CYCLIC ALTERNATING PATTERN AND INTERICTAL EPILEPTIFORM DISCHARGES DURING MORNING SLEEP DEPRIVED EEG IN TEMPORAL LOBE EPILEPSY

Introduction: Sleep deprivation (SD) increases the occurrence of interictal epileptiform discharges (IED) compared to basal EEG in temporal lobe epilepsy (TLE). We aimed to evaluate whether morning sleep after partial nocturnal SD bears additional activating effects on IED compared with nocturnal sleep, and whether changes in sleep instability (as evaluated through the cyclic alternating pattern model, CAP) play a significant role. Materials and methods: Thirteen adult TLE patients underwent in-lab nocturnal polysomnography (n-PSG) and, within seven days, morning SD-EEG, being awake the night before from 2 AM. For both recordings, we obtained the following markers for the first sleep cycles: IED/h (Spike Index, SI), sleep macrostructure, microstructure (CAP rate; A1, A2 and A3 Index), and SI association with CAP phases. Results: The macrostructure of the first sleep cycles was similar in n-PSG and SD-EEG, whereas CAP rate and SI were significantly higher in SD-EEG. SI increase was selectively associated with CAP phases. D/h (Spike Index, SI), sleep macrostructure, microstructure (CAP rate; A1, A2 and A3 Index), and SI association with CAP phases. Conclusions: SD increases the instability of morning recovery sleep compared with n-PSG, and particularly enhances A1 CAP phases, that are associated with the major occurrence of IED. Higher instability of post-SD recovery sleep may account for the increased diagnostic yield in SD-EEG in TLE patients.leep cycles was similar in n-PSG and SD-EEG, whereas CAP rate and SI were significantly higher in SD-EEG. SI increase was selectively associated with CAP phases. D/h (Spike Index, SI), sleep macrostructure, microstructure (CAP rate; A1, A2 and A3 Index), and SI association with CAP phases.