Associations of impaired sleep quality with epilepsy: A case–control study

Epilepsy, a prevalent neurological disorder marked by recurrent, unprovoked seizures, often leads to significant health and economic complications to the effected person and family[1]. There are many evidence which underlines the higher risk of epilepsy patients to poor sleep quality than the general population[2]. However, there is limited evidence on sleep quality among epilepsy patients and associated factors in Riyadh. Therefore, this study aims to compare the sleep patterns and sleep quality among epilepsy patients to non-epileptic individuals.

We conducted a case-control study at King Fahad Medical City in Riyadh, with a total of 434 patients, the sample included 171 epilepsy patients from the epilepsy clinic in KFMC aged 18-50 years, 263 non-epileptic controls from other clinic within the same Hospital. Patients completed a structured questionnaire including demographical data, medical history, and the Pittsburgh Sleep Quality Index (PSQI)

Our study shows a significant difference in sleep patterns between cases and controls. Cases shows later bedtimes (P < 0.001), longer sleep onset latency (P < 0.001), and shorter sleep durations (P < 0.001) compared to controls. Although subjective sleep quality and other individual sleep parameters did not differ significantly between groups, the Global PSQI Score was significantly higher in cases (median 8 [IQR6-10]) compared to controls (median 6 [IQR 4-9]; P = 0.001). Stratified analysis revealed significant associations between sleep disturbance and factors such as age, gender, smoking status, marital status, employment and the presence of chronic disease, with higher odds of sleep disturbance consistently found among cases (P < 0.001 for all).

Editorial note: We conclude that sleep disturbances are significantly prevalent among epilepsy patients and are affected by a range of demographic and clinical factors including age, gender, smoking status, and the presence of chronic illness. To enhance sleep quality, it is crucial to address these factors by conducting a thorough sleep evaluation, educating epilepsy patients on sleep hygiene, along with implementing targeted interventions such as smoking cessation programs.

Table 4 Analysis of Pittsburgh Sleep Quality Index for Epileptic patients and controls at King Fahad Medical City, 2024

Note: Continuous variables presented as Median [IQR]: interquartile Range, * Shows that P-value is statistically significant;

 (<=5 indicate sleep disturbance, > 5 indicate normal sleep)

References:

1.        Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014 [cited 2024 Jul 2];55(4):475-82. Available from: https://pubmed.ncbi.nlm.nih.gov/24730690/

2.        Zuberi SM, Wirrell E, Yozawitz E, Wilmshurst JM, Specchio N, Riney K, et al. ILAE classification and definition of epilepsy syndromes with onset in neonates and infants: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022 Jun 01 [cited 2024 Jul 2];63(6):1349-97. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/epi.17239