OBJECTIVE To investigate the impact of sleep onset and offset on the rate of epileptiform discharges (ED) in idiopathic generalized epilepsies (IGE). METHODS We studied the temporal distribution of EDs with mixed-effects Poisson regression modeling in a cohort of patients diagnosed with IGE who underwent 24-hour ambulatory electroencephalography (EEG) recordings. We defined the mean number discharges per hour per subject as the mean ED rate. The association between each hour and the mean ED rate was quantified with incidence rate ratio (IRR) as the metric. We calculated the IRR of each hourly block for the total cohort in relation to sleep onset and offset. Finally, we admitted secondary risk factors into our Poisson regression model and quantified changes in IRR in order to investigate the impact of those variables on the outcome. The secondary risk factors included: epilepsy syndrome, duration of seizure freedom, duration of epilepsy, number of antiepileptic drugs (AED), type of AED, and age. RESULTS A total of 39 patients with a mean age of 29.1 y (SD = 10.1) were studied. The distribution of ED rate demonstrated a highly significant abrupt increase in the first hour after sleep onset (IRR = 3.96; p < 0.001). On the contrary, the ED rate significantly dropped in the second hour after the sleep offset compared with the last hour block before sleep offset (IRR = 0.39; p < 0.001). None of the secondary risk factors demonstrated any significant impact on this pattern. CONCLUSIONS Sleep onset is a very significant trigger for the generation of EDs in IGE. SIGNIFICANCE Our results support the hypothesis that there is a "critical zone of vigilance" in the sleep-wake boundary from which generalized EDs are more likely to emerge.

中文翻译：

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“睡眠激增”：睡眠开始和抵消对特发性全身性癫痫癫痫样放电的影响

目的 研究睡眠开始和睡眠偏移对特发性全身性癫痫 (IGE) 癫痫样放电 (ED) 率的影响。方法我们使用混合效应泊松回归模型研究了一组诊断为 IGE 且接受 24 小时动态脑电图 (EEG) 记录的患者的 ED 时间分布。我们将每位受试者每小时的平均出院次数定义为平均 ED 率。每小时与平均 ED 率之间的关联以发生率比 (IRR) 作为指标进行量化。我们计算了与睡眠开始和偏移相关的总队列的每个小时块的 IRR。最后，我们将次要风险因素纳入我们的泊松回归模型并量化 IRR 的变化，以研究这些变量对结果的影响。次要危险因素包括：癫痫综合征、无癫痫发作持续时间、癫痫持续时间、抗癫痫药物 (AED) 数量、AED 类型和年龄。结果 共研究了 39 名平均年龄为 29.1 岁 (SD = 10.1) 的患者。ED 率的分布在睡眠开始后的第一个小时内表现出非常显着的突然增加（IRR = 3.96；p < 0.001）。相反，与睡眠偏移前的最后一个小时块相比，睡眠偏移后第二小时的 ED 率显着下降（IRR = 0.39；p < 0.001）。没有任何次要风险因素显示出对这种模式有任何显着影响。结论 睡眠开始是 IGE 中 ED 产生的一个非常重要的触发因素。意义 我们的结果支持存在“关键警戒区”的假设