Non-rapid eye movement sleep instability in adults with epilepsy: a systematic review and meta-analysis of cyclic alternating pattern

Sleep

article

Yeh, Wei-Chih¹  Lin, Huan-Jan³  Li, Ying-Sheng²  Chien, Ching-Fang¹  Wu, Meng-Ni²  Liou, Li-Min²  Hsieh, Cheng-Fang²  Hsu, Chung-Yao² 

[1] Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital;Department of Neurology, Sleep Disorders Center, Kaohsiung Medical University Hospital;Department of Neurology, E-DA Hospital;College of medicine, I-Shou University;Department of Neurology, College of Medicine, Kaohsiung Medical University;Department of Internal Medicine, Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital

关键词: cyclic alternating pattern;    epilepsy;    non-rapid eye movement sleep;    sleep instability;    sleep microstructure;   

DOI  :  10.1093/sleep/zsac041

学科分类：生理学

来源: American Academy of Sleep Medicine

【 摘 要 】

Study Objectives Epilepsy is characterized by disrupted sleep architecture. Studies on sleep macro- and microstructure revealed that patients with epilepsy experience disturbed rapid eye movement (REM) sleep; however, no consensus has been reached on non-REM (NREM) sleep changes. Cyclic alternating pattern (CAP) is a marker of sleep instability that occurs only during NREM sleep. This meta-analysis investigated CAP differences between patients with epilepsy and healthy controls.Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines in searching PubMed, Embase, and Cochrane Central database for studies comparing polysomnographic sleep microstructures between patients with epilepsy and healthy controls. A meta-analysis using a random-effects model was performed. We compared CAP rates, percentages of phase A1, A2, A3 subtypes, and phase B durations between patients with epilepsy and healthy controls.Results A total of 11 studies, including 209 patients with epilepsy and 197 healthy controls, fulfilled the eligibility criteria. Compared with healthy controls, patients with epilepsy had significantly increased CAP rates and decreased A1 subtype percentages, and patients with sleep-related epilepsy had increased A3 subtype percentages. Subgroup analyses revealed that antiseizure medications (ASMs) decreased CAP rates and increased phase B durations but did not affect the microstates of phase A in patients with sleep-related epilepsy.Conclusions This meta-analysis detected statistically significant differences in CAP parameters between patients with epilepsy and healthy controls. Our findings suggest patients with epilepsy experience NREM sleep instability. ASMs treatment may decrease NREM instability but did not alter the microstates of phase A.

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