{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T07:16:38Z","timestamp":1788506198433,"version":"build-2803163510"},"reference-count":49,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T00:00:00Z","timestamp":1688342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002537"],"award-info":[{"award-number":["UL1TR002537"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01 NS113764\u2010 01"],"award-info":[{"award-number":["R01 NS113764\u2010 01"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["U01 NS090414"],"award-info":[{"award-number":["U01 NS090414"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["U0109405"],"award-info":[{"award-number":["U0109405"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["U01NS09407"],"award-info":[{"award-number":["U01NS09407"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Severe respiratory dysfunction induced by generalized convulsive seizures (GCS) is now thought to be a common mechanism for sudden unexpected death in epilepsy (SUDEP). In a mouse model of seizure\u2010induced death, increased interictal respiratory variability was reported in mice that later died of respiratory arrest after GCS. We studied respiratory variability in epilepsy patients as a predictive tool for severity of postictal hypoxemia, a potential biomarker for SUDEP risk. We then explored the relationship between respiratory variability and central CO<jats:sub>2<\/jats:sub> drive, measured by the hypercapnic ventilatory response (HCVR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed clinical, video\u2010electroencephalography, and respiratory (belts, airflow, pulse oximeter, and HCVR) data of epilepsy patients. Mean, SD, and coefficient of variation (CV) of interbreath interval (IBI) were calculated. Primary outcomes were: (1) nadir of capillary oxygen saturation (SpO<jats:sub>2<\/jats:sub>) and (2) duration of oxygen desaturation. Poincar\u00e9 plots of IBI were created. Covariates were evaluated in univariate models, then, based on Akaike information criteria (AIC), multivariate regression models were created.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 66 GCS recorded in 131 subjects, 30 had interpretable respiratory data. In the multivariate model with the lowest AIC value, duration of epilepsy was a significant predictor of duration of oxygen desaturation. Duration of tonic phase and CV of IBI during the third postictal minute correlated with SpO<jats:sub>2<\/jats:sub> nadir, whereas CV of IBI during non\u2010rapid eye movement sleep had a negative correlation. Poincar\u00e9 plots showed that long\u2010term variability was significantly greater in subjects with \u2265200\u2009s of postictal oxygen desaturation after GCS compared to those with &lt;200\u2009s desaturation. Finally, HCVR slope showed a negative correlation with measures of respiratory variability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>These results indicate that interictal respiratory variability predicts severity of postictal oxygen desaturation, suggesting its utility as a potential biomarker. They also suggest that interictal respiratory control may be abnormal in some patients with epilepsy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17691","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T03:46:19Z","timestamp":1687578379000},"page":"2373-2384","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Interictal respiratory variability predicts severity of hypoxemia after generalized convulsive seizures"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8414-1972","authenticated-orcid":false,"given":"Rup K.","family":"Sainju","sequence":"first","affiliation":[{"name":"Department of Neurology University of Iowa Hospitals and Clinics  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deidre N.","family":"Dragon","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Iowa Hospitals and Clinics  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold B.","family":"Winnike","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Translational Science, University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2621-4413","authenticated-orcid":false,"given":"Laura","family":"Vilella","sequence":"additional","affiliation":[{"name":"Department of Neurology, McGovern Medical School University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, McGovern Medical School University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0260-3855","authenticated-orcid":false,"given":"Samden","family":"Lhatoo","sequence":"additional","affiliation":[{"name":"Department of Neurology, McGovern Medical School University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Ten\u00a0Eyck","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Translational Science, University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linder H.","family":"Wendt","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Translational Science, University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George B.","family":"Richerson","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Iowa Hospitals and Clinics  Iowa City Iowa USA"},{"name":"Department of Molecular Physiology and Biophysics University of Iowa  Iowa City Iowa USA"},{"name":"Iowa Neuroscience Institute University of Iowa  Iowa City Iowa USA"},{"name":"VA Medical Center  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3160-1741","authenticated-orcid":false,"given":"Brian K.","family":"Gehlbach","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Iowa Hospitals and Clinics  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12666"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008741"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02952.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2014.277574"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2010.02.007"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2009.11.004"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI94999"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fncir.2022.1002013"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70214-X"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awn277"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2017.04.018"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.med.50.1.249"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-physiol-040510-130049"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.c110033"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1113\/eph8602090"},{"key":"e_1_2_11_17_1","volume-title":"Pharmacology and pathophysiology of the control of breathing","author":"Shakeeb H","year":"2005"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1961.16.1.15"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00039.2017"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nbd.2019.04.006"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.24325"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awy078"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/nan.12638"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.14660"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16997"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000006785"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.14006"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2012.03691.x"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.669517"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.2170\/physiolsci.RP005506"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02490.x"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000006777"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12153"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02594.x"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2019.06.029"},{"key":"e_1_2_11_36_1","unstructured":"CherniackNS LongobardoGS.Handbook of physiology. In:The respiratory system.Control of breathing vol. 2 chap. 22.Bethesda:American Physiological Society;1986. p.729\u201349."},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1982.53.3.644"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.5702"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.0450\u201023.202"},{"key":"e_1_2_11_40_1","first-page":"135","article-title":"A matter of life and death","volume":"19","author":"Macklem P","year":"2002","journal-title":"Rev des Mal Respir"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0147976"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.9728"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1976.00500050042008"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.164.4.2003031"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2201018"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000227175.83575.E9"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181da90db"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2000.tb02769.x"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01152.2011"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-199903000-00010"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.17691","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T19:54:11Z","timestamp":1700682851000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/epi.17691"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,3]]},"references-count":49,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/epi.17691"],"URL":"https:\/\/doi.org\/10.1111\/epi.17691","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,3]]},"assertion":[{"value":"2023-04-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}