University Hospital Ostrava, Department of Neurology, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Clinical Neurosciences, Ostrava, Czech Republic.
University Hospital Ostrava, Department of Neurology, Ostrava, Poruba, Czech Republic.
Sleep Med. 2024 Jul;119:192-200. doi: 10.1016/j.sleep.2024.04.019. Epub 2024 Apr 20.
Nonconvulsive status epilepticus (NCSE) manifests as a change in mental status without a coma (NCSE proper) or comatose NCSE. Hypocretin-1/orexin-A (H/O) is involved in alertness and sleep maintenance. Sleep impairment and excessive daytime sleepiness (EDS) have a negative impact on cognitive functions and activities of daily living (ADL).
Patients meeting the NCSE criteria underwent cerebrospinal fluid and brain magnetic resonance imaging examinations, polysomnographies (PSG), multiple latency sleep tests (MSLT), and completed Epworth Sleepiness Scale (ESS). Montreal Cognitive Assessment was used to evaluate cognitive functions, and the Barthel Index was used to assess ADL in the acute phase (V1) and three months follow-up (V2).
From May 2020 to May 2023, we enrolled 15 patients, eight (53.3 %) women, with a median age of 69 (14) years. The median H/O CSF concentration was 250 (63.6) pg/ml; however, only three CSF samples (20 %) decreased below the borderline concentration of 200 pg/ml. Fourteen out of 15 patients (93.3 %) completed the PSG study. The median of wakefulness after sleep onset was 167 (173.5) min, sleep efficiency (SE) was 62.9 (63) %, sleep latency (SL) was 6 (32) min, REM sleep was 2.85 (7.2) %, and REM first episode latency was 210.5 (196.5) minutes. The medians of the stages N1 NREM were 4.65 (15) %, N2 NREM 68.4 (29.9) %, and N3 NREM 21.8 (35.5) %. MSLT mean latency was 7.7 (12.6) minutes. A significant negative correlation exists between H/O CSF concentrations and the stage N1 NREM (r = -0.612, p = 0.02), and the proportion of cumulative sleep time with oxygen saturation below 90 % in total sleep time (TST) t90 (r = -0.57, p = 0.03). MSLT had significant negative correlation with TST (r = -0.5369, p = 0.0478), with SE (r = -0.5897, p = 0.0265), with apnea-hypopnea index (r = -0.7631, p = 0.0002) and with deoxygenation index (r = -0.8009, p = 0.0006). A positive correlation exists between MSLT and SL (r = 0.6284, p = 0.0161) and between ESS and t90 (r = 0.9014, p = 0.0004). The correlation between H/O CSF concentrations and EDS, cognitive performance, and ADL was not proved.
Patients after NCSE exhibited sleep impairment and excessive daytime sleepiness. Hypocretin-1/orexin-A concentrations decreased only in 20 % of these cases.
非惊厥性癫痫持续状态（NCSE）表现为意识状态改变而无昏迷（NCSE 本身）或昏迷性 NCSE。下丘脑分泌素-1/食欲素-A（H/O）参与觉醒和睡眠维持。睡眠障碍和日间过度嗜睡（EDS）对认知功能和日常生活活动（ADL）有负面影响。
符合 NCSE 标准的患者接受了脑脊液和脑磁共振成像检查、多导睡眠图（PSG）、多次潜伏期睡眠测试（MSLT），并完成了 Epworth 嗜睡量表（ESS）。蒙特利尔认知评估用于评估认知功能，Barthel 指数用于评估急性期（V1）和三个月随访（V2）的 ADL。
从 2020 年 5 月至 2023 年 5 月，我们共纳入了 15 名患者，其中 8 名（53.3%）为女性，中位年龄为 69（14）岁。中位 H/O 脑脊液浓度为 250（63.6）pg/ml；然而，只有 3 份脑脊液样本（20%）低于 200 pg/ml 的边界浓度。15 名患者中有 14 名（93.3%）完成了 PSG 研究。睡眠潜伏期后清醒时间的中位数为 167（173.5）分钟，睡眠效率（SE）为 62.9（63）%，睡眠潜伏期（SL）为 6（32）分钟，快速眼动睡眠（REM）为 2.85（7.2）%，快速眼动睡眠第一潜伏期为 210.5（196.5）分钟。N1 非快速眼动睡眠期、N2 非快速眼动睡眠期和 N3 非快速眼动睡眠期的中位数分别为 4.65（15）%、68.4（29.9）%和 21.8（35.5）%。MSLT 平均潜伏期为 7.7（12.6）分钟。H/O 脑脊液浓度与 N1 非快速眼动睡眠期呈显著负相关（r=-0.612，p=0.02），总睡眠时间中血氧饱和度低于 90%的累积睡眠时间与 TST 比值（TST t90）呈显著负相关（r=-0.57，p=0.03）。MSLT 与 TST（r=-0.5369，p=0.0478）、SE（r=-0.5897，p=0.0265）、呼吸暂停-低通气指数（r=-0.7631，p=0.0002）和脱氧指数（r=-0.8009，p=0.0006）呈显著负相关。MSLT 与 SL 呈正相关（r=0.6284，p=0.0161），ESS 与 TST t90 呈正相关（r=0.9014，p=0.0004）。H/O 脑脊液浓度与 EDS、认知表现和 ADL 之间的相关性未得到证实。
NCSE 后患者出现睡眠障碍和日间过度嗜睡。仅 20%的病例中 H/O 浓度降低。
