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Rapid eye movement sleep reduction in patients with epilepsy: A systematic review and meta-analysis

  • Wei-Chih Yeh
    Affiliations
    Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

    Sleep Disorders Center, Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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  • Huan-Jan Lin
    Affiliations
    Department of Neurology, E-DA Hospital, Kaohsiung, Taiwan

    College of medicine, I-Shou University, Kaohsiung, Taiwan
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  • Ying-Sheng Li
    Affiliations
    Sleep Disorders Center, Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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  • Ching-Fang Chien
    Affiliations
    Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

    Sleep Disorders Center, Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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  • Meng-Ni Wu
    Affiliations
    Sleep Disorders Center, Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

    Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Li-Min Liou
    Affiliations
    Sleep Disorders Center, Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

    Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Cheng-Fang Hsieh
    Affiliations
    Sleep Disorders Center, Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

    Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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  • Chung-Yao Hsu
    Correspondence
    Corresponding author: Chung-Yao Hsu, Department of Neurology, Kaohsiung Medical University Hospital; College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanCorresponding author: Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, No.100, Tzyou 1st Road, Kaohsiung city 80754, Taiwan
    Affiliations
    Sleep Disorders Center, Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan

    Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Published:January 28, 2022DOI:https://doi.org/10.1016/j.seizure.2022.01.014

      Highlights

      • Compared to healthy controls, patients with focal epilepsy had decreased REM sleep and SE.
      • Patients with generalized epilepsy had increased SWS and decreased SE.
      • ASM untreated patients with focal and generalized epilepsy both had decreased REM sleep and SE.
      • This study revealed statistically significant differences in sleep macrostructure between patients with epilepsy and healthy controls.

      Abstract

      Background

      Compared to healthy controls, adults with epilepsy have a disrupted sleep architecture. Changes in sleep macrostructure may be associated with the refractoriness of epilepsy. However, there is no consensus regarding the changes in sleep architecture in patients with epilepsy. This meta-analysis aimed to elucidate the differences in sleep architecture between patients with epilepsy and healthy controls.

      Methods

      This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The PubMed, Embase, and Cochrane Central databases were searched (until May 2021) for studies comparing polysomnographic sleep macrostructures between patients with epilepsy and healthy controls. A meta-analysis was performed using a random-effects model. The percentage of rapid eye movement (REM) sleep, slow-wave sleep (SWS), and sleep efficiency (SE) were compared between patients with epilepsy and healthy controls.

      Results

      Overall, 24 studies involving 789 patients with epilepsy and 599 healthy controls fulfilled the eligibility criteria. Compared to healthy controls, patients with focal epilepsy had decreased REM sleep and SE. Patients with generalised epilepsy had increased SWS and decreased SE. Subgroup analyses focussed on the potential effect of seizure control on sleep architecture. The results revealed that both antiseizure medication (ASM)-untreated and treated patients had decreased SE. ASM treatment may restore REM sleep in patients with generalised epilepsy but not in patients with focal epilepsy.

      Conclusions

      This meta-analysis revealed statistically significant differences in the sleep macrostructure between patients with epilepsy and healthy controls. There were significant differences in the sleep macrostructure between ASM-untreated patients and healthy controls, which may be an intrinsic change attributable to epilepsy.
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