Journal article
Interictal respiratory variability predicts severity of hypoxemia after generalized convulsive seizures
Epilepsia (Copenhagen), Vol.64(9), pp.2373-2384
09/2023
DOI: 10.1111/epi.17691
PMCID: PMC10538446
PMID: 37344924
Appears in UI Libraries Support Open Access
Abstract
OBJECTIVESevere respiratory dysfunction induced by generalized convulsive seizures (GCS) is now thought to be a common mechanism for sudden unexpected death in epilepsy (SUDEP). In a mouse model of seizure-induced death, increased interictal respiratory variability was reported in mice that later die of respiratory arrest after GCS. We studied respiratory variability in epilepsy patients as a predictive tool for severity of postictal hypoxemia, a potential biomarker for SUDEP risk. We then explored the relationship between respiratory variability and central CO2 drive, measured by the hypercapnic ventilatory response (HCVR). METHODSWe reviewed clinical, video-EEG and respiratory (belts, airflow, pulse oximeter, and HCVR) data of epilepsy patients. Mean, standard deviation (SD), and coefficient of variation (CV) of inter-breath-interval (IBI) were calculated. Primary outcomes were: a) nadir of capillary oxygen saturation (SpO2 ) and, b) duration of oxygen desaturation. Poincaré plots of IBI were created. Covariates were evaluated in univariate models, then based on Akaike Information Criteria (AIC) multivariate regression models were created. RESULTSOf 66 GCS recorded in 131 subjects 30 had interpretable respiratory data. In the multivariate model with the lowest AIC value, duration of epilepsy was a significant predictor of duration of oxygen desaturation. Duration of tonic phase and CV of IBI during the 3rd minute postictal correlated with SpO2 nadir while CV of IBI during NREM sleep had a negative correlation. Poincaré plots showed that long-term variability was significantly greater in subjects with > 200 seconds of postictal oxygen desaturation after GCS compared to those with < 200 seconds desaturation. Finally, HCVR slope showed a negative correlation with measures of respiratory variability. SIGNIFICANCEThese results indicate that interictal respiratory variability predicts severity of postictal oxygen desaturation, suggesting its utility as a potential biomarker. They also suggest that interictal respiratory control may be abnormal in some patients with epilepsy.
Details
- Title: Subtitle
- Interictal respiratory variability predicts severity of hypoxemia after generalized convulsive seizures
- Creators
- Rup K SainjuDeidre N Dragon - University of IowaHarold B Winnike - University of IowaLaura Vilella - The University of Texas Health Science CenterXiaojin Li - The University of Texas Health Science CenterSamden Lhatoo - The University of Texas Health Science CenterPatrick Ten EyckLinder H Wendt - University of IowaGeorge B Richerson - University of IowaBrian K Gehlbach - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Epilepsia (Copenhagen), Vol.64(9), pp.2373-2384
- DOI
- 10.1111/epi.17691
- PMID
- 37344924
- PMCID
- PMC10538446
- NLM abbreviation
- Epilepsia
- eISSN
- 1528-1167
- Publisher
- Wiley
- Grant note
- DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences, award: UL1TR002537; DOI: 10.13039/100000065, name: National Institute of Neurological Disorders and Stroke, award: R01 NS113764‐ 01, U01 NS090414; DOI: 10.13039/100000065, name: National Institute of Neurological Disorders and Stroke, award: U0109405, U01NS09407
- Language
- English
- Electronic publication date
- 06/21/2023
- Date published
- 09/2023
- Academic Unit
- Neurology; Molecular Physiology and Biophysics; Pulmonary, Critical Care, and Occupational Medicine; Clinical Research Unit; Iowa Neuroscience Institute; Biostatistics; Neurosurgery; Health, Sport, and Human Physiology ; Internal Medicine; Design Biostat and Ethics
- Record Identifier
- 9984436284102771
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