目的:我们旨在调查耐药癫痫(DRE)儿童的睡眠,包括发育性和癫痫性脑病(DEE)。接下来,我们研究了控制良好的癫痫(WCE)患儿和DRE患儿在睡眠宏观结构和微观结构以及问卷结局方面的差异.此外,我们想找出与这些孩子睡眠不良相关的因素,因为一些因素可能是改善癫痫和神经发育结局的目标。
方法:在4至18岁儿童中进行了一项横断面研究。没有癫痫的儿童,WCE,和DRE都包括在内。隔夜脑电图(EEG),包括下巴肌电图和眼电图,为了允许睡眠分期,已执行。父母被要求填写一份睡眠问卷。手动进行经典的五阶段睡眠评分,主轴自动计数,计算慢波睡眠的第一个小时和最后一个小时的慢波活动(SWA)。
结果:一百八十二例患者包括:48例无癫痫,75与WCE,59与DRE我们发现患有DRE的儿童的睡眠效率(SE%)显着降低,在快速眼动(REM)睡眠中花费的时间更少,更少的睡眠纺锤波,与患有WCE的儿童相比,夜间SWA下降较低。护理人员报告了主观上更严重的睡眠问题,DRE儿童的白天嗜睡更多。最小绝对收缩和选择算子(LASSO)回归显示,多灶性发作间癫痫样放电(IED),苯二氮卓类药物治疗,持续时间较长的癫痫与较低的SE%和较低的REM睡眠时间相关。多灶性放电和脑瘫的存在与较少的纺锤体有关。苯二氮卓治疗,耐药性,睡觉时癫痫发作,智力残疾,年龄和年龄与较低的SWA下降相关。
结论:DRE儿童的睡眠宏观结构和微观结构均受到严重影响,包括那些有DEE的。癫痫参数在REM睡眠中断中起着独特的作用,主轴计数,和SWA下降。
OBJECTIVE: We aimed to investigate sleep in children with drug-resistant epilepsy (DRE), including developmental and epileptic encephalopathies (DEEs). Next, we examined differences in sleep macrostructure and microstructure and questionnaire outcomes between children with well-controlled epilepsy (WCE) and children with DRE. Furthermore, we wanted to identify factors associated with poor sleep outcome in these children, as some factors might be targets to improve epilepsy and neurodevelopmental outcomes.
METHODS: A cross-sectional study was conducted in children 4 to 18-years-old. Children without epilepsy, with WCE, and with DRE were included. Overnight electroencephalography (EEG), including chin electromyography and electrooculography, to allow sleep staging, was performed. Parents were asked to fill out a sleep questionnaire. Classical five-stage sleep scoring was performed manually, spindles were automatically counted, and slow wave activity (SWA) in the first and last hour of slow wave sleep was calculated.
RESULTS: One hundred eighty-two patients were included: 48 without epilepsy, 75 with WCE, and 59 with DRE. We found that children with DRE have significantly lower sleep efficiency (SE%), less time spent in rapid eye movement (REM) sleep, fewer sleep spindles, and a lower SWA decline over the night compared to children with WCE. Subjectively more severe sleep problems were reported by the caregivers and more daytime sleepiness was present in children with DRE. Least absolute shrinkage and selection operator (LASSO) regression showed that multifocal interictal epileptiform discharges (IEDs), benzodiazepine treatment, and longer duration of epilepsy were associated with lower SE% and lower REM sleep time. The presence of multifocal discharges and cerebral palsy was associated with fewer spindles. Benzodiazepine treatment, drug resistance, seizures during sleep, intellectual disability, and older age were associated with lower SWA decline.
CONCLUSIONS: Both sleep macrostructure and microstructure are severely impacted in children with DRE, including those with DEEs. Epilepsy parameters play a distinct role in the disruption REM sleep, spindle count, and SWA decline.