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. 2024 Oct;82(10):1-7.
doi: 10.1055/s-0044-1791517. Epub 2024 Nov 3.

Association of hyperventilation-induced heart rate variability and sudden unexpected death in epilepsy in drug-resistant epilepsy

Demet Ilhan Algin  1 , Oguz Erdinc  1
Affiliations

Association of hyperventilation-induced heart rate variability and sudden unexpected death in epilepsy in drug-resistant epilepsy

Demet Ilhan Algin et al. Arq Neuropsiquiatr. 2024 Oct.

Abstract
in English, Portuguese

Background: Within the general epilepsy population, the incidence of Sudden Unexpected Death in Epilepsy (SUDEP) ranges from approximately 0.35 to 2.3 per 1,000 individuals per year.

Objective: We aimed to evaluate the relationship between SUDEP risk factors and heart rate variability (HRV) parameters as a potential biomarker of SUDEP in patients with drug-resistant epilepsy (DRE).

Methods: There were 52 patients diagnosed with DRE and under follow-up, and controls including 45 healthy subjects, included in the study. Hyperventilation-induced HRV (HRVHV) parameters, including the standard deviation of all RR intervals (SDRR), mean heart rate (HR), root mean squares of successive differences (RMSSD), SD of mean NN intervals recordings (SDANN), and HRV triangular index, were assessed during resting. To predict the risk of SUDEP, the relationship between HRV parameters and SUDEP risks was evaluated using the Risk Assessment for Sudden Death in Epilepsy (SUDEP-7) Risk Inventory.

Results: No statistically significant difference was found in sympathetic skin response (SSR) latency and amplitudes between the patient and control groups. In comparing healthy control subjects with patients experiencing DRE, we observed significant decreases in SDRRHV and hyperventilation-induced RMSSD (RMSSDHV) values, specifically within HRVHV. Notably, a significant correlation emerged concerning the RMSSDHV values (p < 0.01), when examining the correlation between the SUDEP-7 inventory and HRVHV parameters.

Conclusion: This correlation between RMSSDHV and the SUDEP-7 Risk Inventory in patients with DRE represents a novel and consequential finding, suggesting its potential as an indicator of SUDEP risk.

Antecedentes: Na população geral com epilepsia, a incidência de morte súbita inesperada na epilepsia (SUDEP) varia de aproximadamente 0,35 a 2,3 por 1.000 indivíduos por ano.

Objetivo: Nosso objetivo foi avaliar a relação entre os fatores de risco de SUDEP e os parâmetros de variabilidade da frequência cardíaca (VFC) como um possível biomarcador de SUDEP em pacientes com epilepsia refratária (ER). MéTODOS: O estudo incluiu 52 pacientes diagnosticados com ER e em acompanhamento e 45 indivíduos saudáveis como controles. Os parâmetros de VFC induzidos por hiperventilação (VFCHV), incluindo o desvio padrão de todos os intervalos RR (SDRR), frequência cardíaca (FC) média, raiz quadrada média das diferenças sucessivas (RMSSD), DP dos registros de intervalos NN médios (SDANN) e índice triangular de VFC, foram avaliados durante o repouso. Para prever o risco de SUDEP, a relação entre os parâmetros de VFC e os riscos de SUDEP foi avaliada usando o Inventário de Avaliação de Risco de Morte Súbita em Epilepsia (Risk Assessment for Sudden Death in Epilepsy, SUDEP-7).

Resultados: Não houve diferença estatisticamente significativa na latência e amplitudes da resposta simpática da pele (SSR) entre os grupos de pacientes e controles. Ao comparar indivíduos controles saudáveis a pacientes com ER, observamos reduções significativas nos valores de SDRR induzido por hiperventilação (SDRRHV) e RMSSD induzida por hiperventilação (RMSSDHV), especificamente dentro de VFCHV. Houve uma notável correlação significativa em relação aos valores de RMSSDHV (p < 0,01) entre o inventário SUDEP-7 e os parâmetros de VFCHV. CONCLUSãO: Essa correlação entre RMSSDHV e o Inventário de Risco SUDEP-7 em pacientes com ER representa um achado novo e consequente, sugerindo seu potencial como um indicador de risco de SUDEP.

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Conflict of interest statement

The authors have no conflict of interest to declare.

References

    1. Devinsky O, Hesdorffer D C, Thurman D J, Lhatoo S, Richerson G. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol. 2016;15(10):1075–1088. doi: 10.1016/S1474-4422(16)30158-2. - DOI - PubMed
    1. Sveinsson O, Andersson T, Carlsson S, Tomson T. The incidence of SUDEP: A nationwide population-based cohort study. Neurology. 2017;89(02):170–177. doi: 10.1212/WNL.0000000000004094. - DOI - PubMed
    1. Ryvlin P, Rheims S, Lhatoo S D. Risks and predictive biomarkers of sudden unexpected death in epilepsy patient. Curr Opin Neurol. 2019;32(02):205–212. doi: 10.1097/WCO.0000000000000668. - DOI - PMC - PubMed
    1. Da Z, She J, Zhang Z et al. Effects of acute hypoxia on heart rate variability, sample entropy and cardiorespiratory phase synchronization. Biomed Eng Online. 2014;11:13–73. doi: 10.1186/1475-925X-13-73. - DOI - PMC - PubMed
    1. Roche F, Reynaud C, Pichot V et al. Effect of acute hypoxia on QT rate dependence and corrected QT interval in healthy subjects. Am J Cardiol. 2003;91(07):916–919. doi: 10.1016/s0002-9149(03)00040-7. - DOI - PubMed

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