Patients with Drug-resistant Epilepsy Exhibit an Impaired Autonomic Cardiac Arousal Response Following Sleep Apnea
Abstract number :
1.27
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2022
Submission ID :
2203987
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:22 AM
Authors :
Sylvain RHEIMS, MD, PhD – Hospices Civils de Lyon; François Ricordeau, MD – Sleep Medicine and Respiratory Disease Centre, Croix-Rousse Hospital, CHU of Lyon, 69004 Lyon, France – Hospices Civils de Lyon; Emeric Stauffer, MD – Sleep Medicine and Respiratory Disease Centre, Croix-Rousse Hospital, CHU of Lyon, 69004 Lyon, France – Hospices Civils de Lyon; Helene Bastuji, MD – Sleep Medicine and Respiratory Disease Centre, Croix-Rousse Hospital, CHU of Lyon, 69004 Lyon, France – Hospices Civils de Lyon; Elena Charbonnier, MD – Sleep Medicine and Respiratory Disease Centre, Croix-Rousse Hospital, CHU of Lyon, 69004 Lyon, France – Hospices Civils de Lyon; Frederic Gormand, MD – Center for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, Lyon 1 University, Lyon F-69000, France.; Thierry Petitjean, MD – Sleep Medicine and Respiratory Disease Centre, Croix-Rousse Hospital, CHU of Lyon, 69004 Lyon, France – Hospices Civils de Lyon; Vincent Pichot, MD – Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France.; INSERM SAINBIOSE U1059, DVH, Jean Monnet University, Saint Etienne, France.; Frederic Roche, MD PhD – Clinical Physiology, Visas Center, University Hospital, Saint-Etienne, France.; INSERM SAINBIOSE U1059, DVH, Jean Monnet University, Saint Etienne, France.; Florian Chouchou, MD – Irisse Laboratory (ea4075), Ufr She, Réunion University- Le Tampon (France),; laure Peter Derex, MD PhD – Sleep Medicine and Respiratory Disease Centre, Croix-Rousse Hospital, CHU of Lyon, 69004 Lyon, France – Hospices Civils de Lyon
Rationale: Most sudden and unexpected deaths in epilepsy (SUDEP) are triggered by a generalized convulsive seizure occurring during sleep and might primarily result from post-ictal respiratory dysfunction. Whether or not patients with epilepsy might develop impaired apnea-related arousing response is unknown. To address this issue, we compared arousal responses to respiratory events in patients with drug-resistant epilepsy (DRE), patients with drug-sensitive epilepsy (DSE), and control subjects. _x000D_
Methods: Patients DRE or DSE and obstructive sleep apnea (OSA), and patients with OSA without epilepsy (controls) were retrospectively identified among the polysomnography database of the Center for Sleep Medicine and Respiratory Disease of Lyon from January 2017 to September 2020. The three groups were matched for age, sex, BMI and apnea-hypopnea index (AHI). The physiological response to airflow reduction was explored using the cortical arousal index/AHI ratio and an index assessing the respiratory arousal threshold, based on the nadir oxygen saturation, the AHI, and the fraction of hypopnea among respiratory events.1 The cardiac autonomic response to respiratory events was quantified as percentages of changes (20 s after arousal onset) from the baseline (10 s before arousal onset) in RR intervals, high frequency (HF) and low frequency (LF) power, and LF/HF ratio. _x000D_
Results: Sixty patients with obstructive sleep apnea (OSA) were included: 20 controls, 20 DRE, and 20 DSE. No inter-group difference was found for parameters exploring cortical arousal response nor for the respiratory arousal threshold. The decrease in RR intervals was lower for DRE (6.5%) than DSE (9%, p< 0.05) and controls (10%, p< 0.05). Epilepsy patients showed a higher early sympathetic response (LF/HF increase: 115% for DRE and 130% for DSE vs. 80% for controls, p< 0.05). Late parasympathetic activation (HF power increase) was higher in DRE (65%) than DSE (50%, p< 0.05) and controls (32%, p< 0.05). _x000D_
Cormorbidity (Somatic and Psychiatric)