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Tan B, Liu Q, Qin Y, Chen Q, Chen R, Jin Y, Li M, Jia X, Xu X, Zhang Q. Insomnia in epilepsy is associated with nocturnal seizures and anxiety. Epilepsy Behav 2024; 150:109559. [PMID: 38035537 DOI: 10.1016/j.yebeh.2023.109559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/26/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE The purpose of this study was to identify the factors associated with insomnia in patients with epilepsy (PWE) and provide evidence for clinical prevention and treatment. METHODS PWE who visited our epilepsy clinic from December 2021 to December 2022 were enrolled in our study. All participants completed the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). Based on their ISI scores, they were categorized into two groups: PWE with insomnia (ISI score ≥ 10) and PWE without insomnia (ISI score < 10). Univariate analysis and stepwise logistic regression analysis were conducted to identify the factors associated with insomnia in PWE. RESULTS A total of 196 Chinese PWE were recruited in this study(men, 39.8 %). Of these, 39 PWE(19.9 %) had insomnia.The incidence of nocturnal seizures (43.6 %vs19.7 %), depression (46.2 %vs9.6 %), anxiety (59.0 %vs11.5 %), and excessive daytime sleepiness(EDS,28.2 %vs5.7 %) in PWE with insomnia were significantly higher than in those without insomnia(all p<0.01). Univariate regression analysis showed that seizures greater than or equal to once per month, nocturnal seizures, anxiety, depression, and EDS may associate with insomnia in PWE(all p<0.05). Stepwise logistic regression analysis demonstrated that nocturnal seizures (OR = 2.611,95 % CI 1.040-6.478, P = 0.038) and anxiety (mild OR = 4.830,95 %CI 1.741-13.186, P = 0.002;moderate OR = 24.239,95 %CI 4.719-183.935, P<0.001; severe OR = 37.653,95 %CI 4.931-782.741, P = 0.002) were independently associated with insomnia in PWE. CONCLUSION PWE with insomnia are more likely to experience depression and EDS. Nocturnal seizures and anxiety are identified as independent factors associated with insomnia in PWE. Furthermore, Anxiety has a greater impact on insomnia in PWE and the likelihood of insomnia has increased significantly with the aggravation of anxiety levels.
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Affiliation(s)
- Bofei Tan
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Qiang Liu
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China; Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Yameng Qin
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Qiuyan Chen
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Rong Chen
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Yanzi Jin
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Mengyun Li
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Xiaodan Jia
- Clinical Medical College, Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Xianrui Xu
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Qing Zhang
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China.
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Akdağ G, Canbaz Kabay S, Bican Demir A, Ergin Bakar E, Koç G, Üstün Özek S, Küçük A, Ünsal MA, Neyal A, Florentina Ateş M, Çelik HT, Kılıçparlar Cengiz E, Kutlu G, Ağırcan D, Karacan Gölen M, Bek S, Çınar N, Sahin S, Şişman Bayar AB, Terzi M, Kendirli Aslan S, Kenar SG, Kutluhan S, Ekmekyapar Fırat Y, Yılmaz Okuyan D, Bayar MD, Mert Atmaca M, Yalçın D, Genç F, Köse Leba L, Yılmaz B, Eren F, Bolu NE, Keskin Güler S, Akıncı T, Reyhani A, Yıldırım Sitembölükbaşı N, Türkmen N, Karşıdağ S, Velioğlu SK, Demir A, Haytı B, Hasırcı Bayır BR, Ezgi Uçan Tokuç F, Demir G, Çakmakçı G, Özkan H, Bulut O, Kesim Şahin Ö, Sürmeli R, Tekin S, Sarıoğlu ŞG, Gesoğlu Demir T, Akkoyun Arıkan F, Çetiner M. The effect of sleep disorders on quality of life in patients with epilepsy: A multicenter study from Turkey. Epilepsy Behav 2024; 150:109568. [PMID: 38141572 DOI: 10.1016/j.yebeh.2023.109568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/31/2023] [Accepted: 11/26/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life. METHODS In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered. RESULTS The mean age of 1358 patients was 35.92 ± 14.11 (range, 18-89) years. Seven hundred fifty-one (55.30 %) were women. Some 12.7 % of the patients had insomnia (ISI > 14), 9.6 % had excessive daytime sleepiness (ESS > 10), 46.5 % had poor sleep quality (PSQI > 5), and 354 patients (26.1 %) had depressive symptoms (BDI > 16). The mean QOLIE-10 score was 22.82 ± 8.14 (10-48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AOR = 3.714; 95 % confidence interval (CI): [2.440-5.652] < 0.001)). ISI (AOR = 1.184; 95 % CI: [1.128-1.243]; p < 0.001), ESS (AOR = 1.081; 95 % CI: [1.034-1.130]; p < 0.001), PSQI (AOR = 0.928; 95 % CI: [0.867 - 0.994]; p = 0.034), BDI (AOR = 1.106; 95 % CI: [1.084-1.129]; p < 0.001), epilepsy duration (AOR = 1.023; 95 % CI: [1.004-1.041]; p = 0.014), were determined as factors affecting quality of life. SIGNIFICANCE Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy.
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Affiliation(s)
- Gönül Akdağ
- Kutahya Health Sciences University, Faculty of Medicine, Department of Neurology, Kutahya, Türkiye.
| | - Sibel Canbaz Kabay
- Kutahya Health Sciences University, Faculty of Medicine, Department of Neurology, Kutahya, Türkiye.
| | - Aylin Bican Demir
- Uludağ University, Faculty of Medicine, Department of Neurology, Bursa, Türkiye.
| | - Ebru Ergin Bakar
- University of Health Sciences, Ankara Training and Research Hospital, Department of Neurology, Ankara, Türkiye.
| | - Güray Koç
- University of Health Sciences, Ankara City Hospital, Department of Neurology, Ankara, Türkiye
| | - Sibel Üstün Özek
- University of Health Sciences, Prof.Dr.Cemil Taşçıoğlu City Hospital, Department of Neurology, İstanbul, Türkiye.
| | - Ahmet Küçük
- University of Health Sciences, Konya Beyhekim Training and Research Hospital, Neurology Clinic, Konya, Türkiye.
| | - Miraç Ayşen Ünsal
- Sultan 2.Abdulhamid Khan Educational and Research Hospital, Department of Neurology, Istanbul, Türkiye.
| | - Abdurrahman Neyal
- Gaziantep Islam Science and Technology University School of Medicine, Department of Neurology, Gaziantep, Türkiye.
| | | | - Havva Tuğba Çelik
- Haydarpasa Numune Training and Research Hospital, İstanbul, Türkiye.
| | | | - Gülnihal Kutlu
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Neurology, Muğla, Türkiye.
| | - Dilek Ağırcan
- Harran University, Faculty of Medicine, Department of Neurology, Sanlıurfa, Türkiye.
| | | | - Semai Bek
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Neurology, Muğla, Türkiye.
| | - Nilgün Çınar
- Maltepe University, Faculty of Medicine, Department of Neurology, Istanbul, Türkiye.
| | - Sevki Sahin
- University of Health Sciences, Hamidiye Faculty of Medicine, Department of Neurology, Sancaktepe Sehit Prof. Dr. Ilhan Varank SUAM, Istanbul, Türkiye.
| | - Aysel Büşra Şişman Bayar
- Haseki Training and Research Hospital, University of Health Sciences, Department of Neurology, Istanbul, Türkiye.
| | - Murat Terzi
- Ondokuz Mayıs University, Faculty of Medicine, Department of Neurology, Samsun, Türkiye.
| | - Sude Kendirli Aslan
- Maltepe University, Faculty of Medicine, Department of Neurology, Istanbul, Türkiye.
| | - Safiye Gül Kenar
- Necmettin Erbakan University, Faculty of Medicine, Department of Neurology, Konya, Türkiye.
| | - Süleyman Kutluhan
- Süleyman Demirel University, Faculty of Medicine, Department of Neurology, Isparta, Türkiye.
| | | | | | - Muhammet Duran Bayar
- Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Department of Neurology, Istanbul, Türkiye.
| | - Murat Mert Atmaca
- Sultan 2.Abdulhamid Khan Educational and Research Hospital, Department of Neurology, Istanbul, Türkiye.
| | - Destina Yalçın
- Maltepe University, Faculty of Medicine, Department of Neurology, Istanbul, Türkiye.
| | - Fatma Genç
- University of Health Sciences Antalya Training and Research Hospital, Department of Neurology, Antalya, Türkiye.
| | - Leyla Köse Leba
- Necmettin Erbakan University, Faculty of Medicine, Department of Neurology, Konya, Türkiye.
| | - Buket Yılmaz
- SANKO University School of Medicine, Department of Neurology, Gaziantep, Türkiye.
| | - Fettah Eren
- Selçuk University, Faculty of Medicine, Department of Neurology, Konya, Türkiye.
| | - Naci Emre Bolu
- Maltepe University, Faculty of Medicine, Department of Neurology, Istanbul, Türkiye.
| | - Selda Keskin Güler
- University of Health Sciences, Ankara Training and Research Hospital, Department of Neurology, Ankara, Türkiye.
| | - Tuba Akıncı
- Haydarpasa Numune Training and Research Hospital, İstanbul, Türkiye.
| | - Aylin Reyhani
- Sultan 2.Abdulhamid Khan Educational and Research Hospital, Department of Neurology, Istanbul, Türkiye.
| | | | - Nur Türkmen
- Tekirdağ Dr İsmail Fehmi Cumalıoğlu City Hospital, Clinic of Clinical Neurophysiology, Tekirdağ, Türkiye.
| | - Sibel Karşıdağ
- Sultan 2.Abdulhamid Khan Educational and Research Hospital, Department of Neurology, Istanbul, Türkiye.
| | - Sibel K Velioğlu
- Karadeniz Technical University, Faculty of Medicine, Department of Neurology, Clinical Neurophysiology Unit, Trabzon, Türkiye.
| | | | - Barış Haytı
- Pamukkale University, School of Medicine, Department of Neurology, Denizli, Turkey.
| | | | - Firdevs Ezgi Uçan Tokuç
- University of Health Sciences Antalya Training and Research Hospital, Department of Neurology, Antalya, Türkiye
| | - Göksemin Demir
- Pamukkale University, School of Medicine, Department of Neurology, Denizli, Turkey.
| | - Güngör Çakmakçı
- Kutahya Health Sciences University, Faculty of Medicine, Department of Neurology, Kutahya, Türkiye.
| | - Hülya Özkan
- Trakya University, School of Medicine, Department of Neurology, Edirne, Türkiye.
| | | | - Özlem Kesim Şahin
- Haydarpasa Numune Training and Research Hospital, İstanbul, Türkiye.
| | - Reyhan Sürmeli
- Ümraniye Training and Research Hospital, Istanbul, Türkiye.
| | - Selma Tekin
- Pamukkale University, School of Medicine, Department of Neurology, Denizli, Turkey.
| | - Şerife Gizem Sarıoğlu
- Süleyman Demirel University, Faculty of Medicine, Department of Neurology, Isparta, Türkiye.
| | - Tülin Gesoğlu Demir
- Harran University, Faculty of Medicine, Department of Neurology, Sanlıurfa, Türkiye.
| | - Fatma Akkoyun Arıkan
- Kutahya Health Sciences University, Faculty of Medicine, Department of Neurology, Kutahya, Türkiye.
| | - Mustafa Çetiner
- Kutahya Health Sciences University, Faculty of Medicine, Department of Neurology, Kutahya, Türkiye.
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de Bergeyck R, Geoffroy PA. Insomnia in neurological disorders: Prevalence, mechanisms, impact and treatment approaches. Rev Neurol (Paris) 2023; 179:767-781. [PMID: 37620177 DOI: 10.1016/j.neurol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
Insomnia is more prevalent in neurological disorders compared to the general population, with rates ranging from 11 to 74.2% in neurodegenerative disorders, 20 to 37% in vascular diseases, 13.3 to 50% in inflammatory diseases, 28.9 to 74.4% in epilepsy, and nearly 70% in migraines. Insomnia in neurological disorders stems from a variety of factors, encompassing physical and neuropsychiatric factors, behavioral patterns, and disruptions in the biological clock and circadian rhythm. There are bidirectional connections between neurological disorders and insomnia. Insomnia in neurological disorders worsens symptoms, resulting in heightened depressive symptoms, elevated mortality rates, reduced quality of life, and intensified acute symptoms. Managing comorbid sleep disorders, especially in the presence of psychiatric comorbidities, is crucial. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation for insomnia management in neurological disorders. Other treatments are second-line strategies. Melatonin may demonstrate effectiveness in addressing insomnia, with soporific and chronobiotic effects. Furthermore, it has the potential to alleviate "sundowning" and behavioral disturbances, while generally being well-tolerated. Other treatment options that may be of interest include morning bright light therapy, sedative antidepressants, new orexin dual antagonists and levodopa specifically indicated for Parkinson's disease. Benzodiazepines and z-drugs can be used primarily during acute phases to prevent pharmacotolerance and minimize side effects. However, they should be avoided in patients with neurological disorders and not used in patients over 75 years old due to the risk of falls and confusion. In neurological disorders, insomnia has a profound impact on daytime functioning, making its management crucial. Effective treatment can result in improved outcomes, and additional research is necessary to investigate alternative therapeutic options and enhance patient care.
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Affiliation(s)
- R de Bergeyck
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France.
| | - P A Geoffroy
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France; Département de psychiatrie et d'addictologie, DMU Neurosciences, GHU Paris Nord, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Université Paris Cité, NeuroDiderot, Inserm U1141, 75019 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5, rue Blaise-Pascal, 67000 Strasbourg, France
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Tanveer M, Ahmed A, Iqbal M, Aslam F, Saqlain M, Ur Rehman I, Khurshid Hashmi F. Excessive Daytime Sleepiness and Sleep Quality and their Impact on Health-Related Quality of Life in People with Epilepsy: A study from Pakistan. Epilepsy Behav 2022; 128:108565. [PMID: 35104734 DOI: 10.1016/j.yebeh.2022.108565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epilepsy is one of the most common but manageable neurological disorder. The relation between epilepsy, sleep, and health-related quality of life (HRQoL) in culturally distinct environment of Pakistan remains unclear. The purpose of this study was to determine prevalence and predictors of excessive daytime sleepiness (EDS), poor sleep quality (SQ), and to analyze their association with HRQoL in people with epilepsy (PWE). METHODS A study was conducted among PWE attending two tertiary care hospitals of Islamabad and Rawalpindi, Pakistan. The EDS, SQ, and HRQoL were evaluated by Urdu versions of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31). RESULTS The study included 200 PWE and 51 healthy controls with mean (SD) ages of 33.1 ± 13.9, 32.9 ± 10.9, and a disease duration of 5.01 ± 6.17, respectively. The majority of the respondents (n = 130, 65%) had poor seizure control, and most of these (n = 88, 68%) were on combination antiepileptic drug (AED) therapy. In comparison to controls, a higher number of PWE had EDS by ESS (score ≥ 11, 10% vs. 40%, p-value 0.00), and poor SQ by PSQI (score > 5, 9% vs. 71%, p-value 0.00). A multiple logistic regression analysis reveals that the factors significantly associated with EDS were: female gender; increasing age; seizure control; duration of epilepsy; and combination AED therapy. A second multiple binary logistic regression analysis suggests that factors significantly associated with poor SQ were: increasing age; female gender; poor seizure control; and combination therapy. The Hierarchical multivariate analysis suggests that poor seizure control, EDS, and poor SQ were significant predictors of low HRQoL. CONCLUSION The findings suggest high prevalence of EDS and poor SQ in PWE in Pakistan. A significant negative association exists between sleep complaints and HRQoL. During routine clinical consultations, awareness about sleep hygiene practices must be provided to enhance HRQoL.
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Affiliation(s)
- Maria Tanveer
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, Pakistan.
| | - Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia
| | - Mansoor Iqbal
- Neurology Department, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Faiza Aslam
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan
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Simie Tsega S, Yazew BG, Mekonnen K. Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at referral hospitals in Amhara region, Ethiopia. PLoS One 2021; 16:e0261386. [PMID: 34890425 PMCID: PMC8664217 DOI: 10.1371/journal.pone.0261386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, epilepsy is the commonest neurological disorder in adults. It has significant health and economic consequences to the affected individuals and the family. There is ample evidence that epileptic patients are at increased risk of poor sleep quality than the general population. However, there is limited evidence on sleep quality among epileptic patients and associated factors in Ethiopia. Therefore, this study investigated the prevalence of poor sleep quality and associated factors among adult patients with epilepsy. METHOD Institutional based cross-sectional study was conducted among adult epileptic patients attending follow-up care at referral hospitals in the Amhara region. A total of 575 epileptic patients were recruited using a stratified systematic random sampling technique. An interviewer-administered semi-structured questionnaire and record review were used for data collection. To assess sleep quality the pretested Pittsburgh Sleep Quality Index (PSQI) tool was used. A binary logistic regression model was used to assess factors associated with poor sleep quality. Variables with a p-value less than 0.2 in the bivariable binary logistic regression analysis were considered for the multivariable binary logistic regression analysis. In the multivariable binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported to declare the statistical significance and strength of association. Model fitness was assessed using the Hosmer-Lemeshow test and was adequate (p>0.05). Multicollinearity of the independent variables was assessed using the Variance Inflation Factor (VIF) and the mean VIF was less than 10. RESULTS A total of 565 participants were enrolled in the study with a response rate of 98.3%. The prevalence of poor sleep quality among adult epileptic patients was 68.8% [95% CI: 64.8%, 72.5%]. In the multivariable binary logistic regression, being unable to read and write [AOR = 3.16, 95%CI: 1.53, 6.51], taking polytherapy treatment [AOR = 2.10, 95% CI: 1.37, 3.21], poor medication adherence [AOR = 2.53, 95%CI: 1.02, 6.23] and having poor support [AOR = 2.72, 95%CI: 1.53, 4.82] and moderate social support [AOR = 1.89, 95%CI: 1.05, 3.41] were significantly associated with higher odds of poor sleep quality. CONCLUSION AND RECOMMENDATION Poor sleep quality is a major public health concern in Ethiopia. The patient's level of education, number of medication use, medication adherence, and social support were found significant predictors of poor sleep quality. These findings highlight improving medication adherence and social support are effective strategies to improve the sleep quality of epileptic patients. Besides, it is better to give special emphasis to those epileptic patients with a low level of education and taking polytherapy to enhance sleep quality.
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Affiliation(s)
- Sintayehu Simie Tsega
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Birhaneselassie Gebeyehu Yazew
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kennean Mekonnen
- Department of Emergency and Critical Care, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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