Association of Short-term Heart Rate Variability and Sudden Unexpected Death in Epilepsy
Association of Short-term Heart Rate Variability and Sudden Unexpected Death in Epilepsy
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DOI：
10.1212/wnl.0000000000012946
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发表时间：
2021-12-14
期刊：
影响因子：
9.9
通讯作者：
Devinsky, Orrin
中科院分区：
文献类型：
--
作者：
Sivathamboo, Shobi;Friedman, Daniel;Devinsky, Orrin
背景和ObjectivesWe比较了心率变异性（HRV）在癫痫猝死（SUDEP）的情况下，生活epilepsy controls.MethodsThis国际，多中心，回顾性，巢式病例对照研究检查了2003年1月1日和2014年12月31日之间的视频脑电图监测（VEM）承认的患者，随后死于SUDEP。时域和频域成分提取5分钟的发作间期心电图记录在睡眠和觉醒SUDEP病例和controls.ResultsWe确定了31 SUDEP病例和56对照。SUDEP患者清醒时的标准化低频功率（LFP）（中位数42.5，四分位距[IQR] 32.6-52.6）低于癫痫对照组（55.5，IQR40.7-68.9; p = 0.015，临界值= 0.025）。在多变量模型中，SUDEP病例的标准化LFP低于对照组（对比度-11.01，95%置信区间[CI] -20.29至1.73; p = 0.020，临界值= 0.025）。LFP与SUDEP潜伏期呈负相关，其中标准化LFP每减少1%，SUDEP潜伏期减少2.7%（95% CI 0.95-0.995; p = 0.017，临界值= 0.025）。从VEM到SUDEP的生存时间延长与较高的标准化高频功率相关（HFP; p = 0.002，临界值= 0.025）。标准化LFP的生存模型与SUDEP相关（c统计值0.66，95%CI 0.55-0.77），其随着标准化HFP的增加而无显著性增加（c统计值0.70，95%CI 0.59-0.81; p = 0.209）结论短期LFP减少，是一种经验证的猝死生物标志物，与SUDEP相关。在SUDEP中，增加的HFP与更长的生存期相关，并且可能具有心脏保护作用。HRV量化可能有助于对个体SUDEP风险进行分层。
Background and ObjectivesWe compared heart rate variability (HRV) in sudden unexpected death in epilepsy (SUDEP) cases and living epilepsy controls.MethodsThis international, multicenter, retrospective, nested case-control study examined patients admitted for video-EEG monitoring (VEM) between January 1, 2003, and December 31, 2014, and subsequently died of SUDEP. Time domain and frequency domain components were extracted from 5-minute interictal ECG recordings during sleep and wakefulness from SUDEP cases and controls.ResultsWe identified 31 SUDEP cases and 56 controls. Normalized low-frequency power (LFP) during wakefulness was lower in SUDEP cases (median 42.5, interquartile range [IQR] 32.6-52.6) than epilepsy controls (55.5, IQR40.7-68.9; p = 0.015, critical value = 0.025). In the multivariable model, normalized LFP was lower in SUDEP cases compared to controls (contrast -11.01, 95% confidence interval [CI] -20.29 to 1.73; p = 0.020, critical value = 0.025). There was a negative correlation between LFP and the latency to SUDEP, where each 1% incremental reduction in normalized LFP conferred a 2.7% decrease in the latency to SUDEP (95% CI 0.95-0.995; p = 0.017, critical value = 0.025). Increased survival duration from VEM to SUDEP was associated with higher normalized high-frequency power (HFP; p = 0.002, critical value = 0.025). The survival model with normalized LFP was associated with SUDEP (c statistic 0.66, 95% CI 0.55-0.77), which nonsignificantly increased with the addition of normalized HFP (c statistic 0.70, 95% CI 0.59-0.81; p = 0.209)ConclusionsReduced short-term LFP, which is a validated biomarker for sudden death, was associated with SUDEP. Increased HFP was associated with longer survival and may be cardioprotective in SUDEP. HRV quantification may help stratify individual SUDEP risk.