From the Stichting Epilepsie Instellingen Nederland (SEIN) (M.v.d.L., J.W.S., R.D.T.), Heemstede; Leiden University Medical Center (LUMC) (M.v.d.L., R.D.T.), Netherlands; GH Sergievsky Center and Department of Epidemiology (D.C.H.), Columbia University, New York, NY; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
Neurology. 2018 Oct 16;91(16):e1508-e1518. doi: 10.1212/WNL.0000000000006356. Epub 2018 Sep 21.
To estimate the incidence of sudden unexpected death in epilepsy (SUDEP) in people with intellectual disabilities in residential care settings and to ascertain the effects of nocturnal seizures and nocturnal supervision on SUDEP risk.
We conducted a nested case-control study reviewing records of all people who died at 2 residential care settings over 25 years. Four controls per case were selected from the same population, matched on age (±5 years) and residential unit. Nocturnal supervision was graded in 3 categories: (1) no supervision; (2) a listening device or a roommate or physical checks at least every 15 minutes; and (3) 2 of the following: a listening device, roommate, additional device (bed motion sensor/video monitoring), or physical checks every 15 minutes. Outcome measures were compared using Mann-Whitney tests and Fisher exact tests.
We identified 60 SUDEP cases and 198 matched controls. People who died of SUDEP were more likely to have nocturnal convulsive seizures in general (77% of cases vs 33% of controls, < 0.001) and a higher frequency of nocturnal convulsive seizures. Total SUDEP incidence was 3.53/1,000 patient-years (95% confidence interval [CI] 2.73-4.53). The incidence differed among centers: 2.21/1,000 patient-years (95% CI 1.49-3.27) vs 6.12/1,000 patient-years (95% CI 4.40-8.52). There was no significant difference in nocturnal supervision among cases and controls, but there was a difference among centers: the center with a lowest grade of supervision had the highest incidence of SUDEP.
Having nocturnal seizures, in particular convulsions, may increase SUDEP risk. Different levels of nocturnal supervision may account for some of the difference in incidence.
评估居住在护理环境中的智力障碍人群中癫痫猝死（SUDEP）的发生率，并确定夜间发作和夜间监护对 SUDEP 风险的影响。
我们进行了一项嵌套病例对照研究，回顾了 25 年来在 2 个居住护理机构死亡的所有人的记录。每个病例选择 4 个对照，按照年龄（±5 岁）和居住单元匹配。夜间监护分为 3 个等级：（1）无监护；（2）使用监听设备或室友，或每 15 分钟进行一次身体检查；（3）以下 2 种情况中的 1 种：使用监听设备、室友、附加设备（床运动传感器/视频监控），或每 15 分钟进行一次身体检查。使用 Mann-Whitney U 检验和 Fisher 确切检验比较结果。
我们确定了 60 例 SUDEP 病例和 198 例匹配对照。死于 SUDEP 的人更有可能发生夜间惊厥性发作（77%的病例 vs 33%的对照，<0.001）和更高频率的夜间惊厥性发作。总 SUDEP 发生率为 3.53/1000 患者年（95%置信区间[CI] 2.73-4.53）。发生率在中心之间有所不同：2.21/1000 患者年（95%CI 1.49-3.27）vs 6.12/1000 患者年（95%CI 4.40-8.52）。病例和对照之间的夜间监护没有显著差异，但中心之间存在差异：夜间监护程度最低的中心 SUDEP 发生率最高。
夜间发作，特别是惊厥，可能会增加 SUDEP 的风险。夜间监护的不同水平可能是发病率差异的部分原因。
