Division of Neurology Hospital São Lucas PUCRS, Porto Alegre, RS, Brazil.
Epilepsia. 2012 Sep;53(9):1519-25. doi: 10.1111/j.1528-1167.2012.03558.x. Epub 2012 Jun 18.
The effect of etiology on the relationship between epilepsy and sleep during childhood has not been studied in detail. The aim of this study was to evaluate differences in sleep structure in drug-resistant epilepsies with different underlying causes.
We studied 31 patients with drug-resistant epilepsies with or without a structural lesion (lesional and nonlesional) and compared their sleep architecture with that of normal controls and with that of a group of children with benign epilepsy with rolandic spikes (BERS). Subjects underwent a single-night polysomnographic recording. Sleep recordings were scored according to the American Academy of Sleep Medicine (AASM) and cyclic alternating pattern (CAP) criteria.
Compared to normal controls, patients with drug-resistant epilepsy showed a significant reduction of time in bed, total sleep time, rapid eye movement (REM) sleep, sleep stage N3, and sleep efficiency, and a significant increase in wake after sleep onset. The lesional subgroup showed a reduction in total sleep time and sleep latency and an increase in REM latency and wake after sleep onset. No significant differences, however, were found comparing the lesional and nonlesional subgroups. When compared to BERS, patients with drug-resistant epilepsy showed a significant reduction in sleep stage N3, REM sleep, and sleep efficiency. Regarding CAP analysis, when compared to controls, the drug-resistant group had an increased A1% and a decreased A2%, with a decrease of A1 index in N3 and a global decrease of A2 and A3 indexes. The lesional subgroup showed a slight increase of A1% with a decrease of A1 index in N3 and a global decrease of A2 and A3 indexes. Drug-resistant epilepsy, compared to benign epilepsy showed an increase of CAP rate in N2 and of A1 index in N1 and N2 but not in N3; A2 and A3 indexes were similar in both, but patients with drug-resistant epilepsy showed a significant reduction of A3 index in N1.
Our findings suggest that the presence of structural cerebral abnormalities may play an important role in disrupting sleep architecture.
病因对儿童时期癫痫与睡眠之间关系的影响尚未得到详细研究。本研究旨在评估不同潜在病因的耐药性癫痫患者睡眠结构的差异。
我们研究了 31 例耐药性癫痫患者（有或无结构性病变[病变性和非病变性]），并将其睡眠结构与正常对照组和良性罗兰多癫痫伴棘波（BERS）患儿组进行比较。所有受试者均接受了一晩上的多导睡眠描记术。睡眠记录根据美国睡眠医学学会（AASM）和周期性交替模式（CAP）标准进行评分。
与正常对照组相比，耐药性癫痫患者的卧床时间、总睡眠时间、快速眼动（REM）睡眠、睡眠阶段 N3、睡眠效率明显减少，睡眠后觉醒时间明显增加。病变亚组的总睡眠时间和睡眠潜伏期减少，REM 潜伏期和睡眠后觉醒时间增加。然而，病变亚组和非病变亚组之间没有发现显著差异。与 BERS 相比，耐药性癫痫患者的睡眠阶段 N3、REM 睡眠和睡眠效率明显减少。关于 CAP 分析，与对照组相比，耐药组的 A1%增加，A2%减少，N3 中的 A1 指数减少，A2 和 A3 指数整体减少。病变亚组的 A1%略有增加，N3 中的 A1 指数减少，A2 和 A3 指数整体减少。与良性癫痫相比，耐药性癫痫的 N2 中 CAP 率增加，N1 和 N2 中 A1 指数增加，但 N3 中无增加；A2 和 A3 指数在两者中相似，但耐药性癫痫患者的 N1 中 A3 指数明显减少。
我们的发现表明，结构性脑异常的存在可能在破坏睡眠结构方面发挥重要作用。
