Routine polysomnography in an epilepsy monitoring unit

Phillips, Matthew; Costello, Craig; White, Elise; Smit, Michelle; Carino, John; Strawhorn, Andrew; Jackson, Brianna; Kwan, Patrick; French, Chris; Yerra, Sandeep; Tan, K. Meng; O’Brien, Terence J.; Goldin, Jeremy

doi:10.1016/j.eplepsyres.2013.02.015

Cited by 27 publications

(15 citation statements)

References 12 publications

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“…Thirty‐five percent of refractory epilepsy patients in our cohort had pOSA by oximetry, and an even higher 39% of patients had pOSA by either oximetry or one of the screening tools. The relatively high frequency of comorbid pOSA in our cohort is similar to prior studies of refractory epilepsy using polysomnography that reported OSA frequencies of 22%‐30% . Another study comparing polysomnographic variables between refractory and well‐controlled epilepsy patients found that 20% of refractory epilepsy patients had an apnea‐hypopnea index of >5/h, whereas no well‐controlled epilepsy patient had OSA .…”

Section: Discussionsupporting

confidence: 86%

“…15,16 The frequency of comorbid OSA in various epilepsy cohorts has been estimated to range between approximately 10% and 30%, and is more frequent in those with refractory epilepsy. [17][18][19][20] Although it is unclear whether the association between SCD and OSA is relevant to the likely distinct neurocardiorespiratory factors and events thought to mediate SUDEP, there are parallels between these entities in that both SCD and refractory epilepsy have a distinctive link to sleep, implying that OSA might promote sudden death in either case, or alternatively, that OSA may potentiate underlying risk factors and pathophysiologic factors underlying SUDEP. We aimed to determine the frequency of comorbid OSA and utility of screening instruments for detecting OSA in our refractory monitored epilepsy population, and to determine whether OSA is associated with SUDEP risk profile.…”

Section: Key Pointsmentioning

confidence: 99%

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Obstructive sleep apnea in refractory epilepsy: A pilot study investigating frequency, clinical features, and association with risk of sudden unexpected death in epilepsy

et al. 2018

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Summary: Objective: We aimed to determine the frequency of probable obstructive sleep apnea (pOSA) in refractory epilepsy monitoring unit inpatients and clinical features associated with pOSA, including risk for Sudden Unexpected Death in Epilepsy (SUDEP). Methods: We prospectively recruited 49 consecutive adult patients admitted to the Mayo Clinic Epilepsy Monitoring Unit with focal, generalized or unclassified epilepsy syndromes. pOSA was identified using oximetric oxyhemoglobin desaturation index (ODI) and the Sleep Apnea-Sleep Disorders Questionnaire (SA-SDQ) and STOP-BAG screening tools. Revised SUDEP-7 (rSUDEP-7) risk inventory scores were calculated, and epilepsy patients with and without pOSA were compared with Wilcoxon signed rank tests. Correlation and regression analyses were utilized to determine relationships between pOSA and rSUDEP-7 scores. Results: Thirty-five percent of patients had pOSA with a mean ODI of 11.3 ± 5.1/hour (range 5.1–22.8). Patients with pOSA were older, heavier, and more frequently had a focal epilepsy syndrome and longer epilepsy duration, with higher SA-SDQ and STOP-BAG scores (all p<0.05). Median rSUDEP-7 score was 3 ± 1.4 (0–6). Higher rSUDEP-7 scores were positively correlated with higher ODI (p=0.036). rSUDEP-7 score ≥ 5 was associated with pOSA by ODI, SA-SDQ, and STOP-BAG questionnaire criteria (p<0.05). Significance: Our pilot study identified a high frequency of probable OSA in refractory epilepsy monitoring patients, finding that probable OSA patients were older, heavier, with higher screening symptoms for sleep apnea and more frequent focal seizures with a longer epilepsy duration. We also found a possible association between OSA and SUDEP risk. Identification and treatment of OSA in patients with epilepsy could conceivably provide a novel approach toward preventing the risk of SUDEP. Future studies with polysomnography are needed to confirm predictive features for OSA in epilepsy populations, and to determine whether OSA is associated with SUDEP risk.

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Section: Discussionsupporting

confidence: 86%

Section: Key Pointsmentioning

confidence: 99%

Obstructive sleep apnea in refractory epilepsy: A pilot study investigating frequency, clinical features, and association with risk of sudden unexpected death in epilepsy

et al. 2018

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“…We believe that our setting, also including concomitant EEG polysomnographic recordings for selected patients [23], may have enhanced some referrals from the sleep medicine field, as well as the diagnosis of sleep disorders, such as parasomnias, which was not the case in the majority of other studies.…”

Section: Discussionmentioning

confidence: 95%

Diagnostic yield of short-term video-EEG monitoring for epilepsy and PNESs: A European assessment

Bettini

Croquelois

Maeder-Ingvar

et al. 2014

Epilepsy & Behavior

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“…A high prevalence of OSA has been reported among patients with epilepsy (6,7). OSA is a common comorbidity among adults with late-onset or worsening seizures (7).…”

Section: Discussionmentioning

confidence: 99%