Epilepsy and Sleep Apnea Syndrome
Introduction. The reciprocal influence between Epilepsy and Sleep Apnea Syndrome (SAS/OSAS) may aggravate the prognosis of both processes. Hypoxemia during sleep in patients with SAS and sleep fragmentation as a consequence of periodic apneas, that provokes a chronic sleep deprivation, could decrease the convulsive threshold in epileptic patients. Material and methods. We have carried out a descriptive and retrospective study in 20 patients with epilepsy and SAS, of which EEG recordings, video-polysomnography (PSG) and nocturnal oximetry were available. Results. 90% were males. 75% had partial epilepsies and 25% generalized. The mean duration of epilepsy was 14.5 years. The mean seizures frequency was one per month. 35% had nocturnal seizures, 15% diurnal and 50% of the patients had diurnal and nocturnal seizures. Other symptoms associated with seizures were: Snoring (100%), daytime sleepiness (70%), nocturnal respiratory pauses (30%), arterial hypertension (30%), overweight (25%) and morning headache (15%). The PSG showed epileptic interictal discharges in 95% of the cases, focal in 80%, and a disturbance of the sleep architecture, with a decreased sleep efficiency and continuity. The mean hypopnea-apnea index was 38. Conclusions. The association Epilepsy-SAS in adult patients affected of localized epilepsy, with risk factors for SAS (male gender, obesity, snoring, adverse effects of drugs) must be taken into account and a video-PSG-oximetric study is indicated to confirm it. It should be noted that anticonvulsant therapy could cause breathing dysfunction during sleep or aggravate a pre-existing or latent SAS. It be expected that the satisfactory treatment of SAS could improve the control of the seizures in these patients
Resultados El 90% correspondieron al sexo masculino. El 75% de los pacientes presentaban epilepsias parciales y 25% generalizadas. La duración media de la epilepsia fue de 14,5 años. La periodicidad media de las crisis fue de una mensual. Un 35% tuvieron crisis sólo nocturnas, un 15% sólo diurnas y 50% diurnas y nocturnas. Otros síntomas asociados a las crisis fueron: ronquido (100%), somnolencia diurna (70%), pausas respiratorias nocturnas (30%), hipertensión arterial (30%), sobrepeso (25%) y cefalea matutina (15%). Los PSG mostraron anomalías paroxísticas intercríticas en el 95% de los casos, focales en el 80%, y una perturbación de la estructura del sueño, con una disminución de su eficiencia y de su continuidad. El índice de hipopnea-apnea (IHA) medio fue de 38.
Conclusiones La asociación epilepsia-SAS en adultos con epilepsia focal y factores de riesgo para el SAS se debe tener en consideración y confirmarla mediante un estudio vídeo-PSG-pulsioximétrico. La terapia anticonvulsiva podría provocar una disfunción respiratoria en un paciente epiléptico o agravar un SAS latente. Es de esperar que el tratamiento adecuado del SAS pueda mejorar el control de las crisis en estos enfermos
