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Nobili L, Cordani R, Arnaldi D, Mattioli P, Veneruso M, Ng M. Rapid eye movement sleep and epilepsy: exploring interactions and therapeutic prospects. J Sleep Res 2024:e14251. [PMID: 38842061 DOI: 10.1111/jsr.14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/21/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
While research interest in the relationship between sleep and epilepsy is growing, it primarily centres on the effects of non-rapid eye movement (NREM) sleep in favouring seizures. Nonetheless, a noteworthy aspect is the observation that, in the lives of patients with epilepsy, REM sleep represents the moment with the least epileptic activity and the lowest probability of having a seizure. Studies demonstrate a suppressive effect of phasic REM sleep on interictal epileptiform discharges, potentially offering insights into epilepsy localisation and management. Furthermore, epilepsy impacts REM sleep, with successful treatment correlating with improved REM sleep quality. Novel therapeutic strategies aim to harness REM's anti-epileptic effects, including pharmacological approaches targeting orexinergic systems and neuromodulation techniques promoting cortical desynchronisation. These findings underscore the intricate relationship between REM sleep and epilepsy, highlighting avenues for further research and therapeutic innovation in epilepsy management.
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Affiliation(s)
- Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Member of the European Reference Network EpiCARE, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Ramona Cordani
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Member of the European Reference Network EpiCARE, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
- Neurophysiopathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Mattioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
- Neurophysiopathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Veneruso
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Member of the European Reference Network EpiCARE, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Marcus Ng
- Biomedical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Neurology, University of Manitoba, Winnipeg, Manitoba, Canada
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Kilgore-Gomez A, Norato G, Theodore WH, Inati SK, Rahman SA. Sleep physiology in patients with epilepsy: Influence of seizures on rapid eye movement (REM) latency and REM duration. Epilepsia 2024; 65:995-1005. [PMID: 38411987 DOI: 10.1111/epi.17904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE A well-established bidirectional relationship exists between sleep and epilepsy. Patients with epilepsy tend to have less efficient sleep and shorter rapid eye movement (REM) sleep. Seizures are far more likely to arise from sleep transitions and non-REM sleep compared to REM sleep. Delay in REM onset or reduction in REM duration may have reciprocal interactions with seizure occurrence. Greater insight into the relationship between REM sleep and seizure occurrence is essential to our understanding of circadian patterns and predictability of seizure activity. We assessed a cohort of adults undergoing evaluation of drug-resistant epilepsy to examine whether REM sleep prior to or following seizures is delayed in latency or reduced in quantity. METHODS We used a spectrogram-guided approach to review the video-electroencephalograms of patients' epilepsy monitoring unit admissions for sleep scoring to determine sleep variables. RESULTS In our cohort of patients, we found group- and individual-level delay of REM latency and reduced REM duration when patients experienced a seizure before the primary sleep period (PSP) of interest or during the PSP of interest. A significant increase in REM latency and decrease in REM quantity were observed on nights where a seizure occurred within 4 h of sleep onset. No change in REM variables was found when investigating seizures that occurred the day after the PSP of interest. Our study is the first to provide insight about a perisleep period, which we defined as 4-h periods before and after the PSP. SIGNIFICANCE Our results demonstrate a significant relationship between seizures occurring prior to the PSP, during the PSP, and in the 4-h perisleep period and a delay in REM latency. These findings have implications for developing a biomarker of seizure detection as well as longer term seizure risk monitoring.
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Affiliation(s)
| | - Gina Norato
- Biostatistics Group, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - William H Theodore
- Office of Clinical Director, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Sara K Inati
- EEG Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Shareena A Rahman
- EEG Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
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Wang S, Wu M, Wu S, Lin F, Ji X, Yan J. A polysomnographic study of slow-wave sleep loss in elderly patients with epilepsy. Heliyon 2024; 10:e25904. [PMID: 38379992 PMCID: PMC10877289 DOI: 10.1016/j.heliyon.2024.e25904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
Objective The primary objective is to explore what causes slow-wave sleep loss in elderly patients with epilepsy. The secondary objective is to identify the PSG characteristics in elderly patients with epilepsy. The clinical demographics, sleep architecture, sleep-related events, and interictal epileptiform discharges are to be evaluated in the objectives. Methods The video electroencephalography (VEEG) and polysomnogram (PSG) data from 44 elderly patients with epilepsy and 52 elderly patients with sleep disorders but without definite central nervous system diseases were analysed. This was a case-control study. The differences in the PSG sleep architecture parameters (total sleep time (TST), sleep efficiency, wake after sleep onset, etc.) and sleep-related events (apnea hypopnea index, oxygen desaturation index (ODI), periodic limb movement index, etc.) between the epilepsy and control groups. As Additionally, these parameters were assessed within the elderly patients with epilepsy, comparing the slow-wave sleep existence and slow-wave sleep loss groups, using VEEG and PSG. Results The epileptic group exhibited significantly lower TST (343.477 ± 96.3046min vs 389.115 ± 61.5727min, p < 0.05), rapid eye movement (%) (13.011 ± 7.5384 vs 16.992 ± 6.7025, p < 0.05), non-rapid eye movement stage 3 (%) (1.35[0,7.225] vs 3.65[0.425,13.75], p < 0.05), and sleep efficiency (%) (69.482 ± 14.1771% vs 77.242 ± 10.6171%, p < 0.05). Conversely, the ODI (25.6[9.825,51.775] events/hour vs 16.85[5.3,30.425] events/hour, p < 0.05) and spontaneous arousal index (4.0455[2.1805,6.9609] events/hour vs 2.9709[1.4747,5.0554] events/hour, p < 0.05) were significantly higher in elderly patients with epilepsy. The prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) was significantly higher in the slow-wave sleep loss group than in the slow-wave sleep existence group (100% vs 77.8%, p < 0.05). The incidence of slow-wave sleep loss was lower in patients with epilepsy aged between 75 and 85 years compared to those aged between 65 and 75 years. Conclusion Elderly patients with epilepsy exhibit higher levels of ODI and spontaneous arousal index. Our findings indicate that OSAHS could be a contributing factor to slow-wave sleep loss in this population. The incidence of slow-wave sleep loss was lower in patients aged above 75 years among elderly patients with epilepsy.
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Affiliation(s)
| | | | - Sangru Wu
- Department of Neurology and Sleep Medical Center, Fujian Provincial Governmental Hospital, Fuzhou, China
| | - Fang Lin
- Department of Neurology and Sleep Medical Center, Fujian Provincial Governmental Hospital, Fuzhou, China
| | - Xiaolin Ji
- Department of Neurology and Sleep Medical Center, Fujian Provincial Governmental Hospital, Fuzhou, China
| | - Jinzhu Yan
- Department of Neurology and Sleep Medical Center, Fujian Provincial Governmental Hospital, Fuzhou, China
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Chong CS, Tan JK, Ng BH, Lin ABY, Khoo CS, Rajah R, Hod R, Tan HJ. The prevalence and predictors of poor sleep quality and excessive daytime sleepiness in epilepsy: A single tertiary centre experience in Malaysia. J Clin Neurosci 2023; 118:132-142. [PMID: 37935067 DOI: 10.1016/j.jocn.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND AND OBJECTIVE People with epilepsy frequently encounter sleep disruptions that can stem from a variety of complex factors. Epilepsy-related sleep disturbance can lead to reduced quality of life and excessive daytime hypersomnolence. Identification of sleep disturbances may help in the overall management of epilepsy patients. This study was conducted to determine the prevalence and predictors of poor sleep quality and daytime sleepiness in epilepsy. METHODS A cross-sectional study on 284 epilepsy patients was performed in a local tertiary centre. The demographic and clinical epilepsy data were collected. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires were utilised to determine the quality of life and daytime hypersomnolence of epilepsy patients, respectively. RESULTS Poor sleep quality was reported in 78 (27.5%) patients while daytime hypersomnolence was present in 17 (6%) patients. The predictors of poor sleep quality include structural causes (OR = 2.749; 95% CI: 1.436, 5.264, p = 0.002), generalised seizures (OR = 1.959, 95% CI: 1.04, 3.689, p = 0.037), and antiseizure medications such as Carbamazepine (OR = 2.34; 95% CI: 1.095, 5.001, p = 0.028) and Topiramate (OR 2.487; 95% CI: 1.028, 6.014, p = 0.043). Females are 3.797 times more likely score higher in ESS assessment (OR 3.797; 95% CI: 1.064, 13.555 p = 0.04). DISCUSSION Sleep disturbances frequently coexist with epilepsy. Patients should be actively evaluated using the PSQI and ESS questionnaires. It is imperative to identify the key factors that lead to reduced sleep quality and heightened daytime sleepiness in patients with epilepsy, as this is essential to properly manage their condition.
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Affiliation(s)
- Chee Sing Chong
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia
| | - Juen Kiem Tan
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia
| | - Boon Hau Ng
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia
| | - Andrea Ban Yu Lin
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia
| | - Ching Soong Khoo
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia
| | - Rathika Rajah
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia
| | - Hui Jan Tan
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia.
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Devulder A, Macea J, Kalkanis A, De Winter F, Vandenbulcke M, Vandenberghe R, Testelmans D, Van Den Bossche MJA, Van Paesschen W. Subclinical epileptiform activity and sleep disturbances in Alzheimer's disease. Brain Behav 2023; 13:e3306. [PMID: 37950422 PMCID: PMC10726840 DOI: 10.1002/brb3.3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Subclinical epileptiform activity (SEA) and sleep disturbances are frequent in Alzheimer's disease (AD). Both have an important relation to cognition and potential therapeutic implications. We aimed to study a possible relationship between SEA and sleep disturbances in AD. METHODS In this cross-sectional study, we performed a 24-h ambulatory EEG and polysomnography in 48 AD patients without diagnosis of epilepsy and 34 control subjects. RESULTS SEA, mainly detected in frontotemporal brain regions during N2 with a median of three spikes/night [IQR1-17], was three times more prevalent in AD. AD patients had lower sleep efficacy, longer wake after sleep onset, more awakenings, more N1%, less REM sleep and a higher apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). Sleep was not different between AD subgroup with SEA (AD-Epi+) and without SEA (AD-Epi-); however, compared to controls, REM% was decreased and AHI and ODI were increased in the AD-Epi+ subgroup. DISCUSSION Decreased REM sleep and more severe sleep-disordered breathing might be related to SEA in AD. These results could have diagnostic and therapeutic implications and warrant further study at the intersection between sleep and epileptiform activity in AD.
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Affiliation(s)
- Astrid Devulder
- Laboratory for Epilepsy Research, KU Leuven and Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Jaiver Macea
- Laboratory for Epilepsy Research, KU Leuven and Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Alexandros Kalkanis
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven and Department of Pulmonary DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - François‐Laurent De Winter
- Division of Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven and Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Mathieu Vandenbulcke
- Division of Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven and Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, KU Leuven and Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Dries Testelmans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven and Department of Pulmonary DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - Maarten J. A. Van Den Bossche
- Division of Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven and Department of Geriatric PsychiatryUniversity Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, KU Leuven and Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
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Yeh WC, Hsu CY, Li KY, Chien CF, Huang LC, Yang YH. Association between subclinical epileptiform discharge and the behavioral and psychological symptoms in patients with Alzheimer's dementia. Int J Geriatr Psychiatry 2023; 38:e6013. [PMID: 37817385 DOI: 10.1002/gps.6013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in patients with Alzheimer's disease (AD), causing burdens on caregivers. Behavioral and psychological symptoms of dementia and subclinical epileptiform discharge (SED) increased with the disease course of AD. However, the interaction between them was still unknown. The present study aimed to evaluate the associations between SED and BPSD. METHODS/DESIGN Patients with AD from Kaohsiung Municipal Ta-tung Hospital were included in this study. International 10-20 system scalp electroencephalography (EEG) for 13 min was performed to detect SED. Behavioral and psychological symptoms of dementia was assessed by neuropsychiatric inventory (NPI) questionnaires. The occurrence of BPSD subsyndromes was compared between patients with and without SED. RESULTS Two hundred sixty-three adult patients qualified for the inclusion criteria and were enrolled in this study. The mean age of patients was 80.2 years, and approximately 62% were women. 17.1% of patients showed SED on EEG. Apathy was the most commonly reported BPSD subsyndrome in this cohort. There was no significant difference in the prevalence of BPSD between patients with and without SED. (75.6% vs. 67.4%, p = 0.2806). However, the NPI score of irritability subsyndrome was significantly higher in the SED (+) group (2.6 ± 3.7 vs. 1.2 ± 2.7, p = 0.0028). In addition, subclinical epileptiform discharge in the frontal lobe was associated with a considerably higher occurrence of hyperactivity subsyndrome, including irritability. CONCLUSIONS SED may not be a direct cause of BPSD, but the presence of SED may affect the manifestation of BPSD.
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Affiliation(s)
- Wei-Chih Yeh
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuan-Ying Li
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Fang Chien
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Post-baccalaureate Medicine, Kaohsiung Medical, University, Kaohsiung, Taiwan
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Zhang Y, Ren R, Yang L, Zhang H, Shi Y, Vitiello MV, Sanford LD, Tang X. Patterns of polysomnography parameters in 27 neuropsychiatric diseases: an umbrella review. Psychol Med 2023; 53:4675-4695. [PMID: 36377491 DOI: 10.1017/s0033291722001581] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We provide an umbrella review of the reported polysomnographic changes in patients with neuropsychiatric diseases compared with healthy controls. METHODS An electronic literature search was conducted in EMBASE, MEDLINE, All EBM databases, CINAHL, and PsycINFO. Meta-analyses of case-control studies investigating the polysomnographic changes in patients with neuropsychiatric diseases were included. For each meta-analysis, we estimated the summary effect size using random effects models, the 95% confidence interval, and the 95% prediction interval. We also estimated between-study heterogeneity, evidence of excess significance bias, and evidence of small-study effects. The levels of evidence of polysomnographic changes in neuropsychiatric diseases were ranked as follows: not significant, weak, suggestive, highly suggestive, or convincing. RESULTS We identified 27 articles, including 465 case-control studies in 27 neuropsychiatric diseases. The levels of evidence of polysomnographic changes in neuropsychiatric diseases were highly suggestive for increased sleep latency and decreased sleep efficiency (SE) in major depressive disorder (MDD), increased N1 percentage, and decreased N2 percentage, SL and REML in narcolepsy, and decreased rapid eye movement (REM) sleep percentage in Parkinson's disease (PD). The suggestive evidence decreased REM latency in MDD, decreased total sleep time and SE in PD, and decreased SE in posttraumatic stress disorder and in narcolepsy. CONCLUSIONS The credibility of evidence for sleep characteristics in 27 neuropsychiatric diseases varied across polysomnographic variables and diseases. When considering the patterns of altered PSG variables, no two diseases had the same pattern of alterations, suggesting that specific sleep profiles might be important dimensions for defining distinct neuropsychiatric disorders.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Yang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Haipeng Zhang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Schiller K, von Ellenrieder N, Avigdor T, El Kosseifi C, Abdallah C, Minato E, Gotman J, Frauscher B. Focal epilepsy impacts rapid eye movement sleep microstructure. Sleep 2023; 46:zsac250. [PMID: 36242588 PMCID: PMC9905780 DOI: 10.1093/sleep/zsac250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/16/2022] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Katharina Schiller
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Hospital Group Ostallgaeu-Kaufbeuren, Department of Pediatrics, Kaufbeuren, Germany
- Medical University Innsbruck, Department of Pediatrics, Innsbruck, Austria
| | | | - Tamir Avigdor
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Charbel El Kosseifi
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Chifaou Abdallah
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Erica Minato
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Jean Gotman
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Department of Medicine and Center for Neuroscience Studies, Queen’s University; Kingston, Ontario, Canada
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Yeh WC, Hsu CY, Li KY, Chien CF, Huang LC, Yang YH. Association between Subclinical Epileptiform Discharge and the Severity of Cognitive Decline in Alzheimer’s Disease: A Longitudinal Cohort Study. J Alzheimers Dis 2022; 90:305-312. [DOI: 10.3233/jad-220567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Alzheimer’s disease (AD) is the most common type of dementia. Aging is a risk factor for both AD and seizures. Subclinical epileptiform discharge (SED) has no evident clinical manifestation in patients with AD. Therefore, SED is liable to be overlooked in these patients since electroencephalography is not routinely performed in clinical settings. Previous studies about the association between SED and AD have yielded inconsistent results. Objective: The current study aimed to evaluate the prevalence of SED and its effect on AD severity and clinical outcomes. Methods: Patients with AD from Kaohsiung Municipal Ta-tung Hospital were included in this study. International 10–20 system scalp electroencephalography for 13 minutes was performed to detect SED. Clinical outcomes of patients with and without SED were assessed by neuropsychological tests [Cognitive Abilities Screening Instrument (CASI), Mini-Mental State Examination (MMSE), and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB)]. Results: 288 patients (mean age 80.5 years, 60.4% female) were enrolled in this study. Fifty-seven (19.8%) out of 288 patients with AD had SED. The prevalence of SED increased with the severity of cognitive impairment. Compared with patients without SED, those with SED showed significantly greater decline in CASI (–9.32 versus –3.52 points, p = 0.0001) and MMSE (–2.52 versus –1.12 points, p = 0.0042) scores in one year. Conclusion: SED may play a significant role in AD progression and is a potential therapeutic target.
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Affiliation(s)
- Wei-Chih Yeh
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Ying Li
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ching-Fang Chien
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
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