Increased frequency of arousal parasomnias in families with nocturnal frontal lobe epilepsy: A common mechanism?
Increased frequency of arousal parasomnias in families with nocturnal frontal lobe epilepsy: A common mechanism?
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DOI：
10.1111/j.1528-1167.2010.02581.x
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发表时间：
2010-09-01
期刊：
影响因子：
5.6
通讯作者：
Tinuper, Paolo
中科院分区：
文献类型：
--
作者：
Bisulli, Francesca;Vignatelli, Luca;Tinuper, Paolo
目的：回顾观察发现，睡眠不良和夜间额叶癫痫(NFLE)之间存在重叠，不仅在患者中如此，在他们的亲属中也是如此，提示可能存在共同的发病机制。本研究旨在验证NFLE患者亲属是否有较高的睡眠异常率，即唤醒障碍，从而阐明NFLE的病理生理机制。方法：我们招募了NFLE先证者和健康对照的病例对照家庭研究，年龄、性别、教育程度和地理来源匹配。每个先证者和对照组至少包括四名亲属。每个受试者都接受了标准化的访谈，应用国际睡眠障碍分类-修订版(ICSD-R2001)的最低标准来诊断主要睡眠障碍的终生患病率。结果：458名受试者：33名NFLE先证者，200名先证者的亲属，31名对照和194名对照亲属。除一人外，所有NFLE先证者都有零星的NFLE。以下睡眠异常在先证者亲属和对照亲属中的终生患病率不同：唤醒障碍[优势比(OR)4.7，95%可信区间(CI)2.0~11.6；P<；0.001]和噩梦(OR 2.6，95%CI 1.6~4.2；P<；0.001)在先证者亲属中更常见。在比较非睡眠呼吸暂停综合征先证者和对照组的二次分析中，唤醒障碍(OR6.3，95%CI1.3-31.7；p=0.023)和磨牙症(OR5.4，95%CI1.3-21.7；p=0.017)在非睡眠呼吸暂停发作先证者中更为常见。
P>Purpose:Retrospective observations disclosed an overlap between parasomnias and nocturnal frontal lobe epilepsy (NFLE) not only in patients but also in their relatives, suggesting a possible common pathogenetic mechanism. This study aimed to verify whether relatives of patients with NFLE have a higher frequency of parasomnias, namely arousal disorders, and thereby shed light on the still unknown pathophysiologic mechanisms underlying NFLE.Methods:We undertook a case-control family study in which we recruited NFLE probands and healthy controls, matched for age, sex, education, and geographic origin. At least four relatives were included for each proband and control. Each subject underwent a standardized interview, with application of the International Classification of Sleep Disorders-Revised (ICSD-R 2001) minimal criteria to diagnose the lifetime prevalence of the main parasomnias.Results:Four hundred fifty-eight individuals were recruited: 33 NFLE probands, 200 relatives of probands, 31 controls, and 194 control relatives. All NFLE probands but one have sporadic NFLE. The lifetime prevalence of the following parasomnias differed in proband relatives versus control relatives: arousal disorders [odds ratio (OR) 4.7, 95% confidence interval (CI) 2.0-11.6; p < 0.001] and nightmares (OR 2.6, 95% CI 1.6-4.2; p < 0.001) were more frequent among NFLE proband relatives. In the secondary analysis comparing NFLE probands to controls, arousal disorders (OR 6.3, 95% CI 1.3-31.7; p = 0.023) and bruxism (OR 5.4, 95% CI 1.3-21.7; p = 0.017) were more frequent among NFLE probands.Discussion:The higher frequency of arousal disorders in NFLE families suggests an intrinsic link between parasomnias and NFLE and an abnormal (possibly cholinergic) arousal system as a common pathophysiologic mechanism.