Schlafstörungen bei Epilepsie

Zusammenfassung

Die Epilepsie und epileptische Anfälle haben einen signifikanten und nachhaltigen Effekt auf den Schlaf von Epilepsiepatienten. Nächtliche generalisierte tonisch-klonische Anfälle, aber auch multiple fokal-komplexe Anfälle führen zu einer Störung der Schlafarchitektur sowie zu einer vermehrten Tagesmüdigkeit. Zudem ist kein REM-Rebound in den nachfolgenden Nächten zu beobachten. Unabhängig von den Anfällen führt der chronische epileptische Zustand – insbesondere bei Patienten mit fokalen Epilepsien – zu Störungen der Schlafarchitektur. Epilepsiepatienten leiden im Vergleich zur Allgemeinbevölkerung an einer 2- bis 3-fach erhöhten Prävalenz von subjektiv empfundenen Schlafstörungen. Schlafstörungen sind zudem mit einer signifikanten Beeinträchtigung der Lebensqualität assoziiert. Auch Kinder mit Epilepsie leiden häufiger an Schlafstörungen als gesunde Kinder, wobei eine schlechte Schlafqualität wiederum zu Verhaltensproblemen und einer schlechteren Lebensqualität führt. Eine vermehrte Tagesmüdigkeit stellt mit einer Prävalenz von 30–50% die häufigste schlafbezogene Störung bei Epilepsiepatienten dar und konnte auch mit objektiven Tests nachgewiesen werden. Obstruktive Schlaf-Apnoen (OSA) treten bei Epilepsiepatienten mit einer Prävalenz von 10–33% signifikant häufiger auf als in der Allgemeinbevölkerung. Als mögliche Mechanismen sind die Effekte von zentral dämpfenden Antiepileptika, eine durch Antiepileptika verursachte Gewichtszunahme und das gehäufte Vorliegen eines polyzystischen Ovar-Syndroms bei Frauen mit Epilepsie anzuführen. Eine OSA kann mit einer Exazerbation von Anfällen einhergehen. Umgekehrt kann die erfolgreiche Behandlung einer OSA zu einer Verbesserung der Anfallskontrolle führen.

Abstract

Epilepsy and seizures exert a significant and enduring effect on sleep in epilepsy patients. Nocturnal generalised tonic-clonic seizures as well as multiple complex partial seizures distort sleep architecture and result in excessive daytime sleepiness. There is a lack of REM rebound in the successive nights. Furthermore, the chronic epileptic condition especially in focal epilepsy causes a disturbed sleep architecture independently of seizures. Epilepsy patients suffer from a 2- to 3-fold increased prevalence of subjective sleep disturbances as compared to the general population. Sleep disturbances are associated with a significant impairment in quality of life. Children with epilepsy suffer from sleep prob-lems more often than healthy children. Sleep impairment in children with epilepsy causes behavioural problems and reduced quality of life. With a prevalence of 30–50% excessive daytime sleepiness represents the most frequent sleep-related disturbance in epilepsy patients and could be documented with objective tests. Obstructive sleep apnea (OSA) occurs in 10–33% of epilepsy patients and thus significantly more often than in the general population. Possible mechanisms include the effects of central nervous system depressant antiepileptic drugs, weight gain in-duced by antiepileptic drugs and the increased incidence of polycystic ovary syndrome in women with epilepsy. OSA can lead to an exacerbation of seizures. On the contrary, successful treatment of OSA results in improved seizure control.

Schlaf - Epilepsie - obstruktive Schlafapnoe - exzessive Tagesmüdigkeit

sleep - epilepsy - obstructive sleep apnea - excessive daytime sleepiness

Literatur

• 1 Mendez M, Radtke RA. Interactions between sleep and epilepsy.  J Clin Neurophysiol. 2001;  18 106-127
• 2 Vaughn BV, D’Cruz OF. Sleep and epilepsy.  Semin Neurol. 2004;  24 301-313
• 3 Foldvary-Schaefer N, Grigg-Damberger M. Sleep and epilepsy: what we know, don't know, and need to know.  J Clin Neurophysiol. 2006;  23 4-20
• 4 Fere L. Les epilepsies and les epileptiques. Alcan, Paris 1890
• 5 Janz D. The grand mal epilepsies and the sleep-waking cycle.  Epilepsia. 1962;  3 69-109
• 6 Christian W. Bioelektrische Charakteristik tages-periodisch gebundener Verlaufsformen epileptischer Erkrankungen.  Dtsch Z Nervenheilkd. 1960;  181 413-444
• 7 Christian W. Schlaf-Wach-Periodik bei Schlaf- und Aufwachepilepsien.  Nervenarzt. 1961;  32 266-275
• 8 Shouse MN, da Silva AM, Sammaritano M. Circadian rhythm, sleep, and epilepsy.  J Clin Neurophysiol. 1996;  13 32-50
• 9 Cohen HB, Dement WC. Sleep: suppression of rapid eye movement phase in the cat after electroconvulsive shock.  Science. 1966;  154 396-398
• 10 Rondouin G, Baldy-Moulinier M, Passouant P. The influence of hippocampal kindling on sleep organization in cats. Effects of alpha-methylparatyrosine.  Brain Res. 1980;  181 413-424
• 11 Raol YH, Meti BL. Sleep-wakefulness alterations in amygdala-kindled rats.  Epilepsia. 1998;  39 1133-1137
• 12 Tanaka T, Naquet R. Epilepsy and sleep organization in the baboon Papio papio.  Electroencephalogr Clin Neurophysiol. 1976;  41 580-586
• 13 Touchon J, Baldy-Moulinier M, Billiard M. et al . Sleep organization and epilepsy.  Epilepsy Res Suppl. 1991;  2 73-81
• 14 Bazil CW, Walczak TS. Effects of sleep and sleep stage on epileptic and nonepileptic seizures.  Epilepsia. 1997;  38 56-62
• 15 Nunes ML, Ferri R, Arzimanoglou A. et al . Sleep organization in children with partial refractory epilepsy.  J Child Neurol. 2003;  18 763-766
• 16 Silvestri AJ, Kapp BS. Amygdaloid modulation of mesopontine peribrachial neuronal activity: implications for arousal.  Behav Neurosci. 1998;  112 571-588
• 17 Malow BA, Lin X, Kushwaha R. et al . Interictal spiking increases with sleep depth in temporal lobe epilepsy.  Epilepsia. 1998;  39 1309-1316
• 18 Marzec ML, Malow BA. Approaches to staging sleep in polysomnographic studies with epileptic activity.  Sleep Med. 2003;  4 409-417
• 19 Hoeppner JB, Garron DC, Cartwright RD. Self-reported sleep disorder symptoms in epilepsy.  Epilepsia. 1984;  25 434-437
• 20 Malow BA, Bowes RJ, Lin X. Predictors of sleepiness in epilepsy patients.  Sleep. 1997;  20 1105-1110
• 21 Weerd A de, Haas S de, Otte A. et al . Subjective sleep disturbance in patients with partial epilepsy: a questionnaire-based study on prevalence and impact on quality of life.  Epilepsia. 2004;  45 1397-1404
• 22 Alanis-Guevara I, Pena E, Corona T. et al . Sleep disturbances, socioeconomic status, and seizure control as main predictors of quality of life in epilepsy.  Epilepsy Behav. 2005;  7 481-485
• 23 Xu X, Brandenburg NA, MacDermott AM. et al . Sleep disturbances reported by refractory partial-onset epilepsy patients receiving polytherapy.  Epilepsia. 2006;  47 1176-1183
• 24 Khatami R, Zutter D, Siegel A. et al . Sleep-wake habits and disorders in a series of 100 adult epilepsy patients – a prospective study.  Seizure. 2006;  15 299-306
• 25 Piperidou C, Karlovasitou A, Triantafyllou N. et al . Influence of sleep disturbance on quality of life of patients with epilepsy.  Seizure. 2008;  17 588-594
• 26 Cortesi F, Giannotti F, Ottaviano S. Sleep problems and daytime behavior in childhood idiopathic epilepsy.  Epilepsia. 1999;  40 1557-1565
• 27 Wirrell E, Blackman M, Barlow K. et al . Sleep disturbances in children with epilepsy compared with their nearest-aged siblings.  Dev Med Child Neurol. 2005;  47 754-759
• 28 Maganti R, Hausman N, Koehn M. et al . Excessive daytime sleepiness and sleep complaints among children with epilepsy.  Epilepsy Behav. 2006;  8 272-277
• 29 Williams J, Lange B, Sharp G. et al . Altered sleeping arrangements in pediatric patients with epilepsy.  Clin Pediatr (Phila). 2000;  39 635-642
• 30 Lannon SL, Vaughn BV. Sleep hygiene in people with epilepsy.  Epilepsia. 1997;  38 227
• 31 Manni R, Politini L, Ratti MT. et al . Sleep hygiene in adult epilepsy patients: a questionnaire-based survey.  Acta Neurol Scand. 2000;  101 301-304
• 32 Kobau R, DiIorio C. Epilepsy self-management: a comparison of self-efficacy and outcome expectancy for medication adherence and lifestyle behaviors among people with epilepsy.  Epilepsy Behav. 2003;  4 217-225
• 33 Collaborative Group for Epidemiology of Epilepsy . Adverse reactions to antiepileptic drugs: a multicenter survey of clinical practice.  Epilepsia. 1986;  27 323-330
• 34 Mattson RH, Cramer JA, Collins JF. A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group.  N Engl J Med. 1992;  327 765-771
• 35 Weintraub DB, Resor SR, Bazil CW. et al . Head to head comparison of sedating effect of antiepileptic drugs.  Neurology. 2005;  64 A22-A23
• 36 Jenssen S, Gracely E, Mahmood T. et al . Subjective somnolence relates mainly to depression among patients in a tertiary care epilepsy center.  Epilepsy Behav. 2006;  9 632-635
• 37 Drake Jr ME, Weate SJ, Newell SA. et al . Multiple sleep latency tests in epilepsy.  Clin Electroencephalogr. 1994;  25 59-62
• 38 Manni R, Ratti MT, Galimberti CA. et al . Daytime sleepiness in epileptic patients on long-term monotherapy: MSLT, clinical and psychometric assessment.  Neurophysiol Clin. 1993;  23 71-76
• 39 Manni R, Ratti MT, Perucca E. et al . A multiparametric investigation of daytime sleepiness and psychomotor functions in epileptic patients treated with phenobarbital and sodium valproate: a comparative controlled study.  Electroencephalogr Clin Neurophysiol. 1993;  86 322-328
• 40 Barzaghi N, Gatti G, Manni R. et al . Time-dependent pharmacodynamic effects of phenobarbital in humans.  Ther Drug Monit. 1989;  11 661-666
• 41 Bonanni E, Massetani R, Galli R. et al . A quantitative study of daytime sleepiness induced by carbamazepine and add-on vigabatrin in epileptic patients.  Acta Neurol Scand. 1997;  95 193-196
• 42 Bonanni E, Galli R, Maestri M. et al . Daytime sleepiness in epilepsy patients receiving topiramate monotherapy.  Epilepsia. 2004;  45 333-337
• 43 Bonanni E, Galli R, Gori S. et al . Neurophysiological evaluation of vigilance in epileptic patients on monotherapy with lamotrigine.  Clin Neurophysiol. 2001;  112 1018-1022
• 44 Palm L, Anderson H, Elmqvist D. et al . Daytime sleep tendency before and after discontinuation of antiepileptic drugs in preadolescent children with epilepsy.  Epilepsia. 1992;  33 687-691
• 45 Bazil CW, Castro LH, Walczak TS. Reduction of rapid eye movement sleep by diurnal and nocturnal seizures in temporal lobe epilepsy.  Arch Neurol. 2000;  57 363-368
• 46 Salinsky MC, Oken BS, Binder LM. Assessment of drowsiness in epilepsy patients receiving chronic antiepileptic drug therapy.  Epilepsia. 1996;  37 181-187
• 47 Salinsky MC, Binder LM, Oken BS. et al . Effects of gabapentin and carbamazepine on the EEG and cognition in healthy volunteers.  Epilepsia. 2002;  43 482-490
• 48 Malow BA, Levy K, Maturen K. et al . Obstructive sleep apnea is common in medically refractory epilepsy patients.  Neurology. 2000;  55 1002-1007
• 49 Manni R, Terzaghi M, Arbasino C. et al . Obstructive sleep apnea in a clinical series of adult epilepsy patients: frequency and features of the comorbidity.  Epilepsia. 2003;  44 836-840
• 50 Takhar J, Bishop J. Influence of chronic barbiturate administration on sleep apnea after hypersomnia presentation: case study.  J Psychiatry Neurosci. 2000;  25 321-324
• 51 Ben-Menachem E. Weight issues for people with epilepsy–a review.  Epilepsia. 2007;  48 ((Suppl 9)) 42-45
• 52 Peppard PE, Young T, Palta M. et al . Longitudinal study of moderate weight change and sleep-disordered breathing.  Jama. 2000;  284 3015-3021
• 53 Steinhoff BJ, Neususs K, Thegeder H. et al . Leisure time activity and physical fitness in patients with epilepsy.  Epilepsia. 1996;  37 1221-1227
• 54 Jalava M, Sillanpaa M. Physical activity, health-related fitness, and health experience in adults with childhood-onset epilepsy: a controlled study.  Epilepsia. 1997;  38 424-429
• 55 Morrell MJ, Hayes FJ, Sluss PM. et al . Hyperandrogenism, ovulatory dysfunction, and polycystic ovary syndrome with valproate versus lamotrigine.  Ann Neurol. 2008;  64 200-211
• 56 Fogel RB, Malhotra A, Pillar G. et al . Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome.  J Clin Endocrinol Metab. 2001;  86 1175-1180
• 57 Vgontzas AN, Legro RS, Bixler EO. et al . Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance.  J Clin Endocrinol Metab. 2001;  86 517-520
• 58 Rubaj A, Zgodzinski W, Sieklucka-Dziuba M. The epileptogenic effect of seizures induced by hypoxia: the role of NMDA and AMPA/KA antagonists.  Pharmacol Biochem Behav. 2003;  74 303-311
• 59 Chihorek AM, Abou-Khalil B, Malow BA. Obstructive sleep apnea is associated with seizure occurrence in older adults with epilepsy.  Neurology. 2007;  69 1823-1827
• 60 Devinsky O, Ehrenberg B, Barthlen GM. et al . Epilepsy and sleep apnea syndrome.  Neurology. 1994;  44 2060-2064
• 61 Malow BA, Fromes GA, Aldrich MS. Usefulness of polysomnography in epilepsy patients.  Neurology. 1997;  48 1389-1394
• 62 Vaughn BV, D’Cruz OF, Beach R. et al . Improvement of epileptic seizure control with treatment of obstructive sleep apnoea.  Seizure. 1996;  5 73-78
• 63 Malow BA, Weatherwax KJ, Chervin RD. et al . Identification and treatment of obstructive sleep apnea in adults and children with epilepsy: a prospective pilot study.  Sleep Med. 2003;  4 509-515
• 64 Malow BA, Foldvary-Schaefer N, Vaughn BV. et al . Treating obstructive sleep apnea in adults with epilepsy: a randomized pilot trial.  Neurology. 2008;  71 572-577
• 65 Oliveira AJ, Zamagni M, Dolso P. et al . Respiratory disorders during sleep in patients with epilepsy: effect of ventilatory therapy on EEG interictal epileptiform discharges.  Clin Neurophysiol. 2000;  111 ((Suppl 2)) S141-S145
• 66 Foldvary-Schaefer N, Stephenson L, Bingaman W. Resolution of obstructive sleep apnea with epilepsy surgery? Expanding the relationship between sleep and epilepsy.  Epilepsia. 2008;  49 1457-1459

Korrespondenzadresse