Serotonin Reuptake Inhibitor Use Does Not Modify SUDEP Risk in Adults with Epilepsy and Obstructive Sleep Apnea
Abstract number :
V.082
Submission category :
8. Non-ASM/Non-Surgical Treatments (Hormonal, alternative, etc.)
Year :
2021
Submission ID :
1826225
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:53 AM
Authors :
Atiwat Soontornpun, MD - Chiang Mai University; Noah D. Andrews - Department of Neurology - Cleveland Clinic; James Bena - Quantitative Health Sciences - Cleveland Clinic; Madeleine M. Grigg-Damberger - Department of Neurology - University of New Mexico; Nancy Foldvary-Schaefer - Department of Neurology - Cleveland Clinic
Rationale: Prior data demonstrated an association between obstructive sleep apnea (OSA) and risk for sudden unexplained death in epilepsy (SUDEP). Increasing evidence suggests brainstem serotonergic pathways are involved in the pathogenesis of SUDEP. We aimed to study whether serotonin reuptake inhibitors (SRI) are associated with SUDEP risk using the revised SUDEP Risk Inventory (rSUDEP-7) in adults with epilepsy (AWE) and OSA.
Methods: We identified AWE who underwent polysomnography (PSG) January 2004 to December 2016 at Cleveland Clinic. We collected demographics, epilepsy characteristics, PSG data, and SRI use (selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors). We defined OSA as an apnea-hypopnea index (AHI) ≥5, moderate/severe OSA AHI ≥ 15. We used the rSUDEP-7 to measure SUDEP risk; higher rSUDEP-7 scores indicating greater SUDEP risk. We compared median rSUDEP-7 scores by SRI use using Kruskal-Wallis test. We constructed multivariable linear regression models with SRI use as an adjustment factor, along with other factors associated with rSUDEP-7 score or moderate/severe OSA.
Results: We identified 214 AWE who had PSG (mean age 43.5 years, 57% female). Epilepsy was pharmacoresistant in 72 (33.6%); focal-onset 157 (73.4%). OSA was present in 134 (62.6%), moderate/severe in 75 (35%). SRI use was observed in 63 (29.4%). SRI use was not associated with lower rSUDEP-7 scores (1 (IQR (0,3) vs. 1 (IQR (0,3); p=0.39). The interaction between SRI use and moderate-to-severe OSA was not significant (p=0.48). On multivariable analysis, moderate/severe OSA was associated with higher rSUDEP-7 score (OR 1.14 (0.55-1.73), p< 0.001), while SRI use was not (p=0.47).
Conclusions: SRI exposure did not significantly modify SUDEP risk based on the rSUDEP-7 in AWE and OSA. Future studies are needed to confirm this finding.
Funding: Please list any funding that was received in support of this abstract.: -
Non-ASM