Chronotypes and Subjective Sleep Parameters in Epilepsy Patients: A Large Questionnaire Study

Abstract

Accumulating evidence suggests epilepsy and seizures may influence circadian rhythms and that circadian rhythms may influence epilepsy. It is also conceivable that seizure timing influences the timing of daily activities, sleeping, and wakefulness (i.e., chronotype). Only one group has studied the distribution of chronotypes of epileptics, showing significant differences between the diurnal activity patterns in two groups of patients with different epilepsy syndromes. The authors performed a questionnaire-based study of 200 epilepsy patients to compare the distribution of chronotypes and subjective sleep parameters of sleep duration and time of mid-sleep on free days to the distribution in the general population (n = 4042). Within this large group of epilepsy patients, we also compared the chronotypes of subsamples with well-defined epilepsy syndromes, i.e., temporal lobe epilepsy [TLE; n = 46], frontal lobe epilepsy [FLE; n = 30], and juvenile myoclonic epilepsy [JME; n = 38]. In addition, 27 patients who had had surgery for TLE were compared with those with TLE who had not had surgery. Both the Morningness-Eveningness Questionnaire and Munich Chronotype Questionnaire were used to determine chronotypes and subjective sleep parameters. Significant differences in morningness/eveningness distribution, timing of mid-sleep (corrected for sleep duration), and total sleep time on free days were found between epileptics and healthy controls. Those with epilepsy were more morning oriented, had earlier mid-sleep on free days, and longer sleep duration on free days (p < .001). However, distributions of chronotypes and sleep parameters between the groups of people with TLE, FLE, and JME did not differ. Persons who had surgery for TLE had similar morningness-eveningness parameters and similar sleep durations compared to those without surgery, but mid-sleep on free days was earlier in operated patients (p = .039). In conclusion, this is the first large study focusing on chronotypes in people with epilepsy. We show that the distribution of chronotypes and subjective sleep parameters of epileptics, in general, is different from that of healthy controls. Nevertheless, no differences are observed between patients with specified epilepsy syndromes, although they exhibit seizures with different diurnal patterns. Our results suggest that epilepsy, itself, rather than seizure timing, has a significant influence on chronotype behavior and subjective sleep parameters.

Sleep–wake pattern, chronotype and seizures in patients with epilepsy

“…Only GE patients reported more eveningness-preference than FE, which is consistent with a previous study (Pung and Schmitz, 2006). To support the reliability of circadian preference survey, we assessed mid-sleep time during workdays and free-days and calculated social jetlag in both PWE (GE vs. FE) and HC, similar to the previous two studies (Hofstra et al, 2010;Unterberger et al, 2015). Hofstra et al (2010) explained the discrepancies of findings between studies by the difference of age and sample sizes.…”

“…JME patients showed more eveningness-preference compared to TLE patients in similar age groups. Hofstra et al (2010) found significant differences in morningness/eveningness distribution, timing of mid-sleep (corrected for sleep duration), and total sleep time on free days between epileptics and healthy controls. However, overall distributions of chronotypes and sleep parameters between the groups of patients with TLE, FLE, and JME did not differ.…”

“…To support the reliability of circadian preference survey, we assessed mid-sleep time during workdays and free-days and calculated social jetlag in both PWE (GE vs. FE) and HC, similar to the previous two studies (Hofstra et al, 2010;Unterberger et al, 2015). Hofstra et al (2010) explained the discrepancies of findings between studies by the difference of age and sample sizes. In addition to those factors, the difference of sleep-wake patterns and chronotypes may play a role.…”

“…Hofstra et al (2010) compared the results of 48 patients who were seizure-free and 152 who remained to have seizures and found no differences in chronotypes or subjective sleep parameters. Unterberger et al (2015) found that seizures had acute effects on sleep-wake rhythm, whereas chronic sleep disorders were not more common in patients with epilepsy, compared with healthy control.…”

“…Sleep disorders and circadian rhythms have been of interest in patients with epilepsy though knowledge on the interaction between circadian rhythm and human epilepsy is relatively poor (Hofstra and De Weerd, 2009). So far, several controlled questionnaire studies have reported an issue about sleep habits and disorders, circadian rhythm, daytime sleepiness, and seizures in over 100 patients with epilepsy (De Weerd et al, 2004;Hofstra et al, 2010;Khatami et al, 2006;Malow et al, 1997;Manni et al, 2000;Pung and Schmitz, 2006;Unterberger et al, 2015). Pung and Schmitz (2006) reported that Table 3 Partial Spearman correlation analysis between seizure variables and sleep in patients with epilepsy adjusting for age, gender, and the number of antiepileptic drugs.…”