Schlafstörungen bei Epilepsie

Zusammenfassung

Die Epilepsie und epileptische Anfälle haben einen signifikanten und nachhaltigen Effekt auf den Schlaf von Epilepsiepatienten. Nächtliche generalisierte tonisch-klonische Anfälle, aber auch multiple fokal-komplexe Anfälle führen zu einer Störung der Schlafarchitektur sowie zu einer vermehrten Tagesmüdigkeit. Zudem ist kein REM-Rebound in den nachfolgenden Nächten zu beobachten. Unabhängig von den Anfällen führt der chronische epileptische Zustand – insbesondere bei Patienten mit fokalen Epilepsien – zu Störungen der Schlafarchitektur. Epilepsiepatienten leiden im Vergleich zur Allgemeinbevölkerung an einer 2- bis 3-fach erhöhten Prävalenz von subjektiv empfundenen Schlafstörungen. Schlafstörungen sind zudem mit einer signifikanten Beeinträchtigung der Lebensqualität assoziiert. Auch Kinder mit Epilepsie leiden häufiger an Schlafstörungen als gesunde Kinder, wobei eine schlechte Schlafqualität wiederum zu Verhaltensproblemen und einer schlechteren Lebensqualität führt. Eine vermehrte Tagesmüdigkeit stellt mit einer Prävalenz von 30–50% die häufigste schlafbezogene Störung bei Epilepsiepatienten dar und konnte auch mit objektiven Tests nachgewiesen werden. Obstruktive Schlaf-Apnoen (OSA) treten bei Epilepsiepatienten mit einer Prävalenz von 10–33% signifikant häufiger auf als in der Allgemeinbevölkerung. Als mögliche Mechanismen sind die Effekte von zentral dämpfenden Antiepileptika, eine durch Antiepileptika verursachte Gewichtszunahme und das gehäufte Vorliegen eines polyzystischen Ovar-Syndroms bei Frauen mit Epilepsie anzuführen. Eine OSA kann mit einer Exazerbation von Anfällen einhergehen. Umgekehrt kann die erfolgreiche Behandlung einer OSA zu einer Verbesserung der Anfallskontrolle führen.

Abstract

Epilepsy and seizures exert a significant and enduring effect on sleep in epilepsy patients. Nocturnal generalised tonic-clonic seizures as well as multiple complex partial seizures distort sleep architecture and result in excessive daytime sleepiness. There is a lack of REM rebound in the successive nights. Furthermore, the chronic epileptic condition especially in focal epilepsy causes a disturbed sleep architecture independently of seizures. Epilepsy patients suffer from a 2- to 3-fold increased prevalence of subjective sleep disturbances as compared to the general population. Sleep disturbances are associated with a significant impairment in quality of life. Children with epilepsy suffer from sleep prob-lems more often than healthy children. Sleep impairment in children with epilepsy causes behavioural problems and reduced quality of life. With a prevalence of 30–50% excessive daytime sleepiness represents the most frequent sleep-related disturbance in epilepsy patients and could be documented with objective tests. Obstructive sleep apnea (OSA) occurs in 10–33% of epilepsy patients and thus significantly more often than in the general population. Possible mechanisms include the effects of central nervous system depressant antiepileptic drugs, weight gain in-duced by antiepileptic drugs and the increased incidence of polycystic ovary syndrome in women with epilepsy. OSA can lead to an exacerbation of seizures. On the contrary, successful treatment of OSA results in improved seizure control.

Schlüsselwörter

Schlaf - Epilepsie - obstruktive Schlafapnoe - exzessive Tagesmüdigkeit

Key words

sleep - epilepsy - obstructive sleep apnea - excessive daytime sleepiness

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