抗癫痫药物对多导睡眠图参数的影响：系统评价和荟萃分析。

The impact of antiseizure medications on polysomnographic parameters: a systematic review and meta-analysis.

机构信息

Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

出版信息

Sleep Med. 2021 May;81:319-326. doi: 10.1016/j.sleep.2021.02.056. Epub 2021 Mar 4.

DOI:10.1016/j.sleep.2021.02.056

PMID:33756282

Abstract

BACKGROUND

Oral antiseizure medications (ASMs) are first-line treatments for patients with epilepsy. However, ASMs may alter sleep architecture, adversely affecting patient outcomes. The meta-analysis aimed to elucidate the effect of ASMs on sleep architecture.

METHODS

PubMed, Embase, and Cochrane Central database (up to Febrary 2021) were searched for randomized control trials (RCT) with effects of ASMs on polysomnography parameters. A meta-analysis using a random-effects model was performed. We did not set limitation to the participants with underlying diagnosis of epilepsy.

RESULTS

Eighteen randomized-controlled trials fulfilled the eligibility criteria. The effects of five main groups of ASMs (sodium channel blockers, calcium channel blockers, GABA enhancers, synaptic vesicle glycoprotein 2A [SV2A] ligand, and broad-spetrum ASMs) on slow-wave sleep (SWS), rapid eye movement (REM) sleep, and sleep efficiency (SE) were analyzed. Compared with placebo, calcium channel blockers and GABA enhancers significantly increased SWS. GABA enhancers also decreased REM sleep percentage, whereas calcium channel blockers significantly increased SE. Sodium channel blockers, SV2A ligand and broad-spectrum ASMs did not affect SWS, REM sleep, or SE. The subgroup analysis revealed that gabapentin, pregabalin, and tiagabine increased the percentage of SWS. Tiagabine also decreased REM sleep, whereas pregabalin increased SE. Finally, levetiracetam did not affect SWS, REM sleep, and SE.

CONCLUSIONS

This meta-analysis indicated that ASMs can have a statistically significant effect on sleep parameters; the effect differs between ASMs.

摘要

背景

口服抗癫痫药物（ASM）是癫痫患者的一线治疗方法。然而，ASM 可能会改变睡眠结构，对患者的预后产生不利影响。本荟萃分析旨在阐明 ASM 对睡眠结构的影响。

方法

检索了 PubMed、Embase 和 Cochrane Central 数据库（截至 2021 年 2 月）中关于 ASM 对多导睡眠图参数影响的随机对照试验（RCT）。使用随机效应模型进行荟萃分析。我们对潜在癫痫诊断的参与者没有设定限制。

结果

符合纳入标准的 18 项随机对照试验。分析了五类主要 ASM（钠通道阻滞剂、钙通道阻滞剂、GABA 增强剂、突触囊泡糖蛋白 2A [SV2A] 配体和广谱 ASM）对慢波睡眠（SWS）、快速眼动（REM）睡眠和睡眠效率（SE）的影响。与安慰剂相比，钙通道阻滞剂和 GABA 增强剂显著增加了 SWS。GABA 增强剂还降低了 REM 睡眠百分比，而钙通道阻滞剂显著增加了 SE。钠通道阻滞剂、SV2A 配体和广谱 ASM 均不影响 SWS、REM 睡眠或 SE。亚组分析显示，加巴喷丁、普瑞巴林和噻加宾增加了 SWS 的百分比。噻加宾还降低了 REM 睡眠，而普瑞巴林增加了 SE。最后，左乙拉西坦对 SWS、REM 睡眠和 SE 没有影响。