ymjЯкутский медицинский журналYakut Medical Journal1813-19052312-1017ЯНЦ КМП10.25789/YMJ.2024.85.04ymj-340Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHСтруктура сна при рецидиве эпилептических приступов с отдаленной симптоматической этиологией у взрослыхSleep structure in adults with recurrent epileptic seizures of remote symptomatic etiologyhttps://orcid.org/0000-0002-4740-0162ГребенюкО. В.GrebenyukO. V.

ГРЕБЕНЮК Олег Валерьевич – к.м.н., доцент

GREBENYUK Oleg V. – PhD, Associate Professor of the Department of Neurology and Neurosurgery

https://orcid.org/0000-0002-6253-4644КазенныхТ. В.KazennykhT. V.

КАЗЕННЫХ Татьяна Валентиновна – д.м.н., зам. директора, врач-психиатр высшей категории, эпилептолог

KAZENNYKH Tatiana V. – MD, Deputy Director for Scientific and Medical Work of Mental Health Research, Professor of the Department of Psychiatry, Narcology and Psychotherapy of the Federal State Budgetary Educational Institution of Higher Professional Education Siberian State Medical University MH RF

https://orcid.org/0000-0003-0990-2580СветликМ. В.SvetlikM. V.

СВЕТЛИК Михаил Васильевич – к.б.н., доцент Биологич. ин-та Национального исслед. Томского гос. ун-та

SVETLIK Mikhail V. – PhD, Associate Professor of the Department of Human and Animal Physiology

https://orcid.org/0000-0002-3878-1725ПугаченкоН. В.PugachenkoN. V.

ПУГАЧЕНКО Наталия Викторовна – к.м.н., доцент

PUGACHENKO Natalia V. – Associate Professor of the Department of Neurology and Neurosurgery, Cand.Sc. (Medicine)

https://orcid.org/0000-0002-2178-601XАвхименкоВ. А.AvkhimenkoV. A.

АВХИМЕНКО Виктор Александрович – к.м.н., ген. директор 

AVKHIMENKO Viktor A. – PhD, General Director

https://orcid.org/0000-0003-0313-0698ЛевкоА. Н.LevkoA. N.

ЛЕВКО Алена Николаевна – к.м.н., проректор

LEVKO Alena N. – PhD, Vice-Rector for Interaction with Regions

https://orcid.org/0000-0002-4140-3223АлифироваВ. М.AlifirovaV. M.

АЛИФИРОВА Валентина Михайловна – д.м.н., проф,, зав. кафедрой

ALIFIROVA Valentina M. – MD, Head of the Department of Neurology and Neurosurgery, Professor

https://orcid.org/0000-0002-1052-855XБоханН. А.BohanN. A.

БОХАН Николай Александрович – д.м.н., акад. РАН, проф., директор, врач-психиатр высшей категории; зав. кафедрой Сибирского ГМУ

BOKHAN Nikolay A. – MD, Director of Mental Health Research Institute of Tomsk National Research Medical Center, psychiatrist of the highest category, Professor, academician of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Head of the Department of Psychiatry, Narcology and Psychotherapy

Сибирский государств. медицин. ун-т МЗ РФРоссияFederal State Budgetary Educational Institution of Higher Professional Education “Siberian State Medical University” of the Ministry of Health of the Russian FederationRussian FederationНИИ психического здоровья Томского НИМЦРоссияInstitute of Tomsk National Research Medical CenterRussian FederationБиологич. ин-т Национального исслед. Томского гос. ун-таРоссияBiological Institute of the Federal State Autonomous Educational Institution of Higher Education National Research Tomsk State UniversityRussian FederationСибирский государств. медицин. ун-т МЗ РФРоссияFederal State Budgetary Educational Institution of Higher Professional Education Siberian State Medical University of the Ministry of Health of the Russian FederationRussian FederationСибирскbq федеральн. науч.-клинич. центр Федеральн. медико-биологич. агентства РоссииРоссияFederal State Budgetary Institution of the Siberian Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of RussiaRussian FederationНИИ психического здоровья Томского НИМЦРоссияFederal State Budgetary Educational Institution of Higher Professional Education Siberian State Medical University of the Ministry of Health of the Russian FederationRussian Federation202409022025011620Copyright © Гребенюк О.В., Казенных Т.В., Светлик М.В., Пугаченко Н.В., Авхименко В.А., Левко А.Н., Алифирова В.М., Бохан Н.А., 20252025Гребенюк О.В., Казенных Т.В., Светлик М.В., Пугаченко Н.В., Авхименко В.А., Левко А.Н., Алифирова В.М., Бохан Н.А.Grebenyuk O.V., Kazennykh T.V., Svetlik M.V., Pugachenko N.V., Avkhimenko V.A., Levko A.N., Alifirova V.M., Bohan N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ymj.elpub.ru/jour/article/view/340

Проводили видео-полисомнографическое исследование структурных характеристик ночного сна у пациентов с впервые возникшим неспровоцированным тонико-клоническим припадком. В основную группу вошли пациенты с отдаленным симптоматическим приступом (ОСП). У пациентов с рецидивом ОСП регистрировалась меньшая эффективность сна, большая длительность фазы быстрого сна, фрагментация сна, длительность периодов бодрствования во время сна и более частые пробуждения из сна относительно пациентов с однократным ОСП и группой сравнения. Выявленные изменения демонстрируют более глубокие нарушения архитектуры сна у пациентов с рецидивом ОСП и могут учитываться при прогностическом консультировании этой категории больных.

A video-polysomnographic study of the structural characteristics of night sleep was carried out in 157 patients with a first-time unprovoked tonic-clonic seizure. The main group included patients with remote symptomatic seizure (RSS). Over the course of three years, 60 individuals had recurrent attacks; 38 patients had no recurrence of attacks during the observation period. The comparison group included 59 MRI- and EEG-negative patients. Patients with recurrent RSS had lower sleep efficiency, longer rapid eye movement phase, sleep fragmentation, wake after sleep onset, and more frequent awakenings from sleep (number of awakenings) versus patients with a single RSS and the comparison group. The identified changes demonstrate deeper disturbances in sleep architecture in patients with recurrent RSS and can be taken into account in prognostic counseling of this category of patients.

отдаленный симптоматический приступструктура снаremote symptomatic seizuresleep structureСтатья опубликована в рамках выполнения комплексной темы НИР «Биопсихосоциальные механизмы патогенеза и клинического полиморфизма, адаптационный потенциал и предикторы эффективности терапии у больных с психическими и поведенческими расстройствами в регионе Сибири», номер госрегистрации 122020200054-8, шифр темы FGWM-2022-0025.The article was published as part of the complex research topic “Biopsycho- social mechanisms of pathogenesis and clinical polymorphism, adaptive potential and predictors of treatment effectiveness in patients with mental and behavioral disorders in the Siberian region”, state registration number 122020200054-8, topic code FGWM-2022-0025.ReferencesИнсомния, современные диагностические и лечебные подходы / Левин Я. И., Ковров Г. В., Полуэктов М. Г., Корабельникова Е. А., Стрыгин К. Н., Тарасов Б. А., Посохов С. И. М.: Мед-практика-М. 2005. 116 с.Avakyan G.N., Blinov D.V., Lebedeva A.V., Burd S.G., Avakyan G.G. Klassifikatsiya epilepsii Mezhdunarodnoy Protivoepilepticheskoy Ligi: peresmotr i obnovlenie 2017 goda. Epilepsiya i paroksizmal'nye sostoyaniya. [ILAE Classification of the epilepsies: the 2017 revision and update. Epilepsy and Paroxysmal Conditions. 2017;9(1):6-25 (In Russ.).] https://doi.org/10.17749/2077-8333.2017.9.1.006-025Insomnia, modern diagnostic and treatment approaches / Levin Ya.I., Kovrov G.V., Poluektov M.G., Korabelnikova E.A., Strygin K.N., Tarasov B.A, Posokhov S.I. M: Medpraktika-M, 2005.116 p.Karlov V.A., Vlasov P.N., Azhigova A.M., Kozhokaru A.B., Orlova A.S. Fenomen farmakodinamicheskoy aggravatsii pri primenenii blokatorov natrievykh kanalov u patsientov s vpervye vyyavlennoy fokal'noy epilepsiey. Nevrologiya, neyropsikhiatriya, psikhosomatika [Pharmacodynamic sodium channel blockers-induced seizure aggravation in patients with newly diagnosed focal epilepsy. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(4):43-51. (In Russ.).]. https://doi.org/10.14412/2074-2711-2021-4-43-51Классификация эпилепсии Международной Противоэпилептической Лиги: пересмотр и обновление 2017 года / Авакян Г.Н., Блинов Д.В., Лебедева А.В., Бурд С.Г., Авакян Г.Г. // Эпилепсия и пароксизмальные состояния. 2017;9(1):6-25.Levin Ya.I., Kovrov G.V., Poluektov M.G., Korabel'nikova E.A., Strygin K.N., Tarasov B.A., Posokhov S.I. Insomniya, sovremennye diagnosticheskie i lechebnye podkhody [Insomnia, modern diagnostic and treatment approaches. M: Medpraktika-M, 2005.116 p. (In Russ.).]ILAE Classification of the epilepsies: the 2017 revision and update / Avakyan G.N., Blinov D.V., Lebedeva A.V., Burd S.G., Avakyan G.G. Epilepsy and Paroxysmal Conditions. 2017;9(1):6-25. https://doi.org/10.17749/20778333.2017.9.1.006-025Naumova G.I. Organizatsiya meditsinskoy pomoshchi patsientam s vpervye razvivshimsya sudorozhnym pripadkom. Nevrologiya, neyropsikhiatriya, psikhosomatika. 2009;1 (2):37-41. [Organization of health care to patients with new-onset convulsive seizure. Neurology, Neuropsychiatry, Psychosomatics. 2009; 1 (2):37-41 (In Russ.)] doi.org/10.14412/2074-2711-2009-36Наумова Г.И. Организация медицинской помощи пациентам с впервые развившимся судорожным припадком // Неврология, нейропсихиатрия, психосоматика. 2009;1 (2):37-41. Naumova G.I. Organization of health care to patients with new-onset convulsive seizure. Neurology, Neuropsychiatry, Psychosomatics. 2009; 1 (2):37-41. doi.org/10.14412/2074-2711-2009-36Ob effektivnosti, bezopasnosti i otsenke rezul'tatov lekarstvennoy terapii bol'nykh epilepsiey. Epilepsiya i paroksizmal'nye sostoyaniya [Effectiveness, safety and assessing the results of drug therapy in patients with epilepsy. Epilepsy and Paroxysmal Conditions 2021;13(3):306-310. (In Russ.)]. https://doi.org/10.17749/2077-8333/epi.par.con.2021.093Об эффективности, безопасности и оценке результатов лекарственной терапии больных эпилепсией // Эпилепсия и пароксизмальные состояния. 2021;13(3):306-310.Andrade P, Lara-Valderrábano L, Manninen E et al. Seizure susceptibility and sleep disturbance as biomarkers of epileptogenesis after experimental TBI. Biomedicines. 2022;10(5):1138. Published 2022 May 14. https://doi.org/10.3390/biomedicines10051138Effectiveness, safety and assessing the results of drug therapy in patients with epilepsy. Epilepsy and Paroxysmal Conditions. 2021;13(3):306310. https://doi.org/10.17749/2077-8333/epi.par. con.2021.093Berg Anne T. Risk of recurrence after a first unprovoked seizure. Epilepsia 2008;49(Suppl. 1):13-8.Феномен фармакодинамической аггравации при применении блокаторов натриевых каналов у пациентов с впервые выявленной фокальной эпилепсией / Карлов В.А., Власов П.Н., Ажигова А.М., Кожокару А.Б., Орлова А.С. // Неврология, нейропсихиатрия, психосоматика. 2021;13(4):43-51.Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, Troester MT, & Vaughn BV. AASM scoring manual updates for 2017 (version 2.4). Journal of Clinical Sleep Medicine. 2017; 13(5), 665-666. https://doi.org/10.5664/jcsm.6576Pharmacodynamic sodium channel blockers-induced seizure aggravation in patients with newly diagnosed focal epilepsy / Karlov V.A., Vlasov P.N., Azhigova A.M., Kozhokaru A.B., Orlova A.S. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(4):43-51. https://doi.org/10.14412/2074-2711-2021-4-43-51Calvello C, Fernandes M, Lupo C et al. Sleep architecture in drug-naïve adult patients with epilepsy: Comparison between focal and generalized epilepsy. Epilepsia Open. 2023;8(1):165172. https://doi.org/10.1002/epi4.12687Andrade P, Lara-Valderrábano L, Manninen E et al. Seizure susceptibility and sleep disturbance as biomarkers of epileptogenesis after experimental TBI. Biomedicines. 2022;10(5):1138. Published 2022 May 14. https://doi.org/10.3390/biomedicines10051138Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure. 2017;49:6973. doi:10.1016/j.seizure.2017.03.001Berg Anne T. Risk of recurrence after a first unprovoked seizure. Epilepsia 2008;49(Suppl. 1):13-8.Delil S, Senel GB, Demiray DY, Yeni N. The role of sleep electroencephalography in patients with new onset epilepsy. Seizure. 2015;31:80-83. https://doi.org/10.1016/j.seizure.2015.07.011Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, Troester MT, & Vaughn BV. AASM scoring manual updates for 2017 (version 2.4). Journal of Clinical Sleep Medicine. 2017; 13(5), 665-666. https://doi.org/10.5664/jcsm.6576Grigg-Damberger M, Foldvary-Schaefer N. Bidirectional relationships of sleep and epilepsy in adults with epilepsy. Epilepsy Behav. 2021;116:107735. https://doi.org/10.1016/j.yebeh.2020.107735Calvello C, Fernandes M, Lupo C et al. Sleep architecture in drug-naïve adult patients with epilepsy: Comparison between focal and generalized epilepsy. Epilepsia Open. 2023;8(1):165172. https://doi.org/10.1002/epi4.12687Haba-Rubio J, Ibanez V, Sforza E. An alternative measure of sleep fragmentation in clinical practice: the sleep fragmentation index. Sleep Med. 2004;5(6):577-581. https://doi.org/10.1016/j.sleep.2004.06.007Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure. 2017;49:6973. doi:10.1016/j.seizure.2017.03.001Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality. Epilepsia. 2008;49 Suppl 1:8-12. https://doi.org/10.1111/j.1528-1167.2008.01443.xDelil S, Senel GB, Demiray DY, Yeni N. The role of sleep electroencephalography in patients with new onset epilepsy. Seizure. 2015;31:80-83. https://doi.org/10.1016/j.seizure.2015.07.011Kataria L, Vaughn BV. Sleep and epilepsy. Sleep Med Clin. (2016) 11:25–38. https://doi.org/10.1016/j.jsmc.2015.10.008Grigg Damberger M, Foldvary Schaefer N. Bidirectional relationships of sleep and epilepsy in adults with epilepsy. Epilepsy Behav. 2021;116:107735. https://doi.org/10.1016/j.yebeh.2020.107735Kishi A, Struzik ZR, Natelson BH, Togo F, Yamamoto Y. Dynamics of sleep stage transitions in healthy humans and patients with chronic fatigue syndrome. Am J Physiol Regul Integr Comp Physiol. 2008; 294:1980-7.Haba-Rubio J, Ibanez V, Sforza E. An alternative measure of sleep fragmentation in clinical practice: the sleep fragmentation index. Sleep Med. 2004;5(6):577-581. https://doi.org/10.1016/j.sleep.2004.06.007Laffan A, Caffo B, Swihart BJ, Punjabi NM. Utility of sleep stage transitions in a ssessing sleep continuity. SLEEP. 2010;33(12):1681-1686.Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality. Epilepsia. 2008;49 Suppl 1:8-12. https://doi.org/10.1111/j.1528-1167.2008.01443.xLiguori C, Spanetta M, Fernandes M, Izzi F, Placidi F, Mercuri NB. More than sleep and wake disturbances: An actigraphic study showing the sleep-wake pattern dysregulation in epilepsy. Seizure. 2022;94:95–99.Kataria L, Vaughn BV. Sleep and epilepsy. Sleep Med Clin. (2016) 11:25–38. https://doi.org/10.1016/j.jsmc.2015.10.008Maksimova M.Yu., Shalimanova E.V., Brutyan A.G. Post-stroke seizures and epilepsy after stroke. Consilium Medicum. 2020; 22 (9): 38–45. https://doi.org/10.26442/20751753.2020.9.200273Kishi A, Struzik ZR, Natelson BH, Togo F, Yamamoto Y. Dynamics of sleep stage transitions in healthy humans and patients with chronic fatigue syndrome. Am J Physiol Regul Integr Comp Physiol. 2008; 294:1980-7.Moore JL, Carvalho DZ, St Louis EK, Bazil C. Sleep and Epilepsy: a Focused Review of Pathophysiology, Clinical Syndromes, Co-morbidities, and Therapy [published correction appears in Neurotherapeutics. 2021 Apr 13;:]. Neurotherapeutics. 2021;18(1):170-180. https://doi.org/10.1007/s13311-021-01021-wLaffan A, Caffo B, Swihart BJ, Punjabi NM. Utility of sleep stage transitions in a ssessing sleep continuity. SLEEP. 2010;33(12):1681-1686.Serafini A, Kuate C, Gelisse P, et al. Sleep before and after temporal lobe epilepsy surgery. Seizure. 2012;21(4):260–5.Liguori C, Spanetta M, Fernandes M, Izzi F, Placidi F, Mercuri NB. More than sleep and wake disturbances: An actigraphic study showing the sleep-wake pattern dysregulation in epilepsy. Seizure. 2022;94:95–99.Shouse MN, Farber PR, Staba RJ. Physiological basis: how NREM sleep components can promote and REM sleep components can suppress seizure discharge propagation. Clin Neurophysiol. 2000;111(Suppl 2):S9–18.Maksimova M.Yu., Shalimanova E.V., Brutyan A.G. Post-stroke seizures and epilepsy after stroke. Consilium Medicum. 2020; 22 (9): 38–45. https://doi.org/10.26442/20751753.2020.9.200273Sudbrack-Oliveira P, Lima Najar L, Foldvary-Schaefer N, da Mota Gomes M. Sleep architecture in adults with epilepsy: a systematic review. Sleep Med. 2019;53:22-27. https://doi.org/10.1016/j.sleep.2018.09.004].Moore JL, Carvalho DZ, St Louis EK, Bazil C. Sleep and Epilepsy: a Focused Review of Pathophysiology, Clinical Syndromes, Co-morbidities, and Therapy [published correction appears in Neurotherapeutics. 2021 Apr 13;:]. Neurotherapeutics. 2021;18(1):170-180. https://doi.org/10.1007/s13311-021-01021-wTork, M.A., Rashed, H.R., Elnabil, L. et al. Sleep pattern in epilepsy patients: a polysomnographic study. Egypt J Neurol Psychiatry Neurosurg. 2020; 56, 5. https://doi.org/10.1186/s41983019-0141-4Serafini A, Kuate C, Gelisse P, et al. Sleep before and after temporal lobe epilepsy surgery. Seizure. 2012;21(4):260–5.Yeh WC, Lai CL, Wu MN, et al. Rapid eye movement sleep disturbance in patients with refractory epilepsy: A polysomnographic study. Sleep Med. 2021;81:101–8.Shouse MN, Farber PR, Staba RJ. Physiological basis: how NREM sleep components can promote and REM sleep components can suppress seizure discharge propagation. Clin Neurophysiol. 2000;111(Suppl 2):S9-18.Yeh WC, Lin HJ, Li YS, et al. Rapid eye movement sleep reduction in patients with epilepsy: A systematic review and meta-analysis. Seizure. 2022;96:46-58. https://doi.org/10.1016/j.seizure.2022.01.014Sudbrack-Oliveira P, Lima Najar L, Foldvary-Schaefer N, da Mota Gomes M. Sleep architecture in adults with epilepsy: a systematic review. Sleep Med. 2019;53:22-27. https://doi.org/10.1016/j.sleep.2018.09.004].Zanzmera P, Shukla G, Gupta A, et al. Markedly disturbed sleep in medically refractory compared to controlled epilepsy a clinical and polysomnography study. Seizure. 2012;21(7):487–90.Tork, M.A., Rashed, H.R., Elnabil, L. et al. Sleep pattern in epilepsy patients: a polysomnographic study. Egypt J Neurol Psychiatry Neuro-surg. 2020; 56, 5. https://doi.org/10.1186/s41983-019-0141-4Zelano J. Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not? Epilepsia Open. 2021;6(4):634-644. https://doi.org/10.1002/epi4.12543Yeh WC, Lai CL, Wu MN, et al. Rapid eye movement sleep disturbance in patients with refractory epilepsy: A polysomnographic study. Sleep Med. 2021;81:101–8.Yeh WC, Lai CL, Wu MN, et al. Rapid eye movement sleep disturbance in patients with refractory epilepsy: A polysomnographic study. Sleep Med. 2021;81:101–8.Yeh WC, Lin HJ, Li YS, et al. Rapid eye movement sleep reduction in patients with epilepsy: A systematic review and meta-analysis. Seizure. 2022;96:46-58. https://doi.org/10.1016/j.seizure.2022.01.014Yeh WC, Lin HJ, Li YS, et al. Rapid eye movement sleep reduction in patients with epilepsy: A systematic review and meta-analysis. Seizure. 2022;96:46-58. https://doi.org/10.1016/j.seizure.2022.01.014Zanzmera P, Shukla G, Gupta A, et al. Markedly disturbed sleep in medically refractory compared to controlled epilepsy a clinical and polysomnography study. Seizure. 2012;21(7):487–90.Zanzmera P, Shukla G, Gupta A, et al. Markedly disturbed sleep in medically refractory compared to controlled epilepsy a clinical and polysomnography study. Seizure. 2012;21(7):487–90.Zelano J. Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not? Epilepsia Open. 2021;6(4):634-644. https://doi.org/10.1002/epi4.12543Zelano J. Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not? Epilepsia Open. 2021;6(4):634-644. https://doi.org/10.1002/epi4.12543

The authors declare that there are no conflicts of interest present.