Nayak Chetan S, Sinha Sanjib, Nagappa Madhu, Kandavel Thennarasu, Taly Arun B
Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Department of Clinical Neurosciences, NIMHANS, Bangalore, India.
Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
Sleep Med. 2016 Jan;17:129-33. doi: 10.1016/j.sleep.2015.11.006. Epub 2015 Dec 2.
Studies looking at the effect of anti-epileptic medications on sleep microstructure of patients with epilepsy are almost non-existent. The aim of this study was to compare sleep microstructural characteristics of drug-naïve juvenile myoclonic epilepsy (JME) patients with those on valproate (VPA) monotherapy.
Three age- (p = 0.287) and gender- (p = 0.766) matched groups (N = 20 in each group): (1) drug-naïve JME (mean age: 21.2 ± 4.06 years; M : F = 9:11); (2) JME on VPA (mean age: 21.85 ± 4.28 years; M : F = 11:9); (3) healthy controls (mean age: 23.2 ± 3.82 years; M : F = 9:11) underwent overnight polysomnography. Scoring and analysis of arousals American Sleep Disorders Association (ASDA, 2002), cyclic alternating pattern (CAP) (Terzano et al., 2002) parameters were performed. Comparison of arousal and CAP parameters was performed using one-way ANOVA, followed by pairwise comparisons using Fisher's LSD test (p ≤ 0.05).
Rapid eye movement (REM) arousal indices were higher in JME patients (Group 1 [p = 0.002] and Group 2 [p <0.001]), whereas the overall and NREM arousal indices were comparable between the three groups. CAP rate was higher in JME patients as compared to controls (p <0.001). Duration of phase A and its subtypes (p <0.001) was reduced in drug-naïve patients as compared to VPA group and controls. Finally, percentage of phase A1 (p = 0.003) was decreased and A3 (p = 0.045) was increased in drug-naïve patients as compared to VPA group and controls.
We found significant alterations in REM arousal indices and several CAP parameters in JME patients. However, many of these alterations were not seen in the valproate group. This might indicate that anti-epileptic medications such as valproate may beneficially modulate arousal instability in JME patients, and hence promote sleep quality and continuity.
几乎不存在关于抗癫痫药物对癫痫患者睡眠微观结构影响的研究。本研究旨在比较初治青少年肌阵挛性癫痫（JME）患者与接受丙戊酸盐（VPA）单药治疗患者的睡眠微观结构特征。
三个年龄（p = 0.287）和性别（p = 0.766）匹配的组（每组N = 20）：（1）初治JME患者（平均年龄：21.2 ± 4.06岁；男∶女 = 9∶11）；（2）接受VPA治疗的JME患者（平均年龄：21.85 ± 4.28岁；男∶女 = 11∶9）；（3）健康对照者（平均年龄：23.2 ± 3.82岁；男∶女 = 9∶11）进行整夜多导睡眠图监测。按照美国睡眠障碍协会（ASDA，2002）标准对觉醒进行评分和分析，并进行周期性交替模式（CAP）（Terzano等人，2002）参数分析。使用单因素方差分析对觉醒和CAP参数进行比较，随后使用Fisher最小显著差异检验进行两两比较（p≤0.05）。
JME患者（第1组[p = 0.002]和第2组[p <0.001]）的快速眼动（REM）觉醒指数较高，而三组之间的总体和非快速眼动觉醒指数相当。与对照组相比，JME患者的CAP率较高（p <0.001）。与VPA组和对照组相比，初治患者的A期及其亚型的持续时间缩短（p <0.001）。最后，与VPA组和对照组相比，初治患者的A1期百分比降低（p = 0.003），A3期百分比升高（p = 0.045）。
我们发现JME患者的REM觉醒指数和几个CAP参数有显著改变。然而，这些改变在丙戊酸盐组中并未出现。这可能表明丙戊酸盐等抗癫痫药物可能有益地调节JME患者的觉醒不稳定性，从而提高睡眠质量和连续性。
