The impact of antiseizure medications on polysomnographic parameters: a systematic review and meta-analysis.

Wei-Chih Yeh, Shiang-Ru Lu, Meng-Ni Wu, Kuo-Wei Lee, Ching-Fang Chien, Yi-On Fong, Kuan-Ying Li, You-Lin Lai, Chiu-Jung Lin, Ying-Sheng Li, Chien-Yu Su, Yu-Chun Wang, Yu-Han Lin, Tien-Yu Chen, Ping-Tao Tseng, Chung-Yao Hsu

Journal: Sleep medicine 2021;81():319-326

PMID: 33756282

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Oral antiseizure medications (ASMs) are first-line treatments for patients with epilepsy. However, ASMs may alter sleep architecture, adversely affecting patient outcomes. The meta-analysis aimed to elucidate the effect of ASMs on sleep architecture.

METHODS

PubMed, Embase, and Cochrane Central database (up to Febrary 2021) were searched for randomized control trials (RCT) with effects of ASMs on polysomnography parameters. A meta-analysis using a random-effects model was performed. We did not set limitation to the participants with underlying diagnosis of epilepsy.

RESULTS

Eighteen randomized-controlled trials fulfilled the eligibility criteria. The effects of five main groups of ASMs (sodium channel blockers, calcium channel blockers, GABA enhancers, synaptic vesicle glycoprotein 2A [SV2A] ligand, and broad-spetrum ASMs) on slow-wave sleep (SWS), rapid eye movement (REM) sleep, and sleep efficiency (SE) were analyzed. Compared with placebo, calcium channel blockers and GABA enhancers significantly increased SWS. GABA enhancers also decreased REM sleep percentage, whereas calcium channel blockers significantly increased SE. Sodium channel blockers, SV2A ligand and broad-spectrum ASMs did not affect SWS, REM sleep, or SE. The subgroup analysis revealed that gabapentin, pregabalin, and tiagabine increased the percentage of SWS. Tiagabine also decreased REM sleep, whereas pregabalin increased SE. Finally, levetiracetam did not affect SWS, REM sleep, and SE.

CONCLUSIONS

This meta-analysis indicated that ASMs can have a statistically significant effect on sleep parameters; the effect differs between ASMs.

Address: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.; Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.; Department of Neurology, Yuan's General Hospital, Kaohsiung, Taiwan.; Department of Neurology, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan.; Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan. Electronic address: [email protected].; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: [email protected].

DOI: 10.1016/j.sleep.2021.02.056

Link outs

Free resources

Other Literature Sources:

https://scite.ai/reports/33756282

Subscription / membership required

Full Text Sources:

MeSH Terms: Humans, Polysomnography, Sleep, Sleep, REM