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Sleep staging and respiratory events in refractory epilepsy patients: Is there a first night effect?
Author(s) -
Selwa Linda M.,
Marzec Mary L.,
Chervin Ronald D.,
Weatherwax Kevin J.,
Vaughn Bradley V.,
FoldvarySchaefer Nancy,
Wang Lily,
Song Yanna,
Malow Beth A.
Publication year - 2008
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2008.01681.x
Subject(s) - medicine , epilepsy , sleep (system call) , anesthesia , polysomnography , apnea , sleep stages , respiratory system , slow wave sleep , sleep apnea , population , electroencephalography , environmental health , psychiatry , computer science , operating system
Summary Purpose: We performed this analysis of possible first night effects (FNEs) on sleep and respiratory parameters in order to evaluate the need for two serial night polysomnograms (PSGs) to diagnose obstructive sleep apnea (OSA) in epilepsy patients. Methods: As part of a pilot multicenter clinical trial investigating the effects of treating sleep apnea in epilepsy, two nights of PSG recording were performed for 40 patients with refractory epilepsy and OSA symptoms. Sleep architecture was examined in detail, along with respiratory parameters including apnea/hypopnea index (AHI) and minimum oxygen saturation. Analysis included two‐tailed t ‐tests, Wilcox sign rank analysis, and Bland Altman measures of agreement. Results: Total sleep time differed between the two nights (night 1,363.8 min + 59.4 vs. 386.3 min + 68.6, p = 0.05). Rapid eye movement (REM) sleep and percentage of REM sleep were increased during night two (night 1: 12.3% + 5.9 vs. night 2: 15.5% + 6.2, p = 0.007), and the total minutes of slow‐wave sleep (SWS) were increased (night 1: 35.6 + 60.7 vs. night 2: 46.4 + 68.1, p = 0.01). No other sleep or respiratory variables differed between the two nights. Given an AHI inclusion criterion of five apneas per hour, the first PSG identified all but one patient with OSA. Discussion: Respiratory parameters showed little variability between the first and second nights. Sleep architecture was mildly different between the first and second PSG night. Performing two consecutive baseline PSGs to diagnose OSA may not be routinely necessary in this population.