癫痫，癫痫也可影响睡眠结构，但关于儿童群体中这种相互作用的公开数据很少。本研究的目的是验证部分难治性癫痫患儿是否存在睡眠改变。17例部分难治性癫痫患者在癫痫检查过程中接受了全夜多导睡眠图监测。多导睡眠图记录在数字视频脑电图（EEG）系统上进行，包括EEG（24导）、眼电图、肌电图、心电图以及鼻气流和腹部呼吸运动的记录。睡眠阶段按照标准标准进行视觉评分，发作事件根据国际癫痫发作分类进行分类。根据记录当晚是否存在发作性事件，患者还被分为两个亚组。将睡眠结构的结果与正常对照组获得的结果进行比较。睡眠参数分析显示，癫痫患儿的两个亚组在床上的总时间和总睡眠时间均减少；对照组每小时的睡眠阶段转换次数高于两个癫痫亚组。夜间有癫痫发作的癫痫患者中，第2阶段转换的百分比显著降低，而第3至4阶段转换的百分比增加。每小时觉醒次数和第1阶段转换的百分比无明显差异。与正常对照组相比，两个癫痫亚组的快速眼动（REM）睡眠百分比降低，首次REM潜伏期延长，但无统计学意义。17例患者中有9例在多导睡眠图记录期间发作；夜间发作事件大多发生在非快速眼动睡眠第2阶段。我们的结果表明，部分难治性癫痫患者仅有轻度的睡眠结构异常，这可被视为癫痫综合征本身的影响或慢性抗癫痫药物治疗的结果。
