title: Effect of carbamazepine on the sleep microstructure of temporal lobe epilepsy patients: a cyclic alternating pattern-based study.
abstract: Studies looking at the effect of anti-epileptic drugs on the sleep microstructure of patients with epilepsy are scarce. The aim of this study was to compare the sleep microstructural characteristics of drug-naive temporal lobe epilepsy (TLE) patients and those on carbamazepine (CBZ) monotherapy.
  
  
  
  Three age-matched (p = 0.286) and sex-matched (p = 0.398) groups were studied: drug-naive TLE (n = 20); TLE on CBZ (n = 20); and healthy controls (n = 40). All groups underwent overnight polysomnography. Scoring and analysis of arousals and cyclic alternating pattern (CAP) parameters were performed. Comparison of arousal parameters and CAP parameters was performed using either one-way analysis of variance or the Kruskal-Wallis test, followed by pairwise comparisons (p ≤ 0.05).
  
  
  
  Rapid eye movement (REM) arousal indices and overall CAP rates were higher in patients with TLE (group 1, p < 0.001; group 2, p < 0.001) compared to controls. Furthermore, the overall CAP rate was higher in patients on CBZ. The CAP cycle/sequences indices (group 1, p < 0.001; group 2, p < 0.001) were higher, and conversely, the average duration of CAP cycles/sequences (group 1, p = 0.018; group 2, p = 0.003) was lower in patients with TLE. Finally, an increase in A2 percentage was noted in patients with TLE (group 1, p = 0.011; group 2, p = 0.011).
  
  
  
  We found significant alterations in REM arousal indices and CAP parameters in patients with TLE as compared to controls. Moreover, many of these CAP alterations were greater in patients on CBZ. These findings suggest that anti-epileptic drugs such as CBZ may augment arousal instability in patients with TLE, and hence worsen sleep quality and continuity.
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, India.
authors.forename: Chetan S
authors.initials: CS
authors.lastname: Nayak
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. Electronic address: sanjib_sinha2004@yahoo.co.in.
authors.forename: Sanjib
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
authors.forename: Madhu
authors.initials: M
authors.lastname: Nagappa
authors.affiliation: Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, India.
authors.forename: Kandavel
authors.initials: K
authors.lastname: Thennarasu
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
authors.forename: Arun B
authors.initials: AB
authors.lastname: Taly
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001143:Arousal / Q000187:drug effects / Q000502:physiology; D002220:Carbamazepine / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D012890:Sleep / Q000187:drug effects* / Q000502:physiology; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine
keywords: Arousal; CAP; Sleep microstructure; Temporal lobe epilepsy