Relación neurofisiológica entre epilepsia y apnea obstructiva del sueño: Una revisión de la literatura
Palabras clave:
Epilepsy, obstructive sleep apnea, seizure, treatment, pathophysiology, comorbidity, prevalence.Resumen
Introducción: La epilepsia y la apnea obstructiva del sueño (AOS) son entidades de alta prevalencia mundial que comparten mecanismos fisiopatológicos relacionados con la regulación del sueño, la excitabilidad cortical y el control respiratorio. La evidencia reciente sugiere una posible relación bidireccional entre ambas patologías, con implicaciones clínicas relevantes en el control de las crisis, la arquitectura del sueño y el pronóstico neurológico. Objetivo: Analizar los mecanismos fisiopatológicos implicados en su interacción, así como el impacto terapéutico y epidemiológico de su coexistencia. Métodos: Se realizó una revisión narrativa mediante búsqueda en PubMed utilizando los términos MeSH "epilepsy", "obstructive sleep apnea" y "physiopathology", combinados con el operador AND. Se incluyeron estudios publicados entre enero de 2010 y diciembre de 2023 en inglés y español. De 92 artículos identificados, 28 cumplieron los criterios de inclusión (revisiones sistemáticas, reportes de caso y estudios originales). Se excluyeron estudios en población pediátrica, modelos animales y pacientes con condiciones quirúrgicas o respiratorias distintas a la AOS. Resultados: La literatura evidencia una prevalencia elevada de AOS en pacientes con epilepsia, con estimaciones cercanas al 33% en casos leves a graves. Los mecanismos compartidos incluyen hipoxia intermitente, fragmentación del sueño, privación del sueño REM, estrés oxidativo, neuroinflamación y aumento de la excitabilidad cortical; factores que pueden reducir el umbral convulsivo. A su vez, las crisis epilépticas pueden alterar el control neuromuscular de la vía aérea superior. Determinados tratamientos para epilepsia refractaria, como la estimulación del nervio vago (ENV) y algunos fármacos anticrisis (FAC), podrían contribuir a la aparición o exacerbación de la AOS. Por el contrario, la terapia con presión positiva continua en la vía aérea (CPAP) se asocia con mejoría en el control de crisis en pacientes con ambas condiciones. Conclusiones: La evidencia disponible respalda la existencia de una interacción potencialmente bidireccional entre epilepsia y AOS, sustentada en mecanismos fisiopatológicos compartidos que involucran alteraciones del sueño, hipoxemia intermitente y disfunción neuroinflamatoria. La identificación y tratamiento oportuno de la AOS en pacientes con epilepsia podría mejorar el control de las crisis y el pronóstico neurológico. Se requieren estudios prospectivos que permitan establecer con mayor precisión esta relación, especialmente en poblaciones latinoamericanas.
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