{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T18:49:21Z","timestamp":1760986161275,"version":"3.41.2"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T00:00:00Z","timestamp":1681862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Study Objectives<\/jats:title>\n                  <jats:p>Patients with epilepsy exhibit disturbed sleep architecture and shorter rapid eye movement (REM) sleep compared with healthy controls. REM sleep consists of two microstates, phasic and tonic REM. Studies suggest that epileptic activity is suppressed in phasic but not in tonic REM. However, changes in the REM microstructure in patients with epilepsy are still unknown. Therefore, this study evaluated the differences in REM microstructure between patients with refractory and medically controlled epilepsy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective case\u2013control study included patients with refractory and medically controlled epilepsy. Sleep parameters of the patients were recorded by standard polysomnography. In addition, the microstructures of sleep and REM sleep were compared between the two epilepsy groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Forty-two patients with refractory epilepsy and 106 with medically controlled epilepsy were evaluated. The refractory group showed significantly decreased REM sleep (p = 0.0062), particularly in the first and second sleep cycles (p = 0.0028 and 0.00482, respectively), as well as longer REM latency (p = 0.0056). Eighteen and 28 subjects in the refractory and medically controlled epilepsy groups, respectively, with comparable REM sleep percentages, underwent REM microstructure examination. Phasic REM sleep was significantly lower in the refractory group (4.5% \u00b1 2.1% vs. 8.0% \u00b1 4.1%; p = 0.002). In addition, the phasic-to-tonic ratio was significantly decreased (4.8 \u00b1 2.3 vs. 8.9 \u00b1 4.9; p = 0.002) and negatively associated with refractory epilepsy (coefficient = \u22120.308, p = 0.0079).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients with refractory epilepsy exhibited REM sleep disturbance at both macro and microstructure levels.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/sleep\/zsad115","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T23:15:20Z","timestamp":1681946120000},"source":"Crossref","is-referenced-by-count":8,"title":["Reduction in the propensity of rapid eye movement sleep and phasic-to-tonic ratio in patients with refractory epilepsy"],"prefix":"10.1093","volume":"46","author":[{"given":"Wei-Chih","family":"Yeh","sequence":"first","affiliation":[{"name":"Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan"},{"name":"Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University , Kaohsiung , Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying-Sheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kaohsiung Medical University Hospital , Kaohsiung , Taiwan"},{"name":"Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung City , Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9880-5944","authenticated-orcid":false,"given":"Chung-Yao","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kaohsiung Medical University Hospital , Kaohsiung , Taiwan"},{"name":"Department of Neurology, College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,4,19]]},"reference":[{"key":"2023071111285672600_CIT0001","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.sleep.2018.09.004","article-title":"Sleep architecture in adults with epilepsy: a systematic review","volume":"53","author":"Sudbrack-Oliveira","year":"2019","journal-title":"Sleep Med."},{"issue":"3","key":"2023071111285672600_CIT0002","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1001\/archneur.57.3.363","article-title":"Reduction of rapid eye movement sleep by diurnal and nocturnal seizures in temporal lobe epilepsy","volume":"57","author":"Bazil","year":"2000","journal-title":"Arch Neurol."},{"issue":"1","key":"2023071111285672600_CIT0003","doi-asserted-by":"crossref","first-page":"11137","DOI":"10.1038\/s41598-022-15147-0","article-title":"Focal epilepsy disrupts spindle structure and function","volume":"12","author":"Schiller","year":"2022","journal-title":"Sci Rep."},{"key":"2023071111285672600_CIT0004","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.seizure.2022.01.014","article-title":"Rapid eye movement sleep reduction in patients with epilepsy: A systematic review and meta-analysis","volume":"96","author":"Yeh","year":"2022","journal-title":"Seizure."},{"key":"2023071111285672600_CIT0005","doi-asserted-by":"crossref","first-page":"zsac041","DOI":"10.1093\/sleep\/zsac041","article-title":"Non-rapid eye movement sleep instability in adults with epilepsy: a systematic review and meta-analysis of cyclic alternating pattern","volume":"45","author":"Yeh","year":"2022","journal-title":"Sleep."},{"key":"2023071111285672600_CIT0006","doi-asserted-by":"crossref","first-page":"101466","DOI":"10.1016\/j.smrv.2021.101466","article-title":"Sleep quality and daytime sleepiness in epilepsy: Systematic review and meta-analysis of 25 studies including 8,196 individuals","volume":"57","author":"Bergmann","year":"2021","journal-title":"Sleep Med Rev."},{"issue":"4","key":"2023071111285672600_CIT0007","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.sleep.2005.02.005","article-title":"Sawtooth wave density analysis during REM sleep in temporal lobe epilepsy patients","volume":"6","author":"Vega-Bermudez","year":"2005","journal-title":"Sleep Med."},{"key":"2023071111285672600_CIT0008","doi-asserted-by":"crossref","first-page":"101305","DOI":"10.1016\/j.smrv.2020.101305","article-title":"The microstructure of REM sleep: Why phasic and tonic?","volume":"52","author":"Simor","year":"2020","journal-title":"Sleep Med Rev."},{"issue":"3","key":"2023071111285672600_CIT0009","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/j.1365-2869.2010.00831.x","article-title":"Arousal thresholds during human tonic and phasic REM sleep","volume":"19","author":"Ermis","year":"2010","journal-title":"J Sleep Res."},{"issue":"3","key":"2023071111285672600_CIT0010","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/jsr.12376","article-title":"EEG spectral power in phasic and tonic REM sleep: different patterns in young adults and children","volume":"25","author":"Simor","year":"2016","journal-title":"J Sleep Res."},{"issue":"3","key":"2023071111285672600_CIT0011","first-page":"zsx210","article-title":"Long-range alpha and beta and short-range gamma EEG synchronization distinguishes phasic and tonic REM periods","volume":"41","author":"Simor","year":"2017","journal-title":"Sleep."},{"issue":"3","key":"2023071111285672600_CIT0012","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1111\/j.1460-9568.2007.05314.x","article-title":"Functional microstates within human REM sleep: first evidence from fMRI of a thalamocortical network specific for phasic REM periods","volume":"25","author":"Wehrle","year":"2007","journal-title":"Eur J Neurosci."},{"key":"2023071111285672600_CIT0013","first-page":"932790","article-title":"Why are seizures rare in rapid eye movement sleep? Review of the frequency of seizures in different sleep stages","volume":"2013","author":"Ng","year":"2013","journal-title":"Epilepsy Res Treat"},{"issue":"5","key":"2023071111285672600_CIT0014","doi-asserted-by":"crossref","first-page":"fcac183","DOI":"10.1093\/braincomms\/fcac183","article-title":"Interictal epileptiform discharges show distinct spatiotemporal and morphological patterns across wake and sleep","volume":"4","author":"Fouad","year":"2022","journal-title":"Brain Communications"},{"issue":"5","key":"2023071111285672600_CIT0015","doi-asserted-by":"crossref","first-page":"ZSZ281","DOI":"10.1093\/sleep\/zsz281","article-title":"Breakthrough spikes in rapid eye movement sleep from the epilepsy monitoring unit are associated with peak seizure frequency","volume":"43","author":"McKenzie","year":"2020","journal-title":"Sleep."},{"issue":"6","key":"2023071111285672600_CIT0016","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1111\/epi.13389","article-title":"EEG desynchronization during phasic REM sleep suppresses interictal epileptic activity in humans","volume":"57","author":"Frauscher","year":"2016","journal-title":"Epilepsia."},{"key":"2023071111285672600_CIT0017","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.clinph.2022.01.008","article-title":"On the role of REM sleep microstructure in suppressing interictal spikes in Electrical Status Epilepticus during Sleep","volume":"136","author":"Giacomini","year":"2022","journal-title":"Clin Neurophysiol."},{"issue":"6","key":"2023071111285672600_CIT0018","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1111\/j.1528-1167.2009.02397.x","article-title":"Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies","volume":"51","author":"Kwan","year":"2010","journal-title":"Epilepsia."},{"key":"2023071111285672600_CIT0019","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.sleep.2021.02.007","article-title":"Rapid eye movement sleep disturbance in patients with refractory epilepsy: A polysomnographic study","volume":"81","author":"Yeh","year":"2021","journal-title":"Sleep Med."},{"key":"2023071111285672600_CIT0020","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.sleep.2021.07.022","article-title":"Quantitative evaluation of the microstructure of rapid eye movement sleep in refractory epilepsy: a preliminary study using electroencephalography and heart rate variability analysis","volume":"85","author":"Yeh","year":"2021","journal-title":"Sleep Med."},{"issue":"6","key":"2023071111285672600_CIT0021","doi-asserted-by":"crossref","first-page":"563","DOI":"10.5664\/jcsm.27351","article-title":"Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical\/polysomnographic measures in a community sample","volume":"4","author":"Buysse","year":"2008","journal-title":"J Clin Sleep Med."},{"issue":"02","key":"2023071111285672600_CIT0022","doi-asserted-by":"crossref","first-page":"121","DOI":"10.5664\/jcsm.26814","article-title":"The Visual Scoring of Sleep in Adults","volume":"03","author":"Silber","year":"2007","journal-title":"J Clin Sleep Med."},{"issue":"5","key":"2023071111285672600_CIT0023","doi-asserted-by":"crossref","first-page":"597","DOI":"10.5664\/jcsm.2172","article-title":"Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine","volume":"8","author":"Berry","year":"2012","journal-title":"J Clin Sleep Med."},{"issue":"3","key":"2023071111285672600_CIT0024","doi-asserted-by":"crossref","first-page":"e91047","DOI":"10.1371\/journal.pone.0091047","article-title":"Age Differences in the Variability and Distribution of Sleep Spindle and Rapid Eye Movement Densities","volume":"9","author":"Peters","year":"2014","journal-title":"PLoS One."},{"issue":"4","key":"2023071111285672600_CIT0025","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/epi.13709","article-title":"ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology","volume":"58","author":"Scheffer","year":"2017","journal-title":"Epilepsia."},{"key":"2023071111285672600_CIT0026","article-title":"REM sleep.","volume-title":"Reference Module in Neuroscience and Biobehavioral Psychology","author":"Siegel","year":"2021"},{"issue":"22","key":"2023071111285672600_CIT0027","doi-asserted-by":"crossref","first-page":"R1237","DOI":"10.1016\/j.cub.2017.10.026","article-title":"The Biology of REM Sleep","volume":"27","author":"Peever","year":"2017","journal-title":"Curr Biol."},{"issue":"2","key":"2023071111285672600_CIT0028","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/jsr.12371","article-title":"The two-process model of sleep regulation: a reappraisal","volume":"25","author":"Borbely","year":"2016","journal-title":"J Sleep Res."},{"key":"2023071111285672600_CIT0029","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.3389\/fpsyg.2020.01662","article-title":"Neural and Homeostatic Regulation of REM Sleep","volume":"11","author":"Park","year":"2020","journal-title":"Front Psychol."},{"key":"2023071111285672600_CIT0030","doi-asserted-by":"crossref","first-page":"327","DOI":"10.3389\/fneur.2020.00327","article-title":"Epilepsy and Its Interaction With Sleep and Circadian Rhythm","volume":"11","author":"Jin","year":"2020","journal-title":"Front Neurol."},{"issue":"1","key":"2023071111285672600_CIT0031","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s42494-022-00094-0","article-title":"The interaction between circadian rhythm and epilepsy","volume":"4","author":"Liu","year":"2022","journal-title":"Acta Epileptologica"},{"key":"2023071111285672600_CIT0032","article-title":"Focal Epilepsy Impacts Rapid Eye Movement Sleep Microstructure","volume":"46(2)","author":"Schiller","year":"2022","journal-title":"Sleep."},{"issue":"14","key":"2023071111285672600_CIT0033","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1523\/JNEUROSCI.2298-18.2019","article-title":"Regional Delta Waves In Human Rapid Eye Movement Sleep","volume":"39","author":"Bernardi","year":"2019","journal-title":"J Neurosci."},{"article-title":"Co-occurrence of Sawtooth Waves and Rapid Eye Movements during REM Sleep","year":"2009","author":"Takahara","key":"2023071111285672600_CIT0034"},{"issue":"3","key":"2023071111285672600_CIT0035","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1093\/sleep\/32.3.399","article-title":"Auditory inhibition of rapid eye movements and dream recall from REM sleep","volume":"32","author":"Stuart","year":"2009","journal-title":"Sleep."},{"key":"2023071111285672600_CIT0036","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.seizure.2022.03.022","article-title":"Reduced REM sleep: a potential biomarker for epilepsy - a retrospective case-control study","volume":"98","author":"Sadak","year":"2022","journal-title":"Seizure."},{"issue":"1","key":"2023071111285672600_CIT0037","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.yebeh.2013.06.027","article-title":"Rapid eye movement (REM) sleep: a reliable biomarker of intractability in epilepsy","volume":"29","author":"Jaseja","year":"2013","journal-title":"Epilepsy Behav."}],"container-title":["SLEEP"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/sleep\/advance-article-pdf\/doi\/10.1093\/sleep\/zsad115\/50412108\/zsad115.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/sleep\/article-pdf\/46\/7\/zsad115\/50853891\/zsad115.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/sleep\/article-pdf\/46\/7\/zsad115\/50853891\/zsad115.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T11:29:42Z","timestamp":1689074982000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/sleep\/article\/doi\/10.1093\/sleep\/zsad115\/7131406"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,19]]},"references-count":37,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,4,19]]},"published-print":{"date-parts":[[2023,7,11]]}},"URL":"https:\/\/doi.org\/10.1093\/sleep\/zsad115","relation":{},"ISSN":["0161-8105","1550-9109"],"issn-type":[{"type":"print","value":"0161-8105"},{"type":"electronic","value":"1550-9109"}],"subject":[],"published-other":{"date-parts":[[2023,7,1]]},"published":{"date-parts":[[2023,4,19]]},"article-number":"zsad115"}}