目的:尽管有大量证据表明癫痫活动对非快速眼动(NREM)睡眠宏观和微观结构的影响,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),我们将锯齿波(STW)的整体和局灶性干扰作为局灶性癫痫患者REM睡眠的皮质产生的睡眠振荡进行了评估.
方法:22例耐药局灶性癫痫患者(13例女性;平均年龄,32.6±10.7岁;12名颞叶癫痫)和12名健康对照(3名女性;24.0±3.2岁)进行了夜间HD-EEG和多导睡眠图的联合检查。STW率,持续时间,频率,电源,空间范围,分析了IED率和睡眠稳态特性。
结果:与健康对照组相比,局灶性癫痫患者的STW发生率和持续时间降低(速率:0.64/min±0.46vs.1.12/min±0.41,p=.005,d=-0.98;持续时间:3.60s±0.76vs.4.57±1.00,p=.003,d=-1.01)。毫不奇怪,考虑到STW的正面-中央最大值,减少是由颞叶外癫痫患者驱动的(速率:0.45/min±0.31vs.1.12/min±0.41,p=.0004,d=-1.35;持续时间:3.49s±0.92vs.4.57±1.00,p=.017,d=-0.99),并且在第一个与最后一个睡眠周期(第一周期患者与对照:0.60/min±0.49vs.1.10/min±0.55,p=.016,d=-0.90,上一周期患者与对照:0.67/min±0.51vs.0.99/min±0.49,p=.11,d=-0.62;第一周期患者与对照:3.60s±0.76vs.4.57±1.00,p=.003,d=-1.01,最后一个周期持续时间患者与对照:3.66s±0.84vs.4.51±1.26,p=.039,d=-0.80)。癫痫灶与癫痫灶区域的STW没有区域减少对侧(所有p>0.05)。
结论:局灶性癫痫,特别是颞叶外癫痫患者在REM睡眠中表现出整体STW活性降低。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。
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.