睡眠中痫样放电对睡眠的影响

The influence of epileptiform discharges in spontaneous night sleep and quality of life in epileptic patients

目的：观察不同睡眠时相中痫样放电的情况，以及对不同发作类型患者生活品质（QOL）的评价，探讨痫样放电对癫痫患者睡眠的影响以及睡眠对其QOL的影响。方法：对132例癫痫患者进行24h录像脑电图（V-EEG）多项睡眠监测（PSG）检查，检测痢样放电及分析睡眠结构。运用癫痫患者生活质量量表-31（QOLIE-31）对不同发作类型患者进行QOL评估。结果：在全部132例患者中，非痴性异常为32例（25．8％），出现痫样放电为52例（40．9％），觉醒期及睡眠期痫样放电检出率比较差异有显著意义（P〈O．05）。痫样放电组和对照组相比NREM I-Ⅱ期明显延长[分别为65．93（±9．1）％和58．67（士5．7）％]，NREM Ⅲ期明显缩短[分别为17．78（土5．2）％和26．06（土8．2）％]，差异均有统计学意义（P〈0．05）；睡眠参数中痼样放电组REM潜伏期明显延长，同时觉醒次数也增多。而非痫性异常组REM潜伏期、觉醒次数与正常对照组相比均有增加，但差异无统计学意义。不同发作类型睡眠结构差异无统计学意义。各种发作类型的患者各QOL指标均低于正常人群，差异有统计学意义（P〈O．01）；全面性发作患者除药物影响外各指标均低于其他发作类型患者，差异有统计学意义；不同发作类型患者受到药物的影响无明显差异。结论：联合应用V-EEG及PSG可以更好地发现睡眠中痫样放电，从而有助于确诊临床工作中难以发现的癫痫。分析痫样放电与睡眠时相之间的关系，以便指导临床癫痫治疗，更好地控制癫痫发作，改善患者QOL。

Objective：To evaluate the influence of epileptiform discharges on（EDs） sleep and quali- ty of life（QOL） in patients with different types of seizures, by observing the number of EDs in each stage of sleep. Methods.. For all recruiters, 24-hour video-electroencephalogram（V-EEG） monitoring and poly- somnography （PSG） examination were conducted to detect EDs and the sleep structures were analyzed. The QOLIE-31 was used to evaluate the QOL of patients with different types of seizures. Results： The detection rate of EDs was significantly different in wakefulness and sleep （P〈0.05）. Compared with pa- tients who had normal brain electrical activity on sleep,and the duration of NREM I ～ II sleep was pro- longed （65.93土9.1% and 58.67土5.7%）,while NREM Ⅲ sleep were shortened （17.78土5.2% and 26.06土8.2%） in the epileptic patients with EDs. The duration of REM sleep latency was definitely pro- longed as the awakening time increased in patients with EDs, while the duration of REM sleep latency and the awakening times were similar between patients with non-epileptic abnormality and patients with nor- mal brain electrical activity on sleep. Different types of epileptic seizures were no significantly different insleep structure. QOL of patients with epilepsy was lower than in the control group according to a variety of indicators, and the difference was statistically significant （P〈0.01）. All indicators of the cases with generalized seizures were lower than other types of seizures in patients except for the influence of antiepi- leptic drugs, and the difference was statistically significant; different types of seizures in patients had no significant difference caused by the influence of drugs. Conclusion The combination of V-EEG with PSG is a useful method to detect EDs during sleep, analyze the association among EDs sleep-wake cycles in clinical treatment of epilepsy, and improve the QOL.