Department of Neurology, University of Virginia, Charlottesville, VA, USA.
Department of Neurology, University of Virginia, Charlottesville, VA, USA.
Epilepsy Res. 2021 Jan;169:106524. doi: 10.1016/j.eplepsyres.2020.106524. Epub 2020 Dec 1.
To assess the correlation between time of day and sleep-wake state prior to seizure onset for seizures recorded in an inpatient epilepsy monitoring unit.
We prospectively enrolled a consecutive series of patients undergoing inpatient epilepsy monitoring. For each epileptic seizure recorded, continuous EEG data preceding seizure onset was reviewed and scored as W, N1-3, or REM in ten 30-second epochs. Time of day was divided into four 6-h phases (0600-1159, 1200-1759, 1800-2359, 0000-0559). The preictal sleep-wake state was then correlated to nocturnal (0000-0559) versus diurnal (0600-2359) times of day.
A total of 102 seizures from 42 patients met enrollment criteria over a period of 19 months. Eighty-five seizures occurred during the diurnal phase, and 17 seizures occurred during the nocturnal phase. Thirty-six percent of all seizures (n = 37) were preceded by at least 1 epoch of sleep. The proportion of patients sleeping prior to a seizure within each 6-h phase varied significantly from the overall distribution only during nocturnal phase. Seventy-six percent of nocturnal seizures and 28 % of diurnal seizures were preceded by sleep. Therefore, the nocturnal time window from 0000-0559 had a sensitivity of 0.65 (95 % confidence interval 0.48-0.78), a specificity of 0.06 (0.02-0.15), a positive predictive value of 0.28 (0.20-0.39), and a negative predictive value of 0.24 (0.10-0.39) in association with sleep-onset seizures.
The time of day is an inaccurate surrogate for preictal sleep-wake state in the epilepsy monitoring unit despite a correlation between nocturnal period and sleep. Diurnal sleep is a common phenomenon in the inpatient unit.
评估癫痫监测病房记录的癫痫发作前昼夜睡眠-觉醒状态的相关性。
我们前瞻性地纳入了一系列接受住院癫痫监测的连续患者。对于记录的每一次癫痫发作，回顾并分析发作前连续脑电图数据，将其划分为 W、N1-3 或 REM 期，并分为 10 个 30 秒的时程。时间分为四个 6 小时的时段（0600-1159、1200-1759、1800-2359、0000-0559）。然后将发作前的睡眠-觉醒状态与夜间（0000-0559）与日间（0600-2359）时间相关联。
在 19 个月的时间内，共有 42 名患者的 102 次癫痫发作符合纳入标准。85 次发作发生在白天，17 次发作发生在夜间。所有发作中有 36%（n=37）至少有 1 个时程的睡眠。在每个 6 小时的时段中，患者在发作前入睡的比例与总体分布显著不同，仅在夜间时段如此。76%的夜间发作和 28%的日间发作前有睡眠。因此，从 0000-0559 开始的夜间时间窗口具有 0.65 的敏感性（95%置信区间 0.48-0.78）、0.06 的特异性（0.02-0.15）、0.28 的阳性预测值（0.20-0.39）和 0.24 的阴性预测值（0.10-0.39）与睡眠发作相关。
尽管夜间与睡眠之间存在相关性，但时间并不能准确替代癫痫监测病房中的发作前睡眠-觉醒状态。日间睡眠是住院病房中的常见现象。
