Istanbul University - Cerrahpasa, Cerrahpasa Faculty of Medicine, Department Neurology, Division of Clinical Neurophysiology, Istanbul, Turkey.
Istanbul University - Cerrahpasa, Cerrahpasa Faculty of Medicine, Department Neurology, Division of Clinical Neurophysiology, Istanbul, Turkey.
Clin Neurol Neurosurg. 2021 Mar;202:106498. doi: 10.1016/j.clineuro.2021.106498. Epub 2021 Jan 15.
In adult patients with epilepsy, treatment of comorbid obstructive sleep apnea syndrome (OSAS) by positive airway pressure (PAP) therapy results in improvements in the control of seizures. This is the first study investigating the long-term compliance with PAP therapy in patients with sleep-related epilepsy and OSAS.
In this longitudinal study, patients with sleep-related epilepsy and OSAS were followed-up for five years. The compliance with PAP therapy was defined as the use of PAP therapy for at least four hours per night for more than 70 % of nights.
A total of 58 patients with sleep-related epilepsy and OSAS completed study protocol. Eleven patients (19.0 %) refused PAP treatment for OSAS, and 13 patients (22.3 %) showed irregular use. Remaining 34 patients (58.7 %) were compliant with PAP therapy. Females were found to be more compliant than males (p = 0.027), while the age was not found to correlate with the compliance (p = 0.721). Epilepsy-related factors including the types of seizures, whether pure sleep-related or mixed (p = 0.403), localization (p = 0.920) or lateralization (p = 0.697) of discharges, showed no effect on the compliance with PAP therapy. On the other hand, patients with a lower number of seizures (p = 0.042) or with a lower seizure frequency (p = 0.048) showed better compliance with PAP therapy. Polysomnographic parameters including severity of OSAS failed to show a significant correlation.
Our findings showed that about two thirds of the study population was compliant with PAP therapy after a mean follow-up duration of almost three years. Newly-diagnosed patients, mostly females, with a lower number of total seizures and lower seizure frequency seem to be more compliant with PAP therapy, which implies the significance of investigation and treatment of OSAS as early as possible in the patients with sleep-related seizures.
在患有癫痫的成年患者中，通过正压通气（PAP）治疗来治疗合并的阻塞性睡眠呼吸暂停综合征（OSAS）可改善癫痫发作的控制。这是第一项研究，旨在调查与睡眠相关的癫痫和 OSAS 患者对 PAP 治疗的长期依从性。
在这项纵向研究中，对患有与睡眠相关的癫痫和 OSAS 的患者进行了五年的随访。将 PAP 治疗的依从性定义为每晚至少使用 PAP 治疗 4 个小时，超过 70％的夜晚。
共有 58 例与睡眠相关的癫痫和 OSAS 患者完成了研究方案。11 例（19.0％）患者拒绝治疗 OSAS，13 例（22.3％）患者不规则使用 PAP 治疗。其余 34 例（58.7％）患者符合 PAP 治疗的要求。女性比男性更符合要求（p = 0.027），而年龄与依从性无关（p = 0.721）。与癫痫相关的因素，包括发作类型（p = 0.403），是单纯睡眠相关的还是混合性的（p = 0.920），放电的定位（p = 0.920）或侧化（p = 0.697），对 PAP 治疗的依从性无影响。另一方面，发作次数较少（p = 0.042）或发作频率较低（p = 0.048）的患者对 PAP 治疗的依从性更好。包括 OSAS 严重程度在内的多导睡眠图参数未显示出显著相关性。
我们的发现表明，在平均近三年的随访后，约三分之二的研究人群符合 PAP 治疗的要求。新发的、以女性为主的患者，发作次数少、发作频率低，对 PAP 治疗的依从性更高，这表明在与睡眠相关的癫痫患者中尽早检查和治疗 OSAS 具有重要意义。
