The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea
The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea
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DOI：
10.1016/j.yebeh.2019.06.029
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发表时间：
2019-09-01
影响因子：
2.6
通讯作者：
Lhatoo, Samden
中科院分区：
文献类型：
--
作者：
Lacuey, Nuria;Martins, Rita;Lhatoo, Samden
目的：发作期（ICA）和惊厥后中枢性呼吸暂停（PCCA）与癫痫猝死（SUDEP）的病理机制有关。先前的研究表明，血清素再摄取抑制剂（SRI）和苯二氮卓类药物（BZD）可能会影响呼吸。本研究的目的是调查长期使用这些药物是否会改变癫痫患者中枢性呼吸暂停的发生。方法：参与 SUDEP 研究的九个中心的癫痫监测单位 (EMUS) 收治的癫痫患者均获得同意。分析了多描记生理参数，包括视频脑电图（VEEG）、胸腹偏移和脉搏血氧饱和度。收集门诊用药详细信息。患者和癫痫发作分为 SRI、BZD 和对照组（无 SRI 或 BZD）组。对每组的理想中枢性呼吸暂停和 PCCA、低氧血症和电临床特征进行评估。结果：分析了 476 例癫痫发作（204 名患者）。 SRI 组 ICA 的相对风险 (RR) 是对照组的一半 (p = 0.02)。在 BZD 组中，ICA 持续时间显着短于对照组 (p = 0.02)，发作后全身脑电图抑制 (PGES) 持续时间也明显短于对照组 (p = 0.021)。 SRI 和 BZD 组均与较小的癫痫相关氧饱和度降低相关（p = 0.009；p > 0.05）。结论：服用 SRI 的患者癫痫发作 ICA 发生率较低，而长期接受 BZD 治疗的患者 ICA 和 PGES 持续时间较短。在癫痫患者中使用 SRI 和/或 BZD 来预防或缩短 ICA 持续时间可能在降低 SUDEP 风险中发挥作用。 (C) 2019 Elsevier Inc. 保留所有权利。
Objective: Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy.Methods: Patients with epilepsy admitted to epilepsy monitoring units (EMUS) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Idal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group.Results: Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p > 0.05).Conclusions: Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction. (C) 2019 Elsevier Inc. All rights reserved.