Dell Katrina L, Payne Daniel E, Kremen Vaclav, Maturana Matias I, Gerla Vaclav, Nejedly Petr, Worrell Gregory A, Lenka Lhotska, Mivalt Filip, Boston Raymond C, Brinkmann Benjamin H, D'Souza Wendyl, Burkitt Anthony N, Grayden David B, Kuhlmann Levin, Freestone Dean R, Cook Mark J
Department of Medicine, St. Vincent's Hospital, University of Melbourne, Level 4, 29 Regent Street, Fitzroy, Victoria 3065, Australia.
Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
EClinicalMedicine. 2021 Jun 5;37:100934. doi: 10.1016/j.eclinm.2021.100934. eCollection 2021 Jul.
While the effects of prolonged sleep deprivation (≥24 h) on seizure occurrence has been thoroughly explored, little is known about the effects of day-to-day variations in the duration and quality of sleep on seizure probability. A better understanding of the interaction between sleep and seizures may help to improve seizure management.
To explore how sleep and epileptic seizures are associated, we analysed continuous intracranial electroencephalography (EEG) recordings collected from 10 patients with refractory focal epilepsy undergoing ordinary life activities between 2010 and 2012 from three clinical centres (Austin Health, The Royal Melbourne Hospital, and St Vincent's Hospital of the Melbourne University Epilepsy Group). A total of 4340 days of sleep-wake data were analysed (average 434 days per patient). EEG data were sleep scored using a semi-automated machine learning approach into wake, stages one, two, and three non-rapid eye movement sleep, and rapid eye movement sleep categories.
Seizure probability changes with day-to-day variations in sleep duration. Logistic regression models revealed that an increase in sleep duration, by 1·66 ± 0·52 h, lowered the odds of seizure by 27% in the following 48 h. Following a seizure, patients slept for longer durations and if a seizure occurred during sleep, then sleep quality was also reduced with increased time spent aroused from sleep and reduced rapid eye movement sleep.
Our results suggest that day-to-day deviations from regular sleep duration correlates with changes in seizure probability. Sleeping longer, by 1·66 ± 0·52 h, may offer protective effects for patients with refractory focal epilepsy, reducing seizure risk. Furthermore, the occurrence of a seizure may disrupt sleep patterns by elongating sleep and, if the seizure occurs during sleep, reducing its quality.
虽然长期睡眠剥夺（≥24小时）对癫痫发作的影响已得到充分研究，但对于睡眠时长和质量的日常变化对癫痫发作概率的影响却知之甚少。更好地理解睡眠与癫痫之间的相互作用可能有助于改善癫痫管理。
为了探究睡眠与癫痫发作之间的关联，我们分析了2010年至2012年期间从三个临床中心（奥斯汀健康中心、皇家墨尔本医院以及墨尔本大学癫痫研究组的圣文森特医院）收集的10例难治性局灶性癫痫患者在日常生活活动中的连续颅内脑电图（EEG）记录。共分析了4340天的睡眠-觉醒数据（每位患者平均434天）。EEG数据通过半自动机器学习方法进行睡眠评分，分为清醒、非快速眼动睡眠的第一、二、三阶段以及快速眼动睡眠类别。
癫痫发作概率随睡眠时长的日常变化而改变。逻辑回归模型显示，睡眠时长增加1.66±0.52小时，会使接下来48小时内癫痫发作的几率降低27%。癫痫发作后，患者睡眠时间会延长，并且如果癫痫在睡眠期间发作，那么睡眠质量也会下降，从睡眠中觉醒的时间增加，快速眼动睡眠减少。
我们的结果表明，日常睡眠时长与规律的偏差与癫痫发作概率的变化相关。睡眠时间延长1.66±0.52小时，可能为难治性局灶性癫痫患者提供保护作用，降低癫痫发作风险。此外，癫痫发作的发生可能会通过延长睡眠时间来扰乱睡眠模式，并且如果癫痫在睡眠期间发作，还会降低睡眠质量。
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