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Lack of heart rate variability during sleep-related apnea in patients with temporal lobe epilepsy (TLE)—an indirect marker of SUDEP?
- Source :
- Sleep and Breathing. 21:163-172
- Publication Year :
- 2017
- Publisher :
- Springer Science and Business Media LLC, 2017.
-
Abstract
- Apneas occurring during sleep may precipitate autonomic instability in epilepsy patients making them susceptible to sudden death (SUDEP). Literature on heart rate variability (HRV) during apnea among patients with temporal lobe epilepsy (TLE) is sparse. The aim of this study was to characterize the HRV during the peri-apneic period in patients with TLE and compare with HRV of matched healthy individuals during the overnight polysomnographic (PSG) recording. Further, the role of carbamazepine (CBZ) in modulating peri-apneic HRV in the above cohort was also assessed. Twenty patients diagnosed to have TLE (drug naive (n = 10) or on CBZ monotherapy (n = 10)) were compared with ten healthy controls. In both patients and controls, the time domain, frequency domain, and non-linear HRV indices were analyzed for 2 min before and after apnea/hypopnea termination and compared using paired t test (p ≤ 0.05). Additionally, the changes in HRV parameters in the peri-apnea/hypopnea period were compared between the three groups using one-way ANOVA followed by post hoc comparison (p ≤ 0.05). The three study groups were age (p = 0.21) and gender (p = 0.27) matched. In controls (M/F = 5:5; mean age 24.3 ± 5.0 years), there were significant changes in standard deviation of RR interval (SDNN), low frequency (LF) component and long-term HRV (SD2) parameters in the peri-apnea/hypopneic period. Conversely, in drug-naive TLE (M/F = 6:4; mean age: 22.8 ± 4.1 years), all the HRV parameters, including non-linear measures were comparable in the pre- and post-apneic period. On the other hand, patients on CBZ (M/F = 6:4; mean age 20.5 ± 4.8 years) showed significant changes in low-frequency nu (LFnu) and high-frequency nu (HFnu) components in the peri-apnea/hypopneic period. Comparison of the changes in HRV parameters in the peri-apnea/hypopnea period in patients with TLE and controls showed significantly lower changes in drug-naive TLE patients in SDNN, LF, and SD2 as compared to controls. This study showed that there was a lack of apnea-mediated HRV changes in patients with drug-naive TLE. This might suggest a possible alteration in reflex baroreceptor activation in patients with TLE, predisposing them to SUDEP, and this may be worsened with CBZ.
- Subjects :
- Adult
Male
Polysomnography
Primary Dysautonomias
030204 cardiovascular system & hematology
Autonomic Nervous System
Sudden death
Temporal lobe
Death, Sudden
Young Adult
03 medical and health sciences
Epilepsy
Sleep Apnea Syndromes
0302 clinical medicine
Heart Rate
medicine
Humans
Heart rate variability
business.industry
Apnea
Baroreflex
medicine.disease
Drug-naïve
Carbamazepine
Epilepsy, Temporal Lobe
Otorhinolaryngology
Case-Control Studies
Anesthesia
Cohort
Female
Neurology (clinical)
medicine.symptom
business
Hypopnea
Biomarkers
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 15221709 and 15209512
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Sleep and Breathing
- Accession number :
- edsair.doi.dedup.....3979aafff4e90e30139df29bf068cde2