Association of prone position with sudden unexpected death in epilepsy
Association of prone position with sudden unexpected death in epilepsy
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DOI：
10.1212/wnl.0000000000001260
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发表时间：
2015-02-17
期刊：
影响因子：
9.9
通讯作者：
Tao, James X.
中科院分区：
文献类型：
--
作者：
Liebenthal, Jennifer A.;Wu, Shasha;Tao, James X.
目的：探讨俯卧位与癫痫猝死(SUDEP)的关系。方法：通过检索PubMed、Web of Science、Scope us数据库中的文献，以SUDEP、癫痫猝死或原因不明猝死综合征为关键词，进行系统回顾和荟萃分析。25篇文献符合纳入和排除标准并纳入本研究。结果：在253例SUDEP病例中记录了身体位置。在这些患者中，73.3%(95%可信区间[CI]=65.7%，80.9%)死于俯卧位，26.7%(95%CI=16.3%，37.1%)死于非俯卧位。二元随机效应分析表明，与非俯卧位相比，俯卧位与SUDEP显著相关(p<；0.001)。此外，所有11例视频脑电监测的SUDEP患者都报告了俯卧位。此外，在记录了人口学和死亡情况的88例SUDEP患者中，40岁或以下患者中俯卧位的发生率为85.7%(95%CI=74.6%，93.3%)，而40岁以上患者中俯卧位的发生率仅为60%(95%CI=38.7%，78.9%)。统计分析证实，与老年患者组相比，年轻患者组中俯卧位的发生率显著增加(优势比3.9%；95%CI=1.4%，11.4%；p=0.009)。结论：俯卧位与SUDEP有显著的相关性，提示俯卧位是SUDEP的主要危险因素，尤其是在40岁及以下的患者中。因此，SUDEP可能具有类似于婴儿猝死综合征的机制。
Objective:To examine the association between prone position and sudden unexpected death in epilepsy (SUDEP).Methods:We conducted a systematic review and meta-analysis based on a literature search from databases PubMed, Web of Science, and Scopus, using keywords SUDEP or sudden unexpected death in epilepsy or sudden unexplained death syndromes in epilepsy. Twenty-five publications met the inclusion and exclusion criteria and were enrolled in this study.Results:Body positions were documented in 253 cases of SUDEP. Of these patients, 73.3% (95% confidence interval [CI] = 65.7%, 80.9%) died in the prone position, whereas 26.7% (95% CI = 16.3%, 37.1%) died in nonprone positions. Binary random-effects analysis showed that prone position is significantly associated with SUDEP, as compared with nonprone position (p < 0.001). In addition, the prone position was reported in all 11 cases of video-EEG-monitored SUDEP. Moreover, in a subgroup of 88 cases of SUDEP in which demographics and circumstances of death were documented, the prone position was observed in 85.7% (95% CI = 74.6%, 93.3%) of patients aged 40 years or younger, but in only 60% (95% CI = 38.7%, 78.9%) of patients older than 40 years. Statistical analysis confirmed that the prone position was significantly more prevalent in the younger patient group, as compared with the older patient group (odds ratio 3.9; 95% CI = 1.4%, 11.4%; p = 0.009).Conclusion:There is a significant association between prone position and SUDEP, which suggests that prone position is a major risk factor for SUDEP, particularly in patients aged 40 years and younger. As such, SUDEP may share mechanisms similar to sudden infant death syndrome.