Kaleyias Joseph, Kothare Sanjeev V, Pelkey Maryann, Harrison Geoffrey, Legido Agustin, Khurana Divya S
Division of Neurology, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Erie Avenue at Front Street, Philadelphia, PA 19134, USA.
Clin Neurophysiol. 2006 Jul;117(7):1582-4. doi: 10.1016/j.clinph.2006.04.006. Epub 2006 Jun 8.
Interictal epileptiform discharges are often enhanced with attainment of sleep during an EEG. Hyperventilation (HV) during an EEG is often followed by drowsiness. However, the effect of intermittent photic stimulation (IPS) on awake/sleep state is unclear. The current study was conducted to determine if the sequence of activation procedures has an impact on acquisition of sleep during a routine, non-sleep deprived EEG.
Children, scheduled between 9 and 11 a.m., who were not sleep deprived and able to hyperventilate, were included in a 3-month prospective study undertaken at the Neurophysiology Laboratory of a tertiary children's hospital. In the first 48 children evaluated, IPS was started 5 min into the EEG recording and HV was elicited at the end of the session (group I). In the next 48 children, HV was started 5 min into the EEG recording and IPS was presented at the end of the EEG (group II). A third group served as a control group and received both activating procedures at the end of the recording (group III). All 3 groups were assessed for the presence or absence of sleep during their EEG recording.
Only 3 of the 48 (6.2%) children in group I versus 17/48 (35.5%) in group II (P<0.0001), OR=8.68, 95% CI 2.34-32.22) and 11/48 (23%) in group III (P<0.05) attained sleep. The difference between the 3 groups was statistically significant (P=0.02). The children who were hyperventilated at the beginning of the session had an 8-fold increased chance of attaining sleep in comparison with children who received IPS at the beginning of the recording followed by HV at the end.
We recommend that when performing routine non-sleep deprived EEGs in children, HV be performed first with IPS at the end of the EEG in order to maximize the yield of attaining sleep recording during the study.
脑电图（EEG）检查期间，发作间期癫痫样放电常随着睡眠状态的出现而增强。EEG检查期间进行过度换气（HV）后常出现嗜睡。然而，间歇性光刺激（IPS）对清醒/睡眠状态的影响尚不清楚。本研究旨在确定在常规、非剥夺睡眠的EEG检查中，激活程序的顺序是否会对睡眠的诱导产生影响。
纳入一家三级儿童医院神经生理学实验室进行的为期3个月的前瞻性研究，研究对象为上午9点至11点安排检查、未被剥夺睡眠且能够进行过度换气的儿童。在最初评估的48名儿童中，IPS在EEG记录开始5分钟后开始，HV在检查结束时进行（第一组）。在接下来的48名儿童中，HV在EEG记录开始5分钟后开始，IPS在EEG检查结束时进行（第二组）。第三组作为对照组，在记录结束时接受两种激活程序（第三组）。所有三组在EEG记录期间均评估是否出现睡眠。
第一组48名儿童中只有3名（6.2%）入睡，第二组为17/48（35.5%）（P<0.0001，OR=8.68，95%CI 2.34 - 32.22），第三组为11/48（23%）（P<0.05）。三组之间的差异具有统计学意义（P=0.02）。与在记录开始时接受IPS随后在结束时接受HV的儿童相比，在检查开始时进行过度换气的儿童入睡几率增加了8倍。
我们建议，在对儿童进行常规非剥夺睡眠的EEG检查时，应先进行HV，然后在EEG检查结束时进行IPS，以便在研究期间最大限度地提高获得睡眠记录的成功率。
