Cyclic alternating pattern and interictal epileptiform discharges during morning sleep after sleep deprivation in temporal lobe epilepsy

• Published in: Epilepsy & behavior Vol. 73; pp. 131 - 136
• Main Authors: Giorgi, Filippo Sean, Maestri, Michelangelo, Guida, Melania, Carnicelli, Luca, Caciagli, Lorenzo, Ferri, Raffaele, Bonuccelli, Ubaldo, Bonanni, Enrica
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2017
• Subjects: Adult; Aged; Circadian Rhythm - physiology; Cyclic alternating pattern; EEG; Electroencephalography - trends; Epilepsy, Temporal Lobe - diagnosis; Epilepsy, Temporal Lobe - physiopathology; Female; Humans; Male; Middle Aged; Neurology; Night sleep; Polysomnography - trends; Retrospective Studies; Sleep - physiology; Sleep deprivation; Sleep Deprivation - diagnosis; Sleep Deprivation - physiopathology; Spike index; Temporal lobe epilepsy; AED; spike index; temporal lobe epilepsy; night polysomnography; antiepileptic drug; n-PSG; EEG; sleep deprived EEG; IED; interictal epileptiform discharges; non-CAP periods; cyclic alternating pattern; Night sleep; TLE; SD; sleep deprivation; CAP; SI; nCAP; SD-EEG; Cyclic alternating pattern; Sleep deprivation; Temporal lobe epilepsy; Spike index
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2017.05.005

Abstract Purpose Sleep deprivation (SD) increases the occurrence of interictal epileptiform discharges (IED) compared to basal EEG in temporal lobe epilepsy (TLE). In adults, EEG after SD is usually performed in the morning after SD. We aimed to evaluate whether morning sleep after SD bears additional IED-inducing effects compared with nocturnal physiological sleep, and whether changes in sleep stability (described by the cyclic alternating pattern-CAP) play a significant role. Methods Adult patients with TLE underwent in-lab night polysomnography (n-PSG) and, within 7 days from n-PSG, they underwent also a morning EEG after night SD (SD-EEG). We included only TLE patients in which both recordings showed IED. SD-EEG consisted of waking up patients at 2:00 AM and performing video EEG at 8:00 AM. For both recordings, we obtained the following markers for the first sleep cycle: IED/h (Spike Index, SI), sleep macrostructure, microstructure (NREM CAP rate; A1, A2 and A3 Indices), and SI association with CAP variables. Results The macrostructure of the first sleep cycle was similar in n-PSG and morning SD-EEG, whereas CAP rate and SI were significantly higher in SD-EEG. SI increase was selectively associated with CAP phases. Conclusions SD increases the instability of morning recovery sleep compared with n-PSG, and particularly enhances CAP A1 phases, which are associated with the majority of IED. Thus, higher instability of morning recovery sleep may account at least in part for the increased IED yield in SD-EEG in TLE patients.