Purpose: The link existing between epilepsy and sleep is widely recognized. In particular, in Idiopathic Generalized Epilepsies (IGE), a close link of seizures to the sleep–wake cycle has been demonstrated. However, little is known about the prevalence and the clinical consequences of the comorbidity between focal and generalized epilepsy and sleep disorders, especially those sleep phenomena classified as isolated symptoms or normal variants. Objective of the study was to evaluate the frequency of sleep disorders and physiological sleep variants in a group of adult patients with focal and generalized epilepsy as compared to healthy controls by means of nocturnal polysomnography. Methods: We performed a retrospective observational study in the Neurological Clinic of the University of Catania. We studied patients with diagnosis of focal epilepsy, IGE and controls without epilepsy who underwent a polysomnography in the 2015-2019 period. Exclusion criteria were: obstructive sleep apnoea syndrome and epileptic encephalopathy. The following sleep disorders were considered: NREM-related parasomnias; REM-related parasomnias; sleep-related movement disorders; isolated symptoms or normal variants. Results: Focal epilepsy: 100 patients (mean age 30.3 ± 14.7 years, 40 [40%] men) and 62 controls (mean age 36.4 ± 15.9 years, 20 [32.2%] men) were studied. A significant higher percentage of sleep disorders was recorded in patients as compared to controls (73% vs 48.4%; p=0.002). In particular, we found a higher frequency of periodic limb movements (PLM) (20% vs 4.8%; p=0.007), bruxism (20% vs 4.8%; p=0.007) and neck myoclonus (22% vs 4.8%; p=0.003). Idiopathic Generalized Epilepsy: 35 patients with IGE (mean age 28.8 ± 13.1 years, 11 [31.4%] men) and 56 controls without epilepsy (mean age 32.8 ± 11.5 years, 18 [32.1%] men) were studied. A significant higher percentage of sleep disorders was found in patients (82.9% vs 50%, p=0.002) compared to controls. In particular, we found a higher frequency of disorders of arousal (60% vs 30.3%; p=0.01), bruxism (28.6% vs 5.4%; p<0.01) and neck myoclonus (25.7% vs 5.4%; p<0.01). Conclusion: Our study demonstrated a high frequency of sleep disorders in patients with both focal and generalized epilepsy. Although it can be due to different underlying physiopathological mechanisms, this comorbidity should be taken into account in order to ensure an optimal seizures control in these patients.
Obiettivo: il legame esistente tra epilessia e sonno è ampiamente riconosciuto. In particolare, nelle epilessie generalizzate idiopatiche, è stato dimostrato uno stretto legame tra le crisi ed il ciclo sonno-veglia. Tuttavia, poco si sa circa la prevalenza e le conseguenze cliniche della comorbidità tra epilessia focale e generalizzata e disturbi del sonno, in particolare quei fenomeni del sonno classificati come sintomi isolati o varianti normali. Obiettivo dello studio è stato di valutare la frequenza dei disturbi del sonno e varianti fisiologiche del sonno in un gruppo di pazienti adulti con epilessia focale e generalizzata rispetto ai controlli sani mediante polisonnografia notturna. Metodi: abbiamo effettuato uno studio osservazionale retrospettivo presso la Clinica Neurologica dell'Università degli Studi di Catania. Abbiamo valutato pazienti con diagnosi di epilessia focale, epilessia generalizzata idiopatica e controlli senza epilessia sottoposti a polisonnografia nel periodo 2015-2019. Criteri di esclusione erano: sindrome delle apnee ostruttive in sonno ed encefalopatia epilettica. Sono stati considerati i seguenti disturbi del sonno: parasonnie del sonno NREM; parasonnie del sonno REM; disturbi del movimento legati al sonno; sintomi isolati o varianti normali. Risultati: Epilessia focale: sono stati studiati 100 pazienti (età media 30,3 ± 14,7 anni, 40 [40%] uomini) e 62 controlli (età media 36,4 ± 15,9, 20 [32,2%] uomini). Una percentuale significativamente più alta di disturbi del sonno è stata registrata nei pazienti rispetto ai controlli (73% vs 48,4%; p = 0,002). In particolare, abbiamo riscontrato una maggiore frequenza di movimenti periodici agli arti (PLM) (20% vs 4,8%; p = 0,007), bruxismo (20% vs 4,8%; p = 0,007) e mioclono del collo (22% vs 4,8%; p = 0,003). Epilessia generalizzata idiopatica: 35 pazienti (età media 28,8 ± 13,1 anni, 11 [31,4%] uomini) e 56 controlli senza epilessia (età media 32,8 ± 11,5 anni, 18 [32,1%] uomini) sono stati studiati. Una percentuale significativamente più alta di disturbi del sonno è stata riscontrata nei pazienti (82,9% vs 50%, p = 0,002) rispetto ai controlli. In particolare, abbiamo riscontrato una maggiore frequenza di parasonnie NREM (60% vs 30,3%; p = 0,01), bruxismo (28,6% vs 5,4%; p <0,01) e mioclono del collo (25,7% vs 5,4%; p <0,01). Conclusioni: il nostro studio ha dimostrato una elevata frequenza di disturbi del sonno in pazienti con epilessia focale e generalizzata. Sebbene possa essere dovuto a diversi meccanismi fisiopatologici sottostanti, questa comorbilità dovrebbe essere presa in considerazione al fine di garantire un controllo ottimale delle crisi in questi pazienti.
Parasonnie, disturbi del movimento legati al sonno e varianti fisiologiche del sonno in epilessia: una reciproca relazione? / Giuliano, Loretta. - (2021 Nov 22).
Parasonnie, disturbi del movimento legati al sonno e varianti fisiologiche del sonno in epilessia: una reciproca relazione?
GIULIANO, LORETTA
2021-11-22
Abstract
Purpose: The link existing between epilepsy and sleep is widely recognized. In particular, in Idiopathic Generalized Epilepsies (IGE), a close link of seizures to the sleep–wake cycle has been demonstrated. However, little is known about the prevalence and the clinical consequences of the comorbidity between focal and generalized epilepsy and sleep disorders, especially those sleep phenomena classified as isolated symptoms or normal variants. Objective of the study was to evaluate the frequency of sleep disorders and physiological sleep variants in a group of adult patients with focal and generalized epilepsy as compared to healthy controls by means of nocturnal polysomnography. Methods: We performed a retrospective observational study in the Neurological Clinic of the University of Catania. We studied patients with diagnosis of focal epilepsy, IGE and controls without epilepsy who underwent a polysomnography in the 2015-2019 period. Exclusion criteria were: obstructive sleep apnoea syndrome and epileptic encephalopathy. The following sleep disorders were considered: NREM-related parasomnias; REM-related parasomnias; sleep-related movement disorders; isolated symptoms or normal variants. Results: Focal epilepsy: 100 patients (mean age 30.3 ± 14.7 years, 40 [40%] men) and 62 controls (mean age 36.4 ± 15.9 years, 20 [32.2%] men) were studied. A significant higher percentage of sleep disorders was recorded in patients as compared to controls (73% vs 48.4%; p=0.002). In particular, we found a higher frequency of periodic limb movements (PLM) (20% vs 4.8%; p=0.007), bruxism (20% vs 4.8%; p=0.007) and neck myoclonus (22% vs 4.8%; p=0.003). Idiopathic Generalized Epilepsy: 35 patients with IGE (mean age 28.8 ± 13.1 years, 11 [31.4%] men) and 56 controls without epilepsy (mean age 32.8 ± 11.5 years, 18 [32.1%] men) were studied. A significant higher percentage of sleep disorders was found in patients (82.9% vs 50%, p=0.002) compared to controls. In particular, we found a higher frequency of disorders of arousal (60% vs 30.3%; p=0.01), bruxism (28.6% vs 5.4%; p<0.01) and neck myoclonus (25.7% vs 5.4%; p<0.01). Conclusion: Our study demonstrated a high frequency of sleep disorders in patients with both focal and generalized epilepsy. Although it can be due to different underlying physiopathological mechanisms, this comorbidity should be taken into account in order to ensure an optimal seizures control in these patients.File | Dimensione | Formato | |
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