Sleep Disorders & Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States; University of Illinois College of Medicine at Peoria, Peoria, IL, United States; OSF HealthCare Illinois Neurological Institute, Peoria, IL, United States.
Sleep Disorders & Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States.
Epilepsy Behav. 2021 Dec;125:108400. doi: 10.1016/j.yebeh.2021.108400. Epub 2021 Nov 17.
Excessive daytime sleepiness (EDS) is a common complaint in adults with epilepsy (AWE), but objective evaluation is lacking. We used the maintenance of wakefulness test (MWT) to objectively measure the ability of adults with focal-onset epilepsy to maintain wakefulness in soporific conditions.
Adults with epilepsy participating in a study investigating the effects of lacosamide on sleep and wakefulness underwent baseline ambulatory polysomnography (PSG)/EEG followed by MWT. Mean sleep latency (MSL) and mean percent sleep time (MST, mean percentage of non-wake EEG scored in 3-sec bins from lights out to sleep onset averaged over the 4 MWT trials) were quantified. Subjective sleepiness was assessed by the Epworth Sleepiness Scale (ESS). Spearman correlation and linear regression assessed relationships between MWT parameters, ESS and relevant sleep and epilepsy-related variables.
Maintenance of wakefulness test MSL in 51 AWE (mean age 43.5 ± 13 years, 69% female, mean BMI 24.6 ± 11.2 kg/m) was 21.7 ± 11.9 min; 45.1% had an abnormally short MSL <19.4 min and 15.7% <8 min. MST was 9.3% [3.3, 19.1]. Mean ESS score was 8.8 ± 5.7; 39% had elevated ESS (>10). No correlation between subjective ESS and objective MSL (p = 0.67) or MST (p = 0.61) was found. MSL was significantly shorter in subjects with focal to bilateral tonic-clonic seizures (FBTCS; 7.9 min [13.6, 22.3]) compared to those without (27.4 min [21.2, 33.6], p = 0.013). Younger subjects had shorter MSL; MSL increased 3.2 min for every 10-year increase in age.
We found a high prevalence of objective sleepiness/difficulty maintaining wakefulness on the MWT and subjective sleepiness using the ESS in AWE without a correlation between the two. More severe objective sleepiness was found in subjects with a history of FBTCS and younger age. Further research is needed to determine mechanistic underpinnings and optimal measurements of pathological sleepiness in people with epilepsy given the burden of it on quality of life.
日间嗜睡是成人癫痫患者（AWE）常见的主诉，但缺乏客观评估。我们使用维持觉醒试验（MWT）客观测量局灶性癫痫发作成人在催眠条件下保持觉醒的能力。
参与研究拉考酰胺对睡眠和觉醒影响的癫痫患者在基线进行门诊多导睡眠图（PSG）/脑电图检查，然后进行 MWT。平均睡眠潜伏期（MSL）和平均睡眠时间百分比（MST，在 4 次 MWT 试验中，从熄灯到入睡平均每 3 秒评分的非觉醒 EEG 平均百分比）被量化。Epworth 嗜睡量表（ESS）评估主观嗜睡程度。Spearman 相关和线性回归评估 MWT 参数、ESS 与相关睡眠和癫痫相关变量之间的关系。
51 名 AWE 的维持觉醒试验 MSL（平均年龄 43.5±13 岁，69%为女性，平均 BMI 24.6±11.2kg/m）为 21.7±11.9 分钟；45.1%的 MSL 异常短，<19.4 分钟，15.7%的 MSL<8 分钟。MST 为 9.3%[3.3,19.1]。平均 ESS 评分为 8.8±5.7；39%的 ESS 升高（>10）。主观 ESS 与客观 MSL（p=0.67）或 MST（p=0.61）之间无相关性。有局灶性双侧强直阵挛发作（FBTCS）史的患者 MSL 明显短于无 FBTCS 史的患者（7.9 分钟[13.6,22.3]比 27.4 分钟[21.2,33.6]，p=0.013）。年轻患者的 MSL 较短；年龄每增加 10 岁，MSL 增加 3.2 分钟。
我们发现 AWE 患者在 MWT 上存在高度的客观睡眠/难以保持觉醒和主观嗜睡，两者之间无相关性。有 FBTCS 史和年轻的患者，客观睡眠更严重。鉴于癫痫患者的睡眠障碍对生活质量的影响，需要进一步研究以确定病理性睡眠障碍的机制基础和最佳测量方法。
