Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada.
Hospital Group Ostallgaeu-Kaufbeuren, Department of Pediatrics, Kaufbeuren, Germany.
Sleep. 2023 Feb 8;46(2). doi: 10.1093/sleep/zsac250.
Whereas there is plenty of evidence on the influence of epileptic activity on non-rapid eye movement (NREM) sleep macro- and micro-structure, data on the impact of epilepsy on rapid eye movement (REM) sleep remains sparse. Using high-density electroencephalography (HD-EEG), we assessed global and focal disturbances of sawtooth waves (STW) as cortically generated sleep oscillations of REM sleep in patients with focal epilepsy.
Twenty-two patients with drug-resistant focal epilepsy (13 females; mean age, 32.6 ± 10.7 years; 12 temporal lobe epilepsy) and 12 healthy controls (3 females; 24.0 ± 3.2 years) underwent combined overnight HD-EEG and polysomnography. STW rate, duration, frequency, power, spatial extent, IED rates and sleep homeostatic properties were analyzed.
STW rate and duration were reduced in patients with focal epilepsy compared to healthy controls (rate: 0.64/min ± 0.46 vs. 1.12/min ± 0.41, p = .005, d = -0.98; duration: 3.60 s ± 0.76 vs. 4.57 ± 1.00, p = .003, d = -1.01). Not surprisingly given the fronto-central maximum of STW, the reductions were driven by extratemporal lobe epilepsy patients (rate: 0.45/min ± 0.31 vs. 1.12/min ± 0.41, p = .0004, d = -1.35; duration: 3.49 s ± 0.92 vs. 4.57 ± 1.00, p = .017, d = -0.99) and were more pronounced in the first vs. the last sleep cycle (rate first cycle patients vs. controls: 0.60/min ± 0.49 vs. 1.10/min ± 0.55, p = .016, d = -0.90, rate last cycle patients vs. controls: 0.67/min ± 0.51 vs. 0.99/min ± 0.49, p = .11, d = -0.62; duration first cycle patients vs. controls: 3.60s ± 0.76 vs. 4.57 ± 1.00, p = .003, d = -1.01, duration last cycle patients vs. controls: 3.66s ± 0.84 vs. 4.51 ± 1.26, p = .039, d = -0.80). There was no regional decrease of STWs in the region with the epileptic focus vs. the contralateral side (all p > .05).
Patients with focal epilepsy and in particular extratemporal lobe epilepsy show a global reduction of STW activity in REM sleep. This may suggest that epilepsy impacts cortically generated sleep oscillations even in REM sleep when epileptic activity is low.
虽然有大量证据表明癫痫活动对非快速眼动（NREM）睡眠的宏观和微观结构有影响，但关于癫痫对快速眼动（REM）睡眠的影响的数据仍然很少。使用高密度脑电图（HD-EEG），我们评估了药物难治性局灶性癫痫患者（13 名女性；平均年龄 32.6 ± 10.7 岁；12 名颞叶癫痫）和 12 名健康对照者（3 名女性；24.0 ± 3.2 岁）的 REM 睡眠中锯齿波（STW）作为皮质产生的睡眠振荡的全球和局灶性干扰。
22 名药物难治性局灶性癫痫患者（13 名女性；平均年龄 32.6 ± 10.7 岁；12 名颞叶癫痫）和 12 名健康对照者（3 名女性；24.0 ± 3.2 岁）接受了联合夜间高密度脑电图和多导睡眠图检查。分析了 STW 率、持续时间、频率、功率、空间范围、IED 率和睡眠稳态特性。
与健康对照组相比，局灶性癫痫患者的 STW 率和持续时间降低（率：0.64/min ± 0.46 与 1.12/min ± 0.41，p =.005，d = -0.98；持续时间：3.60 s ± 0.76 与 4.57 ± 1.00，p =.003，d = -1.01）。由于 STW 的额中央最大值，这种减少主要是由颞叶外癫痫患者驱动的（率：0.45/min ± 0.31 与 1.12/min ± 0.41，p =.0004，d = -1.35；持续时间：3.49 s ± 0.92 与 4.57 ± 1.00，p =.017，d = -0.99），并且在第一个睡眠周期中比最后一个睡眠周期更明显（第一个周期患者与对照组的比率：0.60/min ± 0.49 与 1.10/min ± 0.55，p =.016，d = -0.90，最后一个周期患者与对照组的比率：0.67/min ± 0.51 与 0.99/min ± 0.49，p =.11，d = -0.62；第一个周期患者与对照组的持续时间：3.60s ± 0.76 与 4.57 ± 1.00，p =.003，d = -1.01，最后一个周期患者与对照组的持续时间：3.66s ± 0.84 与 4.51 ± 1.26，p =.039，d = -0.80）。在癫痫灶区域与对侧区域之间，STW 无区域性减少（所有 p >.05）。
局灶性癫痫患者，特别是颞叶外癫痫患者，REM 睡眠中的锯齿波活动呈全球性减少。这可能表明，即使在癫痫活动较低的 REM 睡眠中，癫痫也会影响皮质产生的睡眠振荡。
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