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Obstructive sleep apnea in drug-resistant epilepsy : A significant comorbidity warranting diagnosis and treatment

REV NEUROL (Paris) , 2016, vol. 172, n° 6-7, p. 361-370
Doc n°: 179472
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1016/j.neurol.2016.03.007

Drug-resistant epilepsy is a debilitating condition that warrants
new therapeutic options.
The last two decades have seen a growing interest in the
relationship between epilepsy and obstructive sleep apnea syndrome (OSAS), which
could ultimately yield non-pharmaceutical treatment strategies. Based on a
Medline search of the literature, this review develops lines of evidence for a
clinically significant role of OSAS in refractory epilepsy.
STATE OF THE ART: OSAS is a primary sleep disorder that could presumably lower the seizure
threshold via mechanisms such as sleep fragmentation, oxygen desaturation and
chronic sleep deprivation. In comparison to the general population, patients with
epilepsy probably have a higher prevalence of OSAS (9-33 % overall; 13-16 % with
moderate to severe OSAS). Several common risk factors for OSAS have proven to be
significant in patients with epilepsy, notably advanced age, male gender and
obesity. Moreover, certain specific conditions, such as refractory seizures,
antiepileptic polytherapy and vagus nerve stimulation, appear to render these
patients particularly vulnerable to OSAS. Prospective data regarding the efficacy
of continuous positive airway pressure (CPAP) therapy for seizure control is
scarce. However, there is compelling retrospective evidence that severe OSAS can
exacerbate the seizure burden and that CPAP may yield a pronounced reduction in
seizure frequency, excessive daytime somnolence and, potentially, cognitive
complaints. PERSPECTIVES: In the light of the severity of drug-resistant epilepsy
and its impact on quality of life, our current knowledge justifies systematic
questionnaire screening for OSAS and a low threshold for referral to sleep
laboratory exploration. In the long run, a large prospective trial is needed to
confirm the therapeutic interest of CPAP treatment for mild to moderate OSAS in
patients with epilepsy. CONCLUSION: OSAS is a significant comorbidity of
drug-resistant epilepsy that has the potential to yield new treatment options for
better seizure control.
CI - Copyright (c) 2016. Published by Elsevier Masson SAS.


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