Macêdo Philippe Joaquim Oliveira Menezes, Oliveira Pedro Sudbrack de, Foldvary-Schaefer Nancy, Gomes Marleide da Mota
Department of Internal Medicine, Medical School: Federal University of Rio de Janeiro, Brazil.
Sleep Disorders and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland/OH, United States.
Epilepsy Res. 2017 Sep;135:158-167. doi: 10.1016/j.eplepsyres.2017.05.014. Epub 2017 Jun 3.
Insomnia is a common sleep complaint in the general population, and sleep loss may be a trigger for epileptic seizures.
To conduct a comprehensive review of the literature of insomnia symptoms and insomnia disorder, their prevalence and epilepsy-related risk factors in people with epilepsy (PWE).
A PUBMED search was performed for articles indexed to June 2016 involving human subjects, excluding papers in languages other than English, Spanish and Portuguese and case reports. Eligible studies were those using a clear definition of insomnia and reporting quantitative data on prevalence rates and risk factors. The search included the following terms: insomnia, sleep disorder(s), sleep disturbance(s) and sleep-wake in the title and abstract; and epilep* in the title. 425 papers were reviewed and 31 were selected for the final analysis (21 adult and 10 paediatric). Twenty-one studies used a control group. Two reviewer authors independently extracted all data and a third author resolved disagreements.
Most studies were hospital-based, cross-sectional and evaluated convenience samples representing highly select populations. Various insomnia inventories were used. Fourteen assessed insomnia (10 in adults, four, children), but only five as primary outcome (none in children). Four evaluated insomnia disorder based on international classification criteria (International Classification of Sleep Disorders - ICSD-2-in 3, and DSM-IV-TR, in 1). In adults, insomnia prevalence was 28.9-51% based on the Insomnia Severity Index ≥15 and 36-74.4% based on DSM-IV-TR or ICSD-2. The prevalence of insomnia in children was 13.1-31.5% using the Sleep Disturbance Scale for Children and 11% based on ICSD-2 diagnostic criteria. Compared to control groups, PWE usually had higher frequencies of insomnia symptoms and disorder. Insomnia was associated with greater impairment in quality of life and higher degree of depressive symptoms in several studies, and was inconsistently related to female gender, poor seizure control and antiepileptic drug polytherapy. In children, insomnia was associated with developmental delay, focal epilepsies and poor seizure control.
Insomnia symptoms and insomnia disorder are highly prevalent among PWE based on a limited number of studies with variable inclusion criteria and methodology. Excessive daytime sleepiness (EDS) was not found to be related to insomnia disorder or symptoms, and the exclusion of individuals with EDS may explain the higher frequencies of insomnia found in some studies. Additional investigations are needed given the potential impact of insomnia on seizure control, mood and QOL in PWE.
失眠是普通人群中常见的睡眠问题，而睡眠不足可能是癫痫发作的诱因。
全面综述癫痫患者（PWE）中失眠症状、失眠症及其患病率和癫痫相关危险因素的文献。
在PUBMED上搜索截至2016年6月索引的涉及人类受试者的文章，排除英语、西班牙语和葡萄牙语以外语言的论文以及病例报告。符合条件的研究是那些使用明确的失眠定义并报告患病率和危险因素定量数据的研究。搜索包括以下术语：标题和摘要中的失眠、睡眠障碍、睡眠干扰和睡眠-觉醒；以及标题中的“epilep*”。共审查了425篇论文，31篇被选入最终分析（21篇成人研究和10篇儿科研究）。21项研究使用了对照组。两位审阅作者独立提取所有数据，第三位作者解决分歧。
大多数研究是以医院为基础的横断面研究，评估的便利样本代表高度特定的人群。使用了各种失眠量表。14项研究评估了失眠（成人10项，儿童4项），但只有5项将其作为主要结局（儿童无）。4项根据国际分类标准评估失眠症（3项采用《国际睡眠障碍分类》第二版[ICSD - 2]，1项采用《精神疾病诊断与统计手册》第四版修订本[DSM - IV - TR]）。在成人中，根据失眠严重程度指数≥15，失眠患病率为28.9% - 51%；根据DSM - IV - TR或ICSD - 2，患病率为36% - 74.4%。使用儿童睡眠干扰量表，儿童失眠患病率为13.1% - 31.5%；根据ICSD - 2诊断标准，患病率为11%。与对照组相比，PWE的失眠症状和失眠症发生率通常更高。在多项研究中，失眠与生活质量受损程度更大和抑郁症状程度更高相关，并且与女性性别、癫痫控制不佳和抗癫痫药物联合治疗的关系不一致。在儿童中，失眠与发育迟缓、局灶性癫痫和癫痫控制不佳有关。
基于纳入标准和方法各异的有限数量研究，失眠症状和失眠症在PWE中高度普遍。未发现日间过度嗜睡（EDS）与失眠症或症状相关，排除有EDS的个体可能解释了一些研究中发现的较高失眠发生率。鉴于失眠对PWE的癫痫控制、情绪和生活质量可能产生的影响，需要进一步研究。
