Billakota Santoshi, Odom Nicole, Westwood Andrew J, Hanna Eric, Pack Alison M, Bateman Lisa M
Comprehensive Epilepsy and Sleep Center, Department of Neurology, Columbia University Medical Center New York, NY, United States.
Comprehensive Epilepsy and Sleep Center, Department of Neurology, Columbia University Medical Center New York, NY, United States; Pinehurst Neurology, P.A., Pinehurst, NC, United States.
Epilepsy Behav. 2018 Oct;87:78-82. doi: 10.1016/j.yebeh.2018.07.011. Epub 2018 Aug 31.
Sudden unexpected death in epilepsy (SUDEP) is a major contributor to epilepsy-related mortality. It is associated with nocturnal seizures and centrally mediated postictal cardiorespiratory dysfunction (CRD), but mechanisms and contributors remain poorly understood.
We performed a prospective, cross-sectional, observational pilot study in the Columbia University Medical Center (CUMC) adult epilepsy monitoring unit (EMU) to explore relationships between periictal CRD, sleep-disordered breathing (SDB), neuroendocrine function, and clinical SUDEP risk. Thirty patients (twenty women, ten men) underwent video-electroencephalogram (EEG) with electrocardiogram (EKG) and digital pulse oximetry, inpatient or outpatient polysomnography (PSG), and comprehensive laboratory evaluation of sex steroid hormones. Sudden unexpected death in epilepsy risk was defined as Low (0-2) or High (≥3) using the revised SUDEP-7 Inventory. Sleep-disordered breathing was defined using standard criteria. Neuroendocrine dysfunction was defined as ≥1 laboratory abnormality.
Cardiorespiratory dysfunction occurred more frequently in high-risk patients (60% vs. 27%, p = 0.018). Endocrine dysfunction was seen in 35% of patients, more in men (p = 0.018). Sleep-disordered breathing was found in 88% of fully scoreable PSGs.
There was no significant relationship between CRD, SDB, and neuroendocrine status, though all PSGs in those with high SUDEP risk or neuroendocrine dysfunction revealed SDB. Larger studies are needed to further elucidate relationships between CRD, SDB, neuroendocrine factors, and SUDEP.
癫痫猝死（SUDEP）是癫痫相关死亡的主要原因。它与夜间发作以及中枢介导的发作后心肺功能障碍（CRD）有关，但相关机制和影响因素仍知之甚少。
我们在哥伦比亚大学医学中心（CUMC）成人癫痫监测单元（EMU）进行了一项前瞻性、横断面观察性试点研究，以探讨发作期CRD、睡眠呼吸紊乱（SDB）、神经内分泌功能与临床SUDEP风险之间的关系。30例患者（20名女性，10名男性）接受了视频脑电图（EEG）检查，并同步记录心电图（EKG）和数字脉搏血氧饱和度，进行住院或门诊多导睡眠图（PSG）检查，以及对性甾体激素进行综合实验室评估。使用修订后的SUDEP-7量表将癫痫猝死风险定义为低风险（0-2）或高风险（≥3）。睡眠呼吸紊乱根据标准标准进行定义。神经内分泌功能障碍定义为≥1项实验室异常。
高风险患者中心肺功能障碍更为常见（60%对27%，p = 0.018）。35%的患者存在内分泌功能障碍，男性更为多见（p = 0.018）。在88%可完全评分的PSG中发现了睡眠呼吸紊乱。
CRD、SDB和神经内分泌状态之间无显著关系，尽管SUDEP高风险或神经内分泌功能障碍患者的所有PSG均显示存在SDB。需要更大规模的研究来进一步阐明CRD、SDB、神经内分泌因素与SUDEP之间的关系。
