Sleep Disorders Have Significant Impact on Patients With Epilepsy

Rodrigo Rocamora, MD, director, epilepsy unit, Hospital del Mar

Rodrigo Rocamora, MD

A group of studies help confirm what previous literature has described—that children with epilepsy, particularly those with refractory disease, experience higher rates of sleep disorders than those without, and that these comorbidities are damaging to patients’ quality of life and social adjustment.

A trio of unrelated studies showed high rates of sleep disorders in patients with epilepsy, and all suggested that these comorbidities may be underestimated and under-evaluated. All 3 studies were presented as posters at the 2019 International Epilepsy Congress, June 22-26, in Bangkok, Thailand.

In the first study, led by Corina Grîu, MD, of Nicolae Testemiţanu State University of Medicine and Pharmacy, a cohort of 50 children with epilepsy and 50 controls, both with a mean age of 4 years 3 months, were evaluated with the Sleep Disturbance Scale for Children questionnaire.¹

Ultimately, 84% (n=48) of the children in the epilepsy group displayed some deviation in total sleep score, compared with only 6% (n=3) of those in the control group (P <.05). Excessive somnolence (85%; n=43), sleep breathing disorders (64%; n=38) and perturbation of arousal (48%; n=24) were the most frequently reported sleep disorders in the study group.

Additionally, disorders of initiating and maintaining sleep (24%; n=12), sleep hyperhidrosis (14%; n=7), and sleep-wake transition disorders (0.6%; n=3) were also reported.

The investigators noted that the negative outcomes of sleep disorders in those with epilepsy could be prevented by daily supervision in clinical practice and that early identification and management of these disorders is highly important.

Griu and colleagues noted that previously collected data reveal “that the most common sleep problems in children with epilepsy are obstructive sleep apnea syndrome, disorders of sleep architecture, and sleep fragmentation,” which in turn lead to excessive daytime sleepiness and alterations in behavior and cognitive function, and can lower quality of life.

The second study, led by Rodrigo Rocamora, MD, director, epilepsy unit, Hospital del Mar, included 322 consecutive patients who were admitted for long-term video electroencephalography (EEG) monitoring. They assessed patients with the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and determined quality of life using the QOLIE-10.²

Rocamora and colleagues wrote that “sleep disorders are highly prevalent in patients with refractory epilepsy and denote an independent negative effect on quality of life. Specific sleep anamnesis and scales should be applied in all pharmacoresistant epilepsies and be considered concurrently in the everyday clinical practice to decide personalized treatment options.”

In the third poster, a group of investigators led by Alvaro Pentagna, MD, neurologist, Hospital e Maternidade São Luiz Itaim, interviewed 114 patients with epilepsy (mean age, 38.6 years) using the Self-Report Social Adjustment Scale (SAS). Sleep quality was assessed with the PSQI, while daytime sleepiness, epilepsy severity, and depressive symptoms were evaluated with the Beck Depression Inventory (BDI) and anxiety symptoms with the State and Trait Anxiety Inventory (STAI).

Ultimately, the results showed a significant correlation between higher PSQI scores and SAS overall score (P =.027), and work (P =.019). Additionally, associations between higher seizure frequency and drug-resistant epilepsy with higher SAS domain scores related to family (extended, P =.013; marital P =.039) and family unit and economic condition (P =.046).

“Our findings corroborate the concept that social functioning in people with epilepsy is a multidimensional construct composed of several aspects of life, not restricted to seizure control,” Pentagna and colleagues wrote. “Mood, anxiety, and sleep, directly or indirectly related to epilepsy, will contribute to social disability.”

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REFERENCES

1. Griu C, Lupusor N, Calcii C, et al. Sleep disorders in children with epilepsy. Presented at: IEC 2019; June 22 to 26, 2019; Bangkok, Thailand. Poster 404.

2. Rocamora R, Chavarria B, Principe A, Ley M, Alvarez I. Prevalence of sleep disorders in patients with pharmacoresistant epilepsy. Presented at: IEC 2019; June 22 to 26, 2019; Bangkok, Thailand. Poster 499.

3. Pentagna A, Vicentiis S, Santos B, Terim S, Valente KD. The role of sleep quality on social adjustment in people with epilepsy. Presented at: IEC 2019; June 22 to 26, 2019; Bangkok, Thailand. Poster 113