Dinkelacker V
Neurology Department, Rothschild Foundation, 25, rue Manin, 75019 Paris, France; Sleep Medicine Center, Béclère Hospital, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; ARAMIS LAB, Brain and Spine institute (Institut du Cerveau et de la Moelle), 47, boulevard de l'Hôpital, 75013 Paris, France.
Rev Neurol (Paris). 2016 Jun-Jul;172(6-7):361-70. doi: 10.1016/j.neurol.2016.03.007. Epub 2016 Jun 22.
Drug-resistant epilepsy is a debilitating condition that warrants new therapeutic options. The last two decades have seen a growing interest in the relationship between epilepsy and obstructive sleep apnea syndrome (OSAS), which could ultimately yield non-pharmaceutical treatment strategies. Based on a Medline search of the literature, this review develops lines of evidence for a clinically significant role of OSAS in refractory epilepsy.
OSAS is a primary sleep disorder that could presumably lower the seizure threshold via mechanisms such as sleep fragmentation, oxygen desaturation and chronic sleep deprivation. In comparison to the general population, patients with epilepsy probably have a higher prevalence of OSAS (9-33 % overall; 13-16 % with moderate to severe OSAS). Several common risk factors for OSAS have proven to be significant in patients with epilepsy, notably advanced age, male gender and obesity. Moreover, certain specific conditions, such as refractory seizures, antiepileptic polytherapy and vagus nerve stimulation, appear to render these patients particularly vulnerable to OSAS. Prospective data regarding the efficacy of continuous positive airway pressure (CPAP) therapy for seizure control is scarce. However, there is compelling retrospective evidence that severe OSAS can exacerbate the seizure burden and that CPAP may yield a pronounced reduction in seizure frequency, excessive daytime somnolence and, potentially, cognitive complaints.
In the light of the severity of drug-resistant epilepsy and its impact on quality of life, our current knowledge justifies systematic questionnaire screening for OSAS and a low threshold for referral to sleep laboratory exploration. In the long run, a large prospective trial is needed to confirm the therapeutic interest of CPAP treatment for mild to moderate OSAS in patients with epilepsy.
OSAS is a significant comorbidity of drug-resistant epilepsy that has the potential to yield new treatment options for better seizure control.
耐药性癫痫是一种使人衰弱的疾病，需要新的治疗选择。在过去二十年中，人们对癫痫与阻塞性睡眠呼吸暂停综合征（OSAS）之间的关系越来越感兴趣，这最终可能产生非药物治疗策略。基于对医学文献数据库（Medline）的文献检索，本综述为OSAS在难治性癫痫中的临床重要作用提供了证据。
OSAS是一种原发性睡眠障碍，可能通过睡眠片段化、氧饱和度降低和慢性睡眠剥夺等机制降低癫痫发作阈值。与普通人群相比，癫痫患者中OSAS的患病率可能更高（总体为9%-33%；中重度OSAS为13%-16%）。已证明OSAS的几个常见危险因素在癫痫患者中具有重要意义，特别是高龄、男性和肥胖。此外，某些特定情况，如难治性癫痫发作、抗癫痫药物联合治疗和迷走神经刺激，似乎使这些患者特别容易患OSAS。关于持续气道正压通气（CPAP）治疗对癫痫控制疗效的前瞻性数据很少。然而，有令人信服的回顾性证据表明，严重OSAS会加重癫痫发作负担，CPAP可能会显著降低癫痫发作频率、过度日间嗜睡，并可能减轻认知症状。
鉴于耐药性癫痫的严重性及其对生活质量的影响，我们目前的知识支持对OSAS进行系统的问卷调查筛查，并降低转诊至睡眠实验室检查的阈值。从长远来看，需要进行一项大型前瞻性试验，以证实CPAP治疗对癫痫患者轻度至中度OSAS的治疗价值。
OSAS是耐药性癫痫的一种重要合并症，有可能产生新的治疗选择以更好地控制癫痫发作。
