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                <term xml:lang="en">Sleep apnea</term>
                <term xml:lang="en">Epilepsy</term>
                <term xml:lang="en">SUDEP</term>
                <term xml:lang="en">Arousal</term>
                <term xml:lang="en">Heart rare</term>
                <term xml:lang="en">Sleep apnea</term>
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              <p>Objective: Sudden and unexpected deaths in epilepsy (SUDEP) pathophysiology may involve an interaction between respiratory dysfunction and sleep/wake state regulation. We investigated whether patients with epilepsy exhibit impaired sleep apnea-related arousals.Methods: Patients with drug-resistant (N = 20) or drug-sensitive (N = 20) epilepsy and obstructive sleep apnea, as well as patients with sleep apnea but without epilepsy (controls, N = 20) were included. We explored (1) the respiratory arousal threshold based on nadir oxygen saturation, apnea-hypopnea index, and fraction of hypopnea among respiratory events; (2) the cardiac autonomic response to apnea/hypopnea quantified as percentages of changes from the baseline in RR intervals (RRI), high (HF) and low (LF) frequency powers, and LF/HF.Results: The respiratory arousal threshold did not differ between groups. At arousal onset, RRI decreased (-9.42%) and LF power (179%) and LF/HF ratio (190%) increased. This was followed by an increase in HF power (118%), p &amp;lt; 0.05. The RRI decrease was lower in drug-resistant (-7.40%) than in drug-sensitive patients (-9.94%) and controls (-10.91%), p &amp;lt; 0.05. LF and HF power increases were higher in drug-resistant (188%/126%) than in drug-sensitive patients (172%/126%) and controls (177%/115%), p &amp;lt; 0.05.Conclusions: Cardiac reactivity following sleep apnea is impaired in drug-resistant epilepsy.Significance: This autonomic dysfunction might contribute to SUDEP pathophysiology.</p>
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