Clinical risk factors in SUDEP A nationwide population-based case-control study
Clinical risk factors in SUDEP A nationwide population-based case-control study
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DOI：
10.1212/wnl.0000000000008741
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发表时间：
2020-01-28
期刊：
影响因子：
9.9
通讯作者：
Tomson, Torbjorn
中科院分区：
文献类型：
--
作者：
Sveinsson, Olafur;Andersson, Tomas;Tomson, Torbjorn
目的 我们在瑞典进行了一项全国范围的病例对照研究，以检验特定临床特征与癫痫突然意外死亡 (SUDEP) 风险增加相关的假设。方法 该研究包括 255 例 SUDEP 病例（明确的和可能的）和 1,148 例匹配的对照。临床信息来自医疗记录和国家患者登记册。 SUDEP 与潜在风险因素之间的关联通过比值比 (OR) 和 95% 置信区间 (CI) 进行评估，并通过交互作用的归因比例 (AP) 评估交互作用。结果 前一年经历全身性强直阵挛性癫痫发作 (GTCS) 的风险增加 27 倍（OR 26.81，95% CI 14.86-48.38），而仅发生非 GTCS 癫痫发作的患者则没有观察到额外的风险（OR 1.15，95% CI 0.54-48.38）。在最后一年的观察中，夜间 GTCS 的存在与 15 倍的风险相关（OR 15.31，95% CI 9.57-24.47）。独居与 SUDEP 风险增加 5 倍相关（OR 5.01，95% CI 2.93-8.57），交互分析显示，不共用卧室和接受 GTCS 相结合的 OR 为 67.10（95% CI 29.66-151.88），AP 估计为 0.69（CI 0.53-0.85）。在合并症中，先前诊断的药物滥用或酒精依赖与 SUDEP 风险过高相关。结论 单独睡眠的 GTCS 患者 SUDEP 风险显着增加。我们的结果表明，如果患有 GTCS 且独居的患者在夜间无人看管或未患有 GTCS，则 69% 的 SUDEP 病例是可以预防的。
Objective We conducted a nationwide case-control study in Sweden to test the hypothesis that specific clinical characteristics are associated with increased risk of sudden unexpected death in epilepsy (SUDEP). Methods The study included 255 SUDEP cases (definite and probable) and 1,148 matched controls. Clinical information was obtained from medical records and the National Patient Register. The association between SUDEP and potential risk factors was assessed by odds ratios (ORs) and 95% confidence intervals (CIs) and interaction assessed by attributable proportion due to interaction (AP). Results Experiencing generalized tonic-clonic seizures (GTCS) during the preceding year was associated with a 27-fold increased risk (OR 26.81, 95% CI 14.86-48.38), whereas no excess risk was seen in those with exclusively non-GTCS seizures (OR 1.15, 95% CI 0.54-48.38). The presence of nocturnal GTCS during the last year of observation was associated with a 15-fold risk (OR 15.31, 95% CI 9.57-24.47). Living alone was associated with a 5-fold increased risk of SUDEP (OR 5.01, 95% CI 2.93-8.57) and interaction analysis showed that the combination of not sharing a bedroom and having GTCS conferred an OR of 67.10 (95% CI 29.66-151.88), with AP estimated at 0.69 (CI 0.53-0.85). Among comorbid diseases, a previous diagnosis of substance abuse or alcohol dependence was associated with excess risk of SUDEP. Conclusions Individuals with GTCS who sleep alone have a dramatically increased SUDEP risk. Our results indicate that 69% of SUDEP cases in patients who have GTCS and live alone could be prevented if the patients were not unattended at night or were free from GTCS.