Obstructive sleep apnea and sudden unexpected death in epilepsy in unselected patients with epilepsy: are they associated?

• Published in: Sleep & breathing Vol. 25; no. 4; pp. 1919 - 1924
• Main Authors: Phabphal, Kanitpong, Koonalintip, Prut, Sithinamsuwan, Pasiri, Wongsritrang, Krongthong, Amornpojnimman, Thanyalak, Ekpitakdamrong, Nichanan, Geater, Alan F.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2021; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Apnea; Comorbidity; Cross-Sectional Studies; Dentistry; Epilepsy; Female; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Otorhinolaryngology; Pediatrics; Pneumology/Respiratory System; Population studies; Sleep; Sleep apnea; Sleep Apnea, Obstructive - epidemiology; Sleep Breathing Physiology and Disorders • Original Article; Sleep disorders; Sudden Unexpected Death in Epilepsy - epidemiology; Young Adult; Revised SUDEP-7 score; Obstructive sleep apnea; Sudden unexpected death in epilepsy; Co-morbidity; Apnea-hypopnea index
• ISSN: 1520-9512; 1522-1709; 1522-1709
• DOI: 10.1007/s11325-021-02307-1

Purpose We aimed to determine (1) the frequency of high-risk sudden unexpected death in epilepsy (SUDEP) in patients with epilepsy who have had obstructive sleep apnea (OSA) in different stages of sleep using the revised SUDEP risk inventory (rSUDEP-7) score instrument and (2) the factors associated with high risk SUDEP in patients with epilepsy who have had OSA. Methods We conducted a cross-sectional study of consecutive subjects who are more than 15 years old without known sleep disorders, recruited from a single epilepsy clinic in a tertiary care facility. Participants underwent polysomnography. Scoring was performed by two blinded board-certified sleep physicians. The relationships between rSUDEP-7 scores and OSA measures were evaluated using Wilcoxon rank-sum test, chi-squared test, and quantile regression. Results Our study population consisted of 95 participants. Overall median (IQR) apnea-hypopnea index (AHI) of our populations was 2.3 (0.7,7.5) events rate per hour; 12 (75%) patients had moderate OSA and 4 (25%) patients had severe OSA. Nine patients had a rSUDEP-7 score of 5 to 7. There was no significant difference between total rSUDEP-7 score or rSUDEP-7 score of > 5 or < 5 and total AHI, supine AHI, non-supine AHI, NREM AHI, or REM AHI; similarly, (2) there was no significant difference in total rSUDEP-7 score between AHI of < 15 or > 15. Conclusion Our study reveals no association between AHI score, OSA, and total rSUDEP-7 score or rSUDEP-7 score of > 5. The pathophysiology underlying SUDEP appears complex. We need further studies on SUDEP to help elucidate the cardiorespiratory mechanisms and predisposing factors.