Effect of Sleep Apnea on Epilepsy

OSA causes disruption and fragmentation of night sleep with intermittent hypox-emia. This provokes a state of chronic sleep deprivation that could decrease the seizure threshold in epileptic patients such that mild or even asymptomatic OSA might cause seizure exacerbation. Further, it is possible that epileptic patients have a low tolerance for intermittent hypoxemia thereby acting as a potential trigger for seizures in susceptible individuals. Also, disruption and fragmentation of the sleep architecture caused by the respiratory events provides a substrate for frequent transitional sleep states, for example, sleep stage changes, and arousals, which also activate epileptogenesis in susceptible individuals. Thus coexistent sleep apnea in patients with epilepsy can worsen seizure frequency, be responsible for poor response to conventional antiseizure medications and even lead to refractory seizures. Additionally, OSA can contribute further to impairment in daytime functions and quality of life.

Several investigators have reported the coexistence between sleep apnea and epilepsy in adults (11-16) and in neurodevelopmentally challenged children (17,18). Malow et al. (13) studied 39 candidates for epilepsy surgery without a history of OSA and diagnosed OSA by polysomnography (PSG) in one-third of the subjects, of which 13% had moderate-to-severe sleep apnea. Further, they suggested that OSA in patients with epilepsy was more common especially among men, older subjects, and those with seizures during sleep. In a larger study on 283 adult epilepsy patients, Manni et al. (19) reported a prevalence of polysomnographically proven OSA in 10.2% epilepsy patients, with mild sleep apnea in 66%, moderate in 22.2% and severe in 11.1% of the cases. They also suggested that "epilepsy + OSA" patients were older, heavier, more frequently male, and sleepier than those with "epilepsy only." de Almeida et al. (20) studied 39 patients with temporal lobe epilepsy and found OSA in 13% patients by PSG. Sonka et al. (21) did a retrospective survey of consecutive 480 adult patients with sleep apnea and reported a 4% incidence of new onset epilepsy (at least 2 seizures) in adults with 10 or more apneas per hour of sleep. The average age at first seizure was 48 years and notably, 79% had exclusively nocturnal seizures. The retrospective survey by Chokroverty et al. (16) of 478 adult patients with PSG diagnosis of OSA provided a figure of 6% with comorbid epilepsy and sleep apnea.

Sleep Apnea

Sleep Apnea

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