Sleep apnea syndrome is a disorder of abnormal respiration during sleep that results in a combination of hypoxemia and hypercapnia. The syndrome can be caused by obstruction of the upper airway during sleep, by abnormality in regulation of breathing by the central nervous system, or by a combination of obstructive and central problems.

Etiologies and risk factors

Epilepsy and sleep apnea syndrome have a reciprocal influence on one another that may exacerbate the processes of both conditions:

  • The apneic episodes lead to hypoxemia and to chronic sleep deprivation, because multiple arousals during the apneic episodes cause sleep fragmentation. Sleep deprivation and hypoxia can decrease the seizure threshold in epilepsy patients. In many epilepsy patients without sleep apnea, seizures may occur on arousal.
  • Antiepileptic drugs (AEDs) exacerbate sleep apnea by inhibiting respiratory drive centers and relaxing upper respiratory muscle tone.138,145

 

Evaluation

Sleep apnea is seen more commonly in men, especially those with snoring and obesity. A bed partner often notices periods of apnea. Jerking movements of the limbs, waking at night, and, occasionally, somnambulism are common. Patients may awaken in the morning with a headache. Morbidity arises from sleep deprivation, daytime hypersomnolence, and cardiac arrhythmias, some of which may be life-threatening and occasionally may lower the seizure threshold.148,149

Treatment

Treatment of sleep apnea is aimed predominantly at weight loss, maintaining oxygen flow by using continuous positive airway pressure (CPAP), and occasionally the use of acetazolamide, protriptyline, or aminophylline. With an obstructive sleep apnea condition, tracheostomy or excision of the obstructing uvula may be helpful. It is very important to treat sleep apnea effectively in a patient with intractable epilepsy to avoid loading with AEDs.138 This is particularly true for children with neurodevelopmental disorders who are taking multiple AEDs and may become excessively sedated.150

Wyler and Weymuller showed that seizures were reduced in an epilepsy patient whose sleep apnea was treated with a tracheostomy.146 Devinsky and colleagues147 also showed that in patients with epilepsy and sleep disorders (including obstructive sleep apnea), seizures were controlled after tracheostomy or initiation of nasal CPAP treatment.

For further information, see Sleep Disorders and Epilepsy.

Adapted from: Sepkuty JP and Kaplan PW. Hematologic and pulmonary disorders. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;209–228.
With permission from Elsevier (www.elsevier.com). 

Authored By: 
JP Sepkuty
PW Kaplan
Steven C. Schachter, MD
I<
Authored Date: 
03/2004
Reviewed By: 
Steven C. Schachter, MD
on: 
Wednesday, March 31, 2004