Sudden unexpected death in epilepsy: People with nocturnal seizures may be at highest risk
Sudden unexpected death in epilepsy: People with nocturnal seizures may be at highest risk
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DOI：
10.1111/j.1528-1167.2011.03360.x
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发表时间：
2012-02-01
期刊：
影响因子：
5.6
通讯作者：
Sander, Josemir W.
中科院分区：
文献类型：
--
作者：
Lamberts, Robert J.;Thijs, Roland D.;Sander, Josemir W.
目的：大多数癫痫患者突然死亡，其死亡归因于癫痫猝死（SUDEP），他们被发现在床上或床边，原因不明。我们评估了睡眠相关SUDEP患者是否更有可能发生夜间癫痫发作，以及癫痫发作模式是否与睡眠相关SUDEP患者的睡眠相关。（白天与夜间）与突然死亡的人和癫痫患者的对照不同。在一组154名癫痫患者中，他们在尸检后突然死亡，其癫痫发作模式符合SUDEP的定义，616名对照癫痫患者被归类为“只在白天或夜间发作。“两组之间进行了比较。SUDEP被分为睡眠相关或非睡眠相关的基础上目击者的帐户和周围的death.Key Findings的情况：SUDEP主要是一个睡眠相关的（58%）和目击（86%）事件。如果与睡眠有关，SUDEP更可能是未被目击的[比值比（OR）4.4，95%置信区间（CI）1.6-12]。睡眠相关SUDEP患者比非睡眠相关SUDEP患者更可能有夜间癫痫发作史（OR 3.6，95% CI 1.4-9.4）。死亡者比活着的对照者更可能有夜间癫痫发作史（OR 3.9，95% CI 2.5-6.0）。在对先前建立的SUDEP风险因素进行校正后（Langan等人，2005），夜间发作仍有显著性意义（OR 2.6，95% CI 1.3-5.0）。这些发现强调了预防措施的重要性，其中可能包括夜间监督。
Purpose: Most people with epilepsy who die suddenly and whose death is attributed to sudden unexpected death in epilepsy (SUDEP) are found in or by the bed for unknown reasons. We assessed whether those with sleep-related SUDEP were more likely to have nocturnal seizures, and whether seizure patterns (diurnal vs. nocturnal) differed from people dying suddenly and living controls with epilepsy.Methods: Seizure patterns in a cohort of 154 people with epilepsy who died suddenly and after autopsy conformed to the definition of SUDEP and 616 controls living with epilepsy were classified as having "exclusively diurnal'' or "nocturnal seizures.'' Comparisons were made between the groups. SUDEP was classified as sleep-related or non-sleep-related based on eyewitness accounts and the circumstances surrounding death.Key Findings: SUDEP was primarily a sleep-related (58%) and unwitnessed (86%) event. If sleep-related, SUDEP was more likely to be unwitnessed [ odds ratio (OR) 4.4, 95% confidence interval (CI) 1.6-12]. Those with sleep-related SUDEP were more likely to have a history of nocturnal seizures than those who had non-sleep-related SUDEP (OR 3.6, 95% CI 1.4-9.4). Those who died were more likely to have a history of nocturnal seizures than living controls (OR 3.9, 95% CI 2.5-6.0). After correction for previously established SUDEP risk factors (Langan et al., 2005), the presence of nocturnal seizures remained significant (OR 2.6, 95% CI 1.3-5.0).Significance: Nocturnal seizures seem to be an independent risk factor for SUDEP. These findings underscore the importance of preventive measures, which may include night supervision.