Sleep staging and respiratory events in refractory epilepsy patients: Is there a first night effect?
Open accessAbstract
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.
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Using an AHI cutoff of ≥ 5 to diagnose OSA, three of the studies identified that 9.9% to 25% of subjects had an AHI < 5 on the first PSG but an AHI ≥ 5 only on the second PSG.
“Using an AHI cutoff of ≥ 5 to diagnose OSA, three of the studies34,130,131 identified that 9.9% to 25% of subjects had an AHI < 5 on the first PSG but an AHI ≥ 5 only on the second PSG.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [131]
The Results report that one patient had an AHI below 5 on the first PSG and at least 5 on the second, so the paper supports the diagnostic threshold and the occurrence of this change. But the Abstract gives a sample of 40 patients, making that one patient 2.5%, not within the claimed 9.9%–25% range. This paper therefore does not support the stated range as a finding of its study. (LLM, conf=0.90)
Experimental — accuracy not yet measuredA meta-analysis of four studies compared AHI data between 2 consecutive nights of PSG and found the mean difference in the AHI between the 2 nights was 0.14 (95% CI: −1.86 to 2.15), which was not statistically or clinically significant.
“A meta-analysis of four studies compared AHI data between 2 consecutive nights of PSG34,129–131 (see supplemental material, Figure S28 and Table S66) and found the mean difference in the AHI between the 2 nights was 0.14 (95% CI: −1.86 to 2.15), which was not statistically or clinically significant.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [131]
The Results (page not provided) compare AHI across two consecutive PSG nights in patients with refractory epilepsy and report no significant difference. This paper is one study, not the four-study meta-analysis, and it does not report the pooled mean difference of 0.14 or its 95% CI. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOnly one of the studies indicated that PSG scorers were blinded to the other PSG result.
“Only one of the studies indicated that PSG scorers were blinded to the other PSG result.131”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [131]
The Methods section states that the PSG studies were scored in a blinded fashion, supporting the claim that this study reported blinded scoring. It does not specify that scorers were blinded to the other night's PSG result, and this paper cannot establish that it was the only study to report blinding. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOur literature search identified four observational studies that compared AHI scores between two consecutive nights of PSG.
“Our literature search identified four observational studies that compared AHI scores between two consecutive nights of PSG.34,129–131”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [131]
One of two studies that reported on sleep architecture changes found a statistically significant increase in REM sleep on the second PSG.
“One of two studies that reported on sleep architecture changes130,131 found a statistically significant increase in REM sleep on the second PSG.131”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [131]
The overall quality of evidence for comparing night-to-night AHI variability was originally considered high, due to precise and consistent data across studies.
“The overall quality of evidence for comparing night-to-night AHI variability was originally considered high, due to precise and consistent data across studies.34,129–131”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [131]
The Methods and Results describe a two-night AHI comparison in patients with refractory epilepsy, and the Discussion notes greater night-to-night variability at higher AHI values (page unavailable). The paper does not assess the overall quality, precision, or consistency of evidence across studies; searches for those terms found no such assessment in our copy. (LLM, conf=0.76)
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Cites
STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
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Flagged first, then by citations
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Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6506 · Cited by 3,253 · see citing works
Clinical utility of the Epworth sleepiness scale
Walker, N. A., Sunderram, J., Zhang, P., Lu, S.-E., & Scharf, M. T. (2020) · Sleep and Breathing · doi:10.1007/s11325-020-02015-2 · Cited by 102 · see citing works
- Authors
- Selwa, L. M., Marzec, M. L., Chervin, R. D., Weatherwax, K. J., Vaughn, B. V., Foldvary‐Schaefer, N., Wang, L., Song, Y., & Malow, B. A.
- Affiliations
- University of Michigan (US)
- University of North Carolina at Chapel Hill (US)
- Cleveland Clinic (US)
- Vanderbilt University (US)
- Corresponding author
- Selwa, Linda M.
- ORCID
- Venue
- Epilepsia
- Publisher
- Wiley
- Published
- 2008-12
- Volume
- 49
- Issue
- 12
- Pages
- 2063-2068
- ISSN
- 0013-9580 (ISSN-L)
- 1528-1167
- PMC
- PMC3748715
- OpenAlex
- W2136914836
- Cited by
- 35
- References
- 1
- Citations by year
- 2023: 1 · 2022: 1 · 2020: 3 · 2019: 1 · 2018: 4 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 3 · 2013: 4 · 2012: 6
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epilepsia (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- UNC Libraries
- Funders
- Vanderbilt University (M01 RR00095)
- Eisai
- National Institute of Neurological Disorders and Stroke (R01NS042698)
- National Center for Research Resources (RR00046, M01RR000095, M01RR000046, RR00041)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- first-night effect, obstructive sleep apnea, drug-resistant epilepsy, sleep stage classification, polysomnography, apnea-hypopnea index, REM sleep, slow-wave sleep, sleep architecture, OSA diagnosis
- MeSH terms
- Adult, Electroencephalography, Epilepsy, Female, Humans, Male, Middle Aged, Respiration, Sleep Stages, Wakefulness, Polysomnography, Sleep Apnea, Obstructive, Young Adult
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