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Effects of Obstructive Sleep Apnea on Epilepsy, and Continuous Positive Airway Pressure as a Treatment Option. J Clin Med 2022; 11:jcm11072063. [PMID: 35407671 PMCID: PMC8999241 DOI: 10.3390/jcm11072063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/17/2022] [Accepted: 04/02/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose: To compare the characteristics of obstructive sleep apnea (OSA) between patients with epilepsy and patients without epilepsy and to investigate CPAP (Continuous Positive Airway Pressure) effect on seizures. Methods: Medical and polysomnography (PSG) data from 235 adult OSA patients with epilepsy (OE; 183 males; mean age, 49.8 years) and 268 age- and sex-matched OSA patients without epilepsy (OSE; 216 males; mean age, 51.3 years), obtained between March 2014 and May 2020 and housed in a database in a university-affiliated hospital, were retrospectively reviewed. All subjects completed surveys addressing comorbidities and medications, and sleep-related questionnaires including the Insomnia Severity Index, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Beck Depression Inventory-II. Results: Compared with the OSE group, the OE group reported fewer sleep-related complaints and less severe OSA-related PSG parameters, with a lower apnea-hypopnea index (24.9 vs. 33.4 events/h; p < 0.003), arousal index (23.3 vs. 30.8 events/h; p < 0.001), and oxygen desaturation index (19.6 vs. 28.8; p < 0.002). The OE group had fewer smokers and lower alcohol consumption but a higher body mass index (27.0 vs. 25.9 kg/m2; p < 0.001). No correlations were observed between OSA-related PSG parameters and epilepsy-related factors, such as age at seizure onset, seizure type, frequency of seizures, presence of nocturnal seizures, and number of antiseizure medications, in the OE group. Patients with OE who demonstrated good compliance with CPAP therapy exhibited a decrease in seizure frequency. Conclusions: The OE group exhibited less severe disease characteristics than their age- and sex-matched OSE counterparts. Nevertheless, because the coexistence of OSA and epilepsy is high, CPAP therapy can reduce the frequency of seizures. Therefore, it is important to evaluate the presence of OSA in patients with epilepsy and to treat the conditions concurrently.
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Bonilla-Jaime H, Zeleke H, Rojas A, Espinosa-Garcia C. Sleep Disruption Worsens Seizures: Neuroinflammation as a Potential Mechanistic Link. Int J Mol Sci 2021; 22:12531. [PMID: 34830412 PMCID: PMC8617844 DOI: 10.3390/ijms222212531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
Sleep disturbances, such as insomnia, obstructive sleep apnea, and daytime sleepiness, are common in people diagnosed with epilepsy. These disturbances can be attributed to nocturnal seizures, psychosocial factors, and/or the use of anti-epileptic drugs with sleep-modifying side effects. Epilepsy patients with poor sleep quality have intensified seizure frequency and disease progression compared to their well-rested counterparts. A better understanding of the complex relationship between sleep and epilepsy is needed, since approximately 20% of seizures and more than 90% of sudden unexpected deaths in epilepsy occur during sleep. Emerging studies suggest that neuroinflammation, (e.g., the CNS immune response characterized by the change in expression of inflammatory mediators and glial activation) may be a potential link between sleep deprivation and seizures. Here, we review the mechanisms by which sleep deprivation induces neuroinflammation and propose that neuroinflammation synergizes with seizure activity to worsen neurodegeneration in the epileptic brain. Additionally, we highlight the relevance of sleep interventions, often overlooked by physicians, to manage seizures, prevent epilepsy-related mortality, and improve quality of life.
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Affiliation(s)
- Herlinda Bonilla-Jaime
- Departamento de Biología de la Reproducción, Área de Biología Conductual y Reproductiva, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de Mexico CP 09340, Mexico;
| | - Helena Zeleke
- Neuroscience and Behavioral Biology Program, College of Arts and Sciences, Emory University, Atlanta, GA 30322, USA;
| | - Asheebo Rojas
- Department of Pharmacology and Chemical Biology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Claudia Espinosa-Garcia
- Department of Pharmacology and Chemical Biology, School of Medicine, Emory University, Atlanta, GA 30322, USA
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Paardekooper D, Thayer Z, Miller L, Nikpour A, Gascoigne MB. Group-based cognitive behavioral therapy program for improving poor sleep quality and quality of life in people with epilepsy: A pilot study. Epilepsy Behav 2020; 104:106884. [PMID: 31982831 DOI: 10.1016/j.yebeh.2019.106884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/18/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
Abstract
Sleep difficulties are commonly reported by patients with epilepsy and can have a detrimental impact on overall quality of life. The purpose of this pilot study was to assess the efficacy of a psychotherapeutic approach, namely Cognitive Behavioral Therapy for Insomnia (CBT-I), in improving sleep quality in patients with epilepsy. Twenty outpatients with epilepsy who reported poor sleep quality were randomized to either a control or CBT-I treatment group, which involved four group-based CBT-I sessions, delivered on a weekly basis. In addition to completing a range of standardized measures related to sleep quality and quality of life, participants also monitored their sleep with a self-completed sleep diary over a two-week period, on two separate occasions. Following CBT-I treatment, no between-group difference was found on any sleep or quality of life measure. However, both the treatment and control groups improved on measures of sleep quality, quality of life, sleep hygiene behaviors, and dysfunctional beliefs about sleep. These findings suggest that sleep monitoring alone may have the potential for prompting healthy behavior change in this clinical population.
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Affiliation(s)
- Diana Paardekooper
- School of Psychological Sciences, Australian College of Applied Psychology, Sydney, Australia
| | - Zoe Thayer
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Laurie Miller
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Armin Nikpour
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael B Gascoigne
- School of Psychological Sciences, Australian College of Applied Psychology, Sydney, Australia; School of Psychology, The University of Sydney, Australia.
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Khachatryan SG, Ghahramanyan L, Tavadyan Z, Yeghiazaryan N, Attarian HP. Sleep-related movement disorders in a population of patients with epilepsy: prevalence and impact of restless legs syndrome and sleep bruxism. J Clin Sleep Med 2020; 16:409-414. [PMID: 31992428 DOI: 10.5664/jcsm.8218] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Sleep disorders are frequent co-occurrences in patients with epilepsy (PWE), but sleep-disordered breathing and insomnia are better studied than others. Our aim was to study sleep-related movement disorders in epilepsy. METHODS We interviewed 175 PWE (age range 18-71 years, mean 35.4 years, 47.4% female) and 130 controls (age range 18-72 years, mean 33.6 years, 47.7% females). Restless legs syndrome (RLS) and sleep bruxism (SB) were diagnosed by International RLS Study Group's diagnostic criteria and International Classification of Sleep Disorders, Third Edition criteria respectively. We also used Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ). RESULTS Our findings suggest that RLS and SB are encountered more frequently in PWE than controls: 20.6% versus 6.1% for RLS, and 23.7% versus 5.4% for SB (P < .05). Insomnia was more prevalent in epilepsy (46.2% versus 24.6%, P < .05) while poor sleep hygiene occurred more frequently in controls (28.3% versus 53.8%), (P < .05). PWE had poorer sleep by PSQI 61.7% versus 41.5% (P < .05). Sleepiness (38.7% versus 39.2%) and snoring (42.8% versus 40.8%) were equally distributed in both groups, also ESS and BQ not showing significant differences (P > .05). CONCLUSIONS Our study demonstrates that sleep disorders comprise important part of epilepsy comorbidity. We demonstrated that unselected PWE had higher prevalence of RLS. For the first time we show higher prevalence of sleep bruxism in epilepsy population. Also complaints of insomnia are seen more in PWE, while snoring and poor sleep hygiene not.
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Affiliation(s)
- Samson G Khachatryan
- Sleep and Movement Disorders Center, Somnus Neurology Clinic, Yerevan, Armenia.,Department of Neurology and Neurosurgery, National Institute of Health, Ministry of Health, Yerevan, Armenia
| | - Lilit Ghahramanyan
- Sleep and Movement Disorders Center, Somnus Neurology Clinic, Yerevan, Armenia
| | - Zaruhi Tavadyan
- Sleep and Movement Disorders Center, Somnus Neurology Clinic, Yerevan, Armenia.,Department of Neurology and Neurosurgery, National Institute of Health, Ministry of Health, Yerevan, Armenia
| | - Nune Yeghiazaryan
- Department of Neurology and Neurosurgery, National Institute of Health, Ministry of Health, Yerevan, Armenia.,Republic Epilepsy Center, Erebouni Medical Center, Yerevan, Armenia
| | - Hrayr P Attarian
- Center for Sleep Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Reddy DS, Chuang SH, Hunn D, Crepeau AZ, Maganti R. Neuroendocrine aspects of improving sleep in epilepsy. Epilepsy Res 2018; 147:32-41. [PMID: 30212766 PMCID: PMC6192845 DOI: 10.1016/j.eplepsyres.2018.08.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 12/15/2022]
Abstract
Sleep plays an intricate role in epilepsy and can affect the frequency and occurrence of seizures. With nearly 35% of U.S. adults failing to obtain the recommended 7 h of sleep every night, understanding the complex relationship between sleep and epilepsy is of utmost relevance. Sleep deprivation is a common trigger of seizures in many persons with epilepsy and sleep patterns play a role in the occurrence of seizures. Some patients have their first seizure or repeated seizures after an "all-nighter" at college or after a long period of chronic sleep deprivation. The strength of the relationship between sleep and seizures varies between patients, but improving sleep and optimizing seizure control can have significant positive effects on the quality of life for all these patients. Research has shown that the changes in the brain's electrical and hormonal activity occurring during normal sleep-wake cycles can be linked to both sleep and seizure patterns. Many questions remain to be answered about sleep and epilepsy. How can sleep deprivation trigger an epileptic seizure? How do circadian and hormonal changes influence sleep pattern and seizure occurrence? Can hormones or sleeping pills help with sleep in epilepsy? In this article we discuss these and many other questions on sleep in epilepsy, with an emphasis on sleep architecture, hormone changes, mechanistic factors, and possible prevention strategies.
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Affiliation(s)
- Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center College of Medicine, Bryan, TX 77807, USA.
| | - Shu-Hui Chuang
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center College of Medicine, Bryan, TX 77807, USA
| | - Dayton Hunn
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center College of Medicine, Bryan, TX 77807, USA
| | - Amy Z Crepeau
- Department of Neurology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA
| | - Rama Maganti
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
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Co-morbid sleep disorders and epilepsy: A narrative review and case examples. Epilepsy Res 2018; 145:185-197. [PMID: 30048932 DOI: 10.1016/j.eplepsyres.2018.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/08/2018] [Accepted: 07/14/2018] [Indexed: 01/03/2023]
Abstract
Co-morbid sleep disorders, including sleep apnea, insomnia, restless legs syndrome, and the parasomnias, occur frequently in people with epilepsy. This article reviews the cardinal presenting symptoms and diagnostic features of each of these disorders to enable epileptologists to readily screen and identify sleep co-morbidities in their patients. It summarizes current evidence concerning the reciprocal relationship between sleep disturbances and epilepsy and available treatment options for common sleep disorders in people with epilepsy. Several illustrative cases demonstrate the practical consequences of co-morbid sleep disorders in epilepsy patients and suggest diagnostic and treatment approaches that may improve daytime functioning, alertness, quality of life, and seizure burden.
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Grayson LP, DeWolfe JL. Sleep Disorders in Epilepsy: Current Trends and Future Perspectives. CURRENT SLEEP MEDICINE REPORTS 2018. [DOI: 10.1007/s40675-018-0110-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Lee SA, Han SH, No YJ, Jo KD, Kwon JH, Kim JY, Shin DJ. Sleep hygiene and its association with mood and quality of life in people with epilepsy. Epilepsy Behav 2015; 52:225-9. [PMID: 26469798 DOI: 10.1016/j.yebeh.2015.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/18/2015] [Accepted: 09/12/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We determined whether sleep hygiene is directly related to mood and quality of life (QoL) in people with epilepsy and, if not, documented the indirect effects of sleep hygiene through sleep quality. METHODS Data were collected from 150 adults with epilepsy. The Sleep Hygiene Index (SHI), Quality of Life in Epilepsy-10 (QOLIE-10), Hospital Anxiety and Depression Scale (HADS), Sleep Problems Index-2 (SPI-2) of the Medical Outcomes Study-Sleep Scale, and Epworth Sleepiness Scale (ESS) were used. To determine the direct and indirect associations between SHI, mood, and QoL, multiple linear regression analyses and the Sobel test were performed. RESULTS Inadequate sleep hygiene behaviors were answered affirmatively by ≥15% of the participants represented by 6 out of 13 items of the SHI. A younger age was independently related to higher SHI scores (p=0.013). The higher SHI scores were directly related to lower QoL independent of sleep quality, anxiety, and depressive symptoms (p<0.05) but not independently related to anxiety and depressive symptoms. The Sobel test confirmed that the SHI scores were associated with anxiety and depressive symptoms through sleep quality (p<0.001). CONCLUSIONS Inadequate sleep hygiene is independently related to low QoL but indirectly related to anxiety and depressive symptoms through sleep quality. Patients of a younger age are at risk of poorer sleep hygiene.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Su-Hyun Han
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Joo No
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Kwang-Deog Jo
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jeong Yeon Kim
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Dong-Jin Shin
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Republic of Korea
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9
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Manni R, Cremascoli R, De Icco R, Terzaghi M. Chronotype in patients with epilepsy: A controlled study in 60 subjects with late-onset focal epilepsy. Epilepsy Behav 2015; 50:1-6. [PMID: 26079115 DOI: 10.1016/j.yebeh.2015.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 11/18/2022]
Abstract
Studies based on self-administered questionnaires indicate that most patients with epilepsy are morning-oriented. We aimed to investigate chronotype in patients with epilepsy with late-onset focal epilepsy by combining subjective data with dim light melatonin onset (DLMO) as an objective marker of the circadian phase. Sixty adult patients (mean age 46.5±13.8; 27 males) with late-onset focal epilepsy under pharmacological treatment were prospectively studied. Subjective chronotype was determined using the Morningness-Eveningness Questionnaire (MEQ) and circadian phase through analysis of salivary melatonin secretion, considering 3pg/ml as the dim light melatonin onset (DLMO) threshold. The mean MEQ score was significantly higher in the patients with epilepsy than in the controls, and significantly, more patients had a MEQ score indicative of the morning type (50.0% vs 30.0%, p=0.02). However, no significant differences were found in mean time of DLMO (21:38±01:21 vs 21:26±01:03; p=ns), and DLMO time was in the range indicative of an intermediate chronotype in both patients and controls. Sleep onset and sleep offset phase angles were significantly shorter in the patients. Patients whose global MEQ score identified them as morning types were significantly older than those with an intermediate or evening chronotype, and they had less social jet lag. No difference in epilepsy features and treatments was found between morning-oriented and nonmorning-oriented patients. Our analyses showed that the patients with epilepsy tended to be morning-oriented and to perceive themselves as morning types, even though this was not reflected in their DLMO values which did not differ significantly from those of controls and mostly fell within the intermediate chronotype range. Several factors may considerably influence subjective chronotype. We speculate that, in patients with epilepsy, the disease itself, prompting certain lifestyle choices, including a regular sleep schedule and early bedtime, may induce morning orientation and a morning-type self-perception.
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Affiliation(s)
- Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy.
| | - Riccardo Cremascoli
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy
| | - Roberto De Icco
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy
| | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy
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Lopez MR, Cheng JY, Kanner AM, Carvalho DZ, Diamond JA, Wallace DM. Insomnia symptoms in South Florida military veterans with epilepsy. Epilepsy Behav 2013; 27:159-64. [PMID: 23434722 DOI: 10.1016/j.yebeh.2013.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/10/2013] [Accepted: 01/12/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the high prevalence of insomnia in veterans with epilepsy, it remains understudied. Our aim was to identify the associations of insomnia with epilepsy, comorbidities, and treatment-related variables in South Florida veterans. METHODS We performed a cross-sectional analysis of veterans attending an epilepsy clinic over 18 months. Participants completed standardized assessments of seizure and sleep. Insomnia was defined as 1) difficulty with sleep onset, maintenance, or premature awakenings with daytime consequences or 2) sedative-hypnotic use on most nights of the previous month. RESULTS One hundred sixty-five veterans (87% male, age 56 ± 15 years) were included: 66 reporting insomnia (40%). In logistic regression analysis, insomnia was significantly associated with post-traumatic seizure etiology, lamotrigine prescription, and mood and psychotic disorders. Female gender and levetiracetam treatment were associated with lower odds for insomnia. CONCLUSION Insomnia was associated with post-traumatic epilepsy, mood/psychotic comorbidities, and antiepileptic regimen. Insomnia represents an under-recognized opportunity to improve comprehensive epilepsy care.
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Affiliation(s)
- M R Lopez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Vendrame M, Yang B, Jackson S, Auerbach SH. Insomnia and epilepsy: a questionnaire-based study. J Clin Sleep Med 2013; 9:141-6. [PMID: 23372467 DOI: 10.5664/jcsm.2410] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although disturbed sleep has been frequently reported in patients with seizures, little is known about insomnia and epilepsy. The aims of this study were (1) to analyze the prevalence and degree of insomnia in patients with epilepsy, (2) to examine the clinical features and correlates of insomnia in these patients, and (3) to evaluate the impact of poor sleep on their quality of life. METHODS One hundred-fifty-two patients with epilepsy (mean age 46 years) completed the following questionnaires: Insomnia Severity Index, Pittsburgh Sleep Quality Index, Beck Depression Inventory-II, Quality of Life in Epilepsy Inventory-31. Patients with other known sleep disorders, including obstructive sleep apnea, were excluded from the study. Regression analysis was conducted for adjusting for age, years since epilepsy onset, number of antiepileptic drugs, comorbidities, and depression scores. RESULTS More than half of the participants (55%) suffered from insomnia and more than 70% were "poor sleepers." Insomnia and poor sleep quality were significantly correlated with the number of antiepileptic medications and scores of depressive symptoms. After controlling for covariates, insomnia and poor sleep quality were significant predictors of lower quality of life. CONCLUSION These results suggest that insomnia and poor sleep are common in patients with epilepsy and may adversely impact quality of life. Further studies should examine whether improvements in sleep can improve seizure control and quality of life of these patients.
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Abstract
A sleep history should be taken routinely in patients with epilepsy. Treatment of sleep disorders and improvement in sleep hygiene may improve seizure control, daytime cognitive functioning, and quality of life. Patients with recurrent sleepiness interfering with daily activities or an Epworth Sleepiness Scale score more than 10 should be considered for additional evaluation by a sleep specialist. Treatment options for insomnia include improvements in sleep hygiene, cognitive behavior therapies, and sedative or hypnotic drugs. Alterations in the timing or type of antiepileptic drugs (AEDs) may be helpful (for example, using sedating medications before bedtime and avoiding evening use of drugs that may exacerbate insomnia ). Improvements in sleep hygiene alone are less effective than cognitive behavioral therapy or pharmacologic therapy. Cognitive behavioral therapy is more efficacious and its effects longer lasting than pharmacologic treatments. Sedative and hypnotic drugs may exacerbate AED cognitive adverse effects during the day and should be used only after other therapies have failed. Excessive daytime sleepiness (EDS) in patients with epilepsy may be secondary to AEDs, nocturnal seizures, or a concomitant sleep disorder such as sleep apnea or restless leg syndrome. Sedating AEDs should be minimized during the day, and activating AEDs should be used as appropriate. Video electroencephalogram polysomnography should be performed when EDS interferes with daily activities and the etiology of sleepiness is unclear. AEDs that are associated with weight gain should be avoided in patients with sleep apnea. AEDs that may promote weight loss should be considered for obese patients with sleep apnea. Continuous positive airway pressure is the treatment of choice for sleep apnea.
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Affiliation(s)
- Susan T Herman
- Hospital of the University of Pennsylvania, Department of Neurology, 3400 Spruce Street, Philadelphia, PA 10104, USA.
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13
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Comorbidity between epilepsy and sleep disorders. Epilepsy Res 2010; 90:171-7. [PMID: 20570109 DOI: 10.1016/j.eplepsyres.2010.05.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 04/21/2010] [Accepted: 05/02/2010] [Indexed: 11/24/2022]
Abstract
Despite being relatively common and potentially able to have clinical and pathophysiological consequences, the comorbidity between epilepsy and sleep disorders is poorly investigated in the literature and rarely taken into consideration by clinicians in general practice. There is increasing evidence that obstructive sleep apnoea (OSA) coexists in epilepsy (in 10% of unselected adult epilepsy patients, 20% of children with epilepsy and up to 30% of drug-resistant epilepsy patients). A few lines of evidence suggest that continuous positive airway pressure treatment of OSA in epilepsy patients improves seizure control, cognitive performance and quality of life. Parasomnias and epileptic seizures can coexist in the same subject making the differential diagnosis of these conditions particularly challenging. In childhood, a frequent association between epilepsy and NREM arousal parasomnias, enuresis and rhythmic movement disorder has been documented. A particular pattern of association has been found between nocturnal frontal lobe epilepsy (NFLE) and NREM arousal parasomnias, the latter being found in the personal or family history of up to one third of NFLE patients. As far as REM parasomnias are concerned, REM sleep behaviour disorder, unrecognised or misdiagnosed, has been found to co-occur in 12% of elderly epilepsy patients. Patients with epilepsy often complain of poor, non-restorative sleep; however, insomnia in epilepsy is poorly investigated, with the literature giving conflicting prevalence data and no information on the impact of this disorder on seizure control, or on the best therapeutic approach to insomnia in this particular group of patients. A greater awareness, among clinicians, of the comorbidities between sleep disorders and epilepsy may help to prevent misdiagnosis and mistreatment. Sleep hygiene measures in epilepsy need to be more comprehensive, taking into account the various pathologies that may underlie disordered sleep in epilepsy patients.
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Kang JH, Chen SC. Effects of an irregular bedtime schedule on sleep quality, daytime sleepiness, and fatigue among university students in Taiwan. BMC Public Health 2009; 9:248. [PMID: 19615098 PMCID: PMC2718885 DOI: 10.1186/1471-2458-9-248] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 07/19/2009] [Indexed: 11/25/2022] Open
Abstract
Background An irregular bedtime schedule is a prevalent problem in young adults, and could be a factor detrimentally affecting sleep quality. The goal of the present study was to explore the association between an irregular bedtime schedule and sleep quality, daytime sleepiness, and fatigue among undergraduate students in Taiwan. Methods A total of 160 students underwent a semi-structured interview and completed a survey comprising 4 parts: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and a rating of irregular bedtime frequency. Participants were grouped into 3 groups in terms of irregular bedtime frequency: low, intermediate, or high according to their 2-week sleep log. To screen for psychological disorders or distress that may have affected responses on the sleep assessment measures, the Chinese health questionnaire-12 (CHQ-12) was also administered. Results We found an increase in bedtime schedule irregularity to be significantly associated with a decrease in average sleep time per day (Spearman r = -0.22, p = 0.05). Multivariate regression analysis revealed that irregular bedtime frequency and average sleep time per day were correlated with PSQI scores, but not with ESS or FSS scores. A significant positive correlation between irregular bedtime frequency and PSQI scores was evident in the intermediate (partial r = 0.18, p = 0.02) and high (partial r = 0.15, p = 0.05) frequency groups as compared to low frequency group. Conclusion The results of our study suggest a high prevalence of both an irregular bedtime schedule and insufficient sleep among university students in Taiwan. Students with an irregular bedtime schedule may experience poor sleep quality. We suggest further research that explores the mechanisms involved in an irregular bedtime schedule and the effectiveness of interventions for improving this condition.
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Affiliation(s)
- Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 252 Wu-Xing Street, Taipei 110, Taiwan, Republic of China.
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15
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Suen LKP, Hon KLE, Tam WWS. Association between sleep behavior and sleep-related factors among university students in Hong Kong. Chronobiol Int 2009; 25:760-75. [PMID: 18780202 DOI: 10.1080/07420520802397186] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sleep problems among university students are common; however, the association between many sleep-related factors and sleep behaviors is still unclear. The purpose of this study is to examine different sleep behaviors and sleep-related factors influencing such behaviors in university students. A descriptive survey was conducted on 400 university students in Hong Kong. The instruments for data collection consisted of the Pittsburgh Sleep Quality Index (PSQI), a sleep hygiene practice questionnaire, demographic data, and other sleep-related factors. The results reveal that 57.5% of the 400 university students are poor sleepers. Sex, year of study, sleep hygiene practice, and perceived adequate sleep in the past month all demonstrate significant associations with poor sleepers. A high prevalence of sleep-related problems among college students is confirmed and associated factors are identified. Students should be encouraged to follow sleep hygiene practice, adequate time management for academic and social activities, and suitable stress-relieving measures.
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Affiliation(s)
- Lorna K P Suen
- Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, HKSAR, Hong Kong.
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Foldvary-Schaefer N, Grigg-Damberger M. Sleep and epilepsy: what we know, don't know, and need to know. J Clin Neurophysiol 2006; 23:4-20. [PMID: 16514348 DOI: 10.1097/01.wnp.0000206877.90232.cb] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Long-term video-EEG and, more recently, video-polysomnography, have provided the means to confirm and expand on the interconnections between sleep and epilepsy. Some of these relationships have become firmly established. When one of the authors (N.F.S.) presented part of this paper at a symposium on the Future of Sleep in Neurology at an American Clinical Neurophysiology Society annual meeting in 2004, the purpose was to summarize what we know, don't know, and need to know about the effects of sleep on epilepsy and epilepsy on sleep. Here we seek to summarize some of the more firmly established relationships between sleep and epilepsy and identify intriguing associations that require further elucidation.
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