PND158 - CHANGES IN SLEEP PATTERNS AFTER VAGUS NERVE STIMULATION, DEEP BRAIN STIMULATION OR EPILEPSY SURGERY: SYSTEMATIC REVIEW OF THE LITERATURE

Abstract

In patients with epilepsy, multiple factors such as ictal frequency, interictal activity and anticonvulsant therapy affect sleep architecture and quality. Daytime somnolence is the most common complaint of patients with epilepsy. An increase in obstructive sleep apnea/hypopnea syndrome has been documented in patients with refractory epilepsy, associated with a decline in the quality of life. We wanted to review of the literature on the effects of three invasive procedures used in certain cases of refractory epilepsy: vagus nerve stimulation (VNS), deep brain stimulation (DBS) and epilepsy surgery, in subjective and objective sleep parameters. We performed a literature search in all the main medical databases: Medline, Embase, Cochrane, DARE and LILACS, looking for studies that evaluated the effects of VNS, DBS or epilepsy surgery on sleep parameters. In all, 36 studies, coming from 11 countries, including reviews, cohort studies, case series and case reports were included. VNS seems to induce sleep apnea, depending on stimulation variables. This condition can be reverted modifying these settings. Surgical procedures for epilepsy has been associated with an improvement in objective and subjective sleep parameters, that depend on the success of the procedure evaluated through ictal frequency control. There is evidence that non-pharmacologic treatment of epilepsy has different effects on sleep patterns. It is advisable to include objective and subjective sleep parameters in the initial evaluation and follow-up of patients considered for invasive procedures for epilepsy control, especially with VNS, due to the risk of sleep apnea. Most information comes from observational studies, with small sample sizes. More high quality studies are needed.