Excessive Daytime Sleepiness and Sleep Disorders in a Population of Patients with Epilepsy: a Case-Control Study

Abstract

Background and PurposeThere are several primary causes for excessive daytime sleepiness (EDS) and sleep disorders in patients with epilepsy. Up to now, studies in the literature report conflicting data in terms of both prevalence and aetiology. The aim of our study was therefore to evaluate the prevalence of EDS and some sleep disorders in a population of patients with epilepsy treated with no more than two antiepileptic drugs (AEDs). We also investigated the role of the depression of mood as a variable that can negatively affect EDS.MethodsWe prospectively and consecutively recruited 99 patients with a diagnosis of epilepsy, sleep disorders and EDS, belonging to the Centre for Epilepsy of the Department of Experimental Biomedicine and Clinical Neurosciences of the University of Palermo. 61.6% of patients recruited were suffering from focal epilepsy, and 38.3% from generalized epilepsy. 68.6% were undertaking monotherapy and 27.2% were drug resistant. Patients were matched for sex and age (+/− 5 years) with 96 non epileptic controls recruited from high school students, college students, relatives and friends of the medical team that conducted the study. EDS was found in 11.1% of patients with epilepsy. Clinical evaluation of sleep disorders was performed using validated questionnaires to investigate excessive daytime sleepiness (EDS), insomnia, Restless Legs Syndrome (RLS) and Obstructive Sleep Apnoea Syndrome (OSAS). In a second phase of the study, 43 of the investigated patients and 34 controls - after giving their consent - underwent a polysomnographic examination by “Compumedics Somtè”.ResultsOur study shows a statistically significant difference between cases and controls with regard to the prevalence of RLS (p = 0.022) and severity of OSAS with an increased risk in moderate-severe forms of epilepsy (odd ratio [OR] 2.5) most significantly associated with male gender (p = 0.04) and focal epilepsy (OR 3.8) with PSG seizures (0.02). Moreover, a statistically significant difference was demonstrated about mood disorders (p = 0.001) among patients with epilepsy and non epileptic controls. Sleepiness in patients with epilepsy seems to be particularly related to both the depression of mood (p = 0.01) and the presence of OSAS (p = 0.03), as well as to a higher mean age (p = 0.006) and a longer duration of illness (p = 0.04).ConclusionsOur results confirm that drowsiness trouble frequently complained by patients with epilepsy, is particularly related not only to the presence of OSAS but also to the depression of mood.

Impaired vigilance networks in temporal lobe epilepsy: Mechanisms and clinical implications

“…40 Many other studies have found high rates of EDS, sleep fragmentation, and disturbed sleep architecture in focal epilepsy, as well as increased risk of obstructive sleep apnea. [41][42][43] Furthermore, several investigations have found that EDS and sleep disturbances are not solely related to antiepileptic medications, [44][45][46] but instead are closely associated with severity and/or duration of disease, [45][46][47] and may be accompanied by decline in quality of life. 44,48 Overall, these clinical studies suggest potential impairment of vigilance networks in focal epilepsy patients.…”

“…In one recent neuroimaging study of mTLE patients after epilepsy surgery, we noted that certain functional connectivity alternations recovered to levels resembling those of controls in patients who became free of seizures, regardless of whether they were still taking medications. 99 Furthermore, several studies have noted impaired vigilance, 26,39 neurocognitive deficits, 24,37,38 and EDS [44][45][46] in epilepsy patients that are not fully explained by medications and often present in the absence of medications. Therefore, distinguishing the contributions of medications and subcortical network impairments to vigilance and cognition is critical to understand their clinical implications in mTLE treatment.…”

Apathy in people with epilepsy and its clinical significance: A case-control study

“…Consequently, it is not surprising that apathy is closely related to depression. Furthermore, depressed PWE have been reported to elicit comorbid anxiety and sleep problems [11,33,34]. Thus, it is natural that apathy is likely to accompany these psychosomatic symptoms.…”

Sleep Disorders in Epilepsy: Current Trends and Future Perspectives

“…Excessive daytime sleepiness is a common complaint in patients with epilepsy (PWE). Evidence suggests that uncontrolled seizures, comorbid sleep disorders, and mood disorders are major contributing factors [11,14,28,49]. There are conflicting studies regarding the impact of AEDs on daytime sleepiness.…”

“…A recent study by Maestri et al demonstrated that newly diagnosed PWE not on AEDs had no difference from controls on Multiple Sleep Latency tests, reaction times, or Epworth Sleepiness Scale scores [26]. Another study demonstrated 11.1% of PWE had excessive daytime sleepiness, more frequently in the presence of obstructive sleep apnea and depression [49]. Although excessive daytime sleepiness is frequently reported, comorbid narcolepsy and epilepsy has been infrequently documented with only a few recent case series published [50,51].…”