Impaired post-sleep apnea autonomic arousals in patients with drug-resistant epilepsy

Objective: Sudden and unexpected deaths in epilepsy (SUDEP) pathophysiology may involve an interaction between respiratory dysfunction and sleep/wake state regulation. We investigated whether patients with epilepsy exhibit impaired sleep apnea -related arousals. Methods: Patients with drug -resistant (N = 20) or drug -sensitive (N = 20) epilepsy and obstructive sleep apnea, as well as patients with sleep apnea but without epilepsy (controls, N = 20) were included. We explored (1) the respiratory arousal threshold based on nadir oxygen saturation, apnea-hypopnea index, and fraction of hypopnea among respiratory events; (2) the cardiac autonomic response to apnea/hypopnea quantified as percentages of changes from the baseline in RR intervals (RRI), high (HF) and low (LF) frequency powers, and LF/HF. Results: The respiratory arousal threshold did not differ between groups. At arousal onset, RRI decreased (-9.42%) and LF power (179%) and LF/HF ratio (190%) increased. This was followed by an increase in HF power (118%), p < 0.05. The RRI decrease was lower in drug -resistant (-7.40%) than in drug -sensitive patients (-9.94%) and controls (-10.91%), p < 0.05. LF and HF power increases were higher in drug -resistant (188%/126%) than in drug -sensitive patients (172%/126%) and controls (177%/115%), p < 0.05. Conclusions: Cardiac reactivity following sleep apnea is impaired in drug -resistant epilepsy. Significance: This autonomic dysfunction might contribute to SUDEP pathophysiology. (c) 2024 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.