Abstract: Objective To explore the correlation between the changes of electroencephalogram (EEG) power spectrum and sleep disorder (SD) in patients with drug-resistant epilepsy (DRE),and to evaluate the effect of agomelatine (AGM) combined with eszopiclone (ESZ) on improving sleep and epilepsy (EP) frequency in patients with DRE. Methods 110 patients with DRE admitted from June 2023 to April 2025 were selected and divided into the SD group (n=50) and the non-SD group (n=60) based on pittsburgh sleep quality index (PSQI≥7),and clinical data,EEG parameters (δ,θ,α,β relative power),and polysomnography parameters[sleep onset latensy (SOL),total sleep time (TST),etc] of the patients were collected.Patients in the SD group were treated with AGM and ESZ for 12 weeks in addition to maintaining the original anti EP drug therapy,and the correlation between EEG parameters and SD and the treatment effect were analyzed. Results The age of patients in the SD group,the proportion of generalized seizures,high-frequency seizures (>1/month),and the use of traditional anti EP drugs were all higher than those in the non SD group (P＜0.05).The relative power of the β,δ,and θ frequency bands in the SD group was significantly higher than that in the non SD group (P＜0.05),and was positively correlated with PSQI score and SOL (P＜0.05),and negatively correlated with TST and sleep efficiency (SE) (P＜0.05).Multiple Logistic regression showed that the relative power of the β,δ,and θ frequency bands was an independent influencing factor of SD (OR=1.545~1.744,P＜0.05).RCS analysis showed a non-linear dose-response relationship between relative power in the β,δ,and θ frequency bands and SD risk (nonlinear test all P＜0.001).After treatment,the PSQI score,insomnia severity index scale (ISI),and frequency of EP attacks in the SD group were significantly reduced (P＜0.05),and the incidence of adverse reactions was 16%,all of which were mild.Compared with before treatment,DRE patients with SD had lower relative power in the β,δ,and θ frequency bands after 12 weeks of treatment (P＜0.05). Conclusion The abnormal EEG power spectrum of DRE patients (relative power of the β,δ,and θ frequency band increases) is closely related to SD,and AGM combined with ESZ can effectively improve sleep quality and reduce EP episodes,with good safety,and EEG parameters may serve as potential biomarkers for assessing the risk of SD in DRE patients.

Key words: Drug resistant epilepsy, Electroencephalogram, Sleep disorders, Relativity

摘要： 目的 探讨耐药型癫痫(DRE)患者脑电图(EEG)功率谱变化与睡眠障碍(SD)的相关性,并评估阿戈美拉汀(AGM)联合右佐匹克隆(ESZ)对改善DRE患者睡眠及癫痫(EP)发作频率的效果。方法 选取2023年6月至2025年4月收治的110例DRE患者,根据匹兹堡睡眠质量指数(PSQI≥7分)分为SD组(n=50)和无SD组(n=60),收集患者临床资料、EEG参数(δ、θ、α、β频段相对功率)及多导睡眠监测参数[睡眠潜伏期(SOL)、总睡眠时间(TST)等]。SD组患者在维持原抗EP药物治疗基础上联合AGM和ESZ治疗12周,分析EEG参数与SD的关联性及治疗效果。结果 SD组患者年龄、全面性发作比例、高频发作(>1次/月)及传统抗EP药物使用率均高于无SD组(P＜0.05)。SD组β、δ、θ频段相对功率显著高于无SD组(P＜0.05),且与PSQI评分、SOL呈正相关(P＜0.05),与TST、睡眠效率(SE)呈负相关(P＜0.05)。多因素Logistic回归显示,β、δ、θ频段相对功率是SD的独立影响因素(OR=1.545~1.744,P＜0.05)。RCS分析显示,β、δ、θ频段相对功率与SD风险存在非线性剂量-反应关系(非线性检验均P＜0.001)。治疗后,SD组PSQI评分、失眠严重程度指数量表(ISI)及EP发作频率均显著降低(P＜0.05),不良反应发生率为16%,均为轻度。与治疗前相比,DRE伴SD患者治疗12周β、δ、θ频段相对功率均更低(P＜0.05)。结论 DRE患者EEG功率谱异常(β、δ、θ频段相对功率增高)与SD密切相关,AGM联合ESZ可有效改善睡眠质量并减少EP发作,安全性良好,EEG参数可能作为评估DRE患者SD风险的潜在生物标志物。

关键词: 耐药型癫痫, 脑电图, 睡眠障碍, 相关性