Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; Department of Neuroscience, Monash Medical Centre, Melbourne, Australia; School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Australia.
Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
Clin Neurophysiol. 2020 May;131(5):1044-1050. doi: 10.1016/j.clinph.2020.01.021. Epub 2020 Feb 21.
To investigate the impact of sleep onset and offset on the rate of epileptiform discharges (ED) in idiopathic generalized epilepsies (IGE).
We studied the temporal distribution of EDs with mixed-effects Poisson regression modeling in a cohort of patients diagnosed with IGE who underwent 24-hour ambulatory electroencephalography (EEG) recordings. We defined the mean number discharges per hour per subject as the mean ED rate. The association between each hour and the mean ED rate was quantified with incidence rate ratio (IRR) as the metric. We calculated the IRR of each hourly block for the total cohort in relation to sleep onset and offset. Finally, we admitted secondary risk factors into our Poisson regression model and quantified changes in IRR in order to investigate the impact of those variables on the outcome. The secondary risk factors included: epilepsy syndrome, duration of seizure freedom, duration of epilepsy, number of antiepileptic drugs (AED), type of AED, and age.
A total of 39 patients with a mean age of 29.1 y (SD = 10.1) were studied. The distribution of ED rate demonstrated a highly significant abrupt increase in the first hour after sleep onset (IRR = 3.96; p < 0.001). On the contrary, the ED rate significantly dropped in the second hour after the sleep offset compared with the last hour block before sleep offset (IRR = 0.39; p < 0.001). None of the secondary risk factors demonstrated any significant impact on this pattern.
Sleep onset is a very significant trigger for the generation of EDs in IGE.
Our results support the hypothesis that there is a "critical zone of vigilance" in the sleep-wake boundary from which generalized EDs are more likely to emerge.
研究特发性全面性癫痫（IGE）患者睡眠起始和结束对癫痫样放电（ED）发生率的影响。
我们通过对接受 24 小时动态脑电图（EEG）记录的 IGE 患者队列进行混合效应泊松回归模型研究，分析 ED 的时间分布。我们将每个受试者每小时的平均放电数定义为平均 ED 率。以发病率比（IRR）作为指标，定量每个小时与平均 ED 率之间的关联。我们计算了总队列中每个小时块相对于睡眠起始和结束的总 ED 率的 IRR。最后，我们将次要风险因素纳入泊松回归模型，并量化 IRR 的变化，以调查这些变量对结果的影响。次要风险因素包括：癫痫综合征、无癫痫发作持续时间、癫痫持续时间、抗癫痫药物（AED）数量、AED 类型和年龄。
共纳入 39 名平均年龄为 29.1 岁（标准差=10.1）的患者。ED 率的分布显示，睡眠起始后第一个小时 ED 率显著急剧增加（IRR=3.96；p<0.001）。相反，与睡眠起始前最后一个小时相比，睡眠结束后第二个小时的 ED 率显著降低（IRR=0.39；p<0.001）。没有任何次要风险因素对这种模式有任何显著影响。
睡眠起始是 IGE 患者 ED 发生的一个非常重要的触发因素。
我们的研究结果支持了这样一种假说，即在睡眠-觉醒边界存在一个“警觉临界区”，在这个区域，更有可能出现全身性 ED。
