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Published on: November 15, 2013
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1Neurology Department, Rothschild Foundation, 25, rue Manin, 75019 Paris, France; Sleep Medicine Center, Béclère Hospital, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; ARAMIS LAB, Brain and Spine institute (Institut du Cerveau et de la Moelle), 47, boulevard de l'Hôpital, 75013 Paris, France.
Introduction:
Drug-resistant epilepsy is a debilitating condition that warrants new therapeutic options. The last two decades have seen a growing interest in the relationship between epilepsy and obstructive sleep apnea syndrome (OSAS), which could ultimately yield non-pharmaceutical treatment strategies. Based on a Medline search of the literature, this review develops lines of evidence for a clinically significant role of OSAS in refractory epilepsy.
State Of The Art:
OSAS is a primary sleep disorder that could presumably lower the seizure threshold via mechanisms such as sleep fragmentation, oxygen desaturation and chronic sleep deprivation. In comparison to the general population, patients with epilepsy probably have a higher prevalence of OSAS (9-33 % overall; 13-16 % with moderate to severe OSAS). Several common risk factors for OSAS have proven to be significant in patients with epilepsy, notably advanced age, male gender and obesity. Moreover, certain specific conditions, such as refractory seizures, antiepileptic polytherapy and vagus nerve stimulation, appear to render these patients particularly vulnerable to OSAS. Prospective data regarding the efficacy of continuous positive airway pressure (CPAP) therapy for seizure control is scarce. However, there is compelling retrospective evidence that severe OSAS can exacerbate the seizure burden and that CPAP may yield a pronounced reduction in seizure frequency, excessive daytime somnolence and, potentially, cognitive complaints.
Perspectives:
In the light of the severity of drug-resistant epilepsy and its impact on quality of life, our current knowledge justifies systematic questionnaire screening for OSAS and a low threshold for referral to sleep laboratory exploration. In the long run, a large prospective trial is needed to confirm the therapeutic interest of CPAP treatment for mild to moderate OSAS in patients with epilepsy.
Conclusion:
OSAS is a significant comorbidity of drug-resistant epilepsy that has the potential to yield new treatment options for better seizure control.
Insights
Obstructive Sleep Apnea Syndrome (OSAS) is common in drug-resistant epilepsy and may worsen seizures. Treating OSAS with CPAP shows promise for reducing seizure frequency and improving quality of life.
Area of Science:
- Neurology
- Sleep Medicine
- Internal Medicine
Background:
- Drug-resistant epilepsy presents significant challenges, necessitating novel therapeutic approaches.
- Obstructive Sleep Apnea Syndrome (OSAS) is increasingly recognized as a relevant comorbidity in epilepsy patients.
- The interplay between OSAS and epilepsy may offer non-pharmaceutical treatment avenues.
Purpose of the Study:
- To review the evidence linking Obstructive Sleep Apnea Syndrome (OSAS) to refractory epilepsy.
- To explore the potential of OSAS as a therapeutic target for improving seizure control.
Main Methods:
- Systematic review of Medline-searched literature.
- Analysis of the prevalence, risk factors, and mechanisms connecting OSAS and epilepsy.
- Evaluation of existing evidence on Continuous Positive Airway Pressure (CPAP) therapy for seizure management.
Main Results:
- Patients with epilepsy exhibit a higher prevalence of OSAS (9-33%) compared to the general population.
- Risk factors for OSAS in epilepsy include advanced age, male gender, obesity, polytherapy, and vagus nerve stimulation.
- Retrospective data suggest CPAP therapy can significantly reduce seizure frequency and associated symptoms like daytime somnolence.
Conclusions:
- Systematic screening for OSAS in drug-resistant epilepsy patients is warranted.
- Early referral for sleep studies and consideration of CPAP treatment are recommended.
- Further prospective trials are needed to confirm CPAP efficacy in mild to moderate OSAS for epilepsy management.
