Obstructive sleep apnea and epilepsy: understanding the pathophysiology of the comorbidity.

International journal of physiology, pathophysiology and pharmacology Pub Date : 2023-08-15 eCollection Date: 2023-01-01
Manish Goyal, Priyadarshini Mishra, Harinder Jaseja
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Abstract

Obstructive sleep apnea (OSA) is a sleep disorder of significant health concern with a high prevalence in the general population. It has been found to exhibit a high incidence of comorbidity with epilepsy, the exact underlying pathophysiology of which still remains poorly understood. OSA is characterized by apnea/hypopnea spells and arousals, leading to intermittent hypoxemia and sleep deprivation. Both sleep deprivation and hypoxemia adversely affect the cortical excitability and favor epileptogenesis and worsening of pre-existing epilepsy, if any. In patients with OSA, deprivation of rapid eye movement sleep (REMS) phase (known for its strong antiepileptic influence) is relatively more than that non rapid eye movement sleep phase leading to postulation of REMS deprivation as a significant factor in the development of epilepsy as a comorbidity in patients with OSA. Furthermore, OSA and epilepsy both have shown to exercise a bidirectional influence on one another and are also likely to exacerbate each other through a positive feedback mechanism. This is especially based on the reports of improved control of epilepsy upon treatment of comorbid OSA. This brief paper attempts to present an underlying pathophysiological basis of the comorbidity of OSA and epilepsy based upon sleep deprivation and hypoxemia that are characteristic features observed in patients with OSA.

阻塞性睡眠呼吸暂停和癫痫:了解合并症的病理生理学。
阻塞性睡眠呼吸暂停(OSA)是一种在普通人群中发病率很高的严重健康问题睡眠障碍。研究发现,它与癫痫共病的发病率很高,其确切的潜在病理生理学仍知之甚少。OSA的特点是呼吸暂停/低通气期和觉醒,导致间歇性低氧血症和睡眠剥夺。睡眠不足和低氧血症都会对皮层兴奋性产生不利影响,有利于癫痫的发生和先前存在的癫痫的恶化(如果有的话)。在OSA患者中,快速眼动睡眠(REMS)剥夺期(以其强大的抗癫痫作用而闻名)相对多于非快速眼动睡眠期,导致REMS剥夺被认为是OSA患者癫痫发展的一个重要因素。此外,OSA和癫痫都显示出对彼此的双向影响,也可能通过正反馈机制加剧彼此。这尤其是基于合并OSA治疗后癫痫控制改善的报告。本文试图基于睡眠剥夺和低氧血症,提出OSA和癫痫合并症的潜在病理生理基础,这是OSA患者的特征性特征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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