{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:28:37Z","timestamp":1790879317914,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,5,28]],"date-time":"2017-05-28T00:00:00Z","timestamp":1495929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Sudden unexpected death in epilepsy (<jats:styled-content style=\"fixed-case\">SUDEP<\/jats:styled-content>) is a common cause of death in epilepsy and frequently occurs following generalized tonic\u2013clonic seizures (<jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content>) in sleep. Postictal generalized electroencephalography (EEG) suppression (<jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content>), postictal immobility, and periictal respiratory dysfunction are potential risk factors for <jats:styled-content style=\"fixed-case\">SUDEP<\/jats:styled-content>. We sought to determine whether there was a difference in respiratory dysfunction, <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content>, and postictal immobility for <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content> occurring during wakefulness or sleep.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed video\u2010<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content> telemetry data in the epilepsy\u2010monitoring unit. Patients\u2019 state at seizure onset and seizure characteristics were identified. Respiratory parameters and heart rate were recorded. Presence and duration of <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> and time to first postictal nonrespiratory movement were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 165 seizures in 67 patients. There was no significant difference in the duration of postictal immobility in <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content> occurring out of wakefulness or sleep (p\u00a0=\u00a00.280). Oxygen desaturation nadir (p\u00a0=\u00a00.572) and duration of oxygen desaturation were not significantly different for <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content> starting during sleep or wakefulness (p\u00a0=\u00a00.992). <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> occurred more frequently when seizure onset was in sleep than in wakefulness (p\u00a0=\u00a00.004; odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>]\u00a02.760). There was no difference in the duration of <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> occurs more commonly after <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content> in sleep than in wakefulness but, in the epilepsy\u2010monitoring unit (<jats:styled-content style=\"fixed-case\">EMU<\/jats:styled-content>), a patient's state at seizure onset does not affect the degree of respiratory dysfunction or duration of postictal immobility. In sleep, outside the hospital setting, <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content> are likely to go unnoticed. Postictal immobility in prone patients prevents head repositioning and unimpeded air exchange. A positive feedback cycle ensues with increasing respiratory distress, potentiating postictal immobility and <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> and eventually leading to asystole. Our findings suggest that the high incidence of nocturnal <jats:styled-content style=\"fixed-case\">SUDEP<\/jats:styled-content> may be related to the unsupervised environment during sleep rather than the severity of sleep\u2010related respiratory dysfunction or <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> duration in the immediate postictal period.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.13805","type":"journal-article","created":{"date-parts":[[2017,5,28]],"date-time":"2017-05-28T09:42:37Z","timestamp":1495964557000},"page":"1409-1414","source":"Crossref","is-referenced-by-count":50,"title":["Postictal generalized <scp>EEG<\/scp> suppression and respiratory dysfunction following generalized tonic\u2013clonic seizures in sleep and wakefulness"],"prefix":"10.1111","volume":"58","author":[{"given":"Weifeng","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Neurology University of California, Davis Sacramento California U.S.A."},{"name":"Department of Neurology Zhongshan Hospital Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Danison","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Davis Sacramento California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masud","family":"Seyal","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Davis Sacramento California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60176-1"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.67.4.439"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.64.3.349"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2010.07.006"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2011.03360.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000156352.61328.CB"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00011.2016"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000147"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22101"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2011.04.008"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a6cbeb"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02518.x"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13312"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2012.03691.x"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001949"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awn277"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2009.118"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1995.tb01061.x"},{"key":"e_1_2_6_20_1","first-page":"932790","article-title":"Why are seizures rare in rapid eye movement sleep? 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