Sleep misperception in persons with epilepsy

Abstract

Being able to confidently ascertain the amount of sleep is critical to the clinical management of epilepsy. Sleep misperception is the phenomenon in which an individual underestimates the amount of time spent asleep. Little is known about sleep misperception in patients with epilepsy.We conducted retrospective chart reviews on individuals who self-identified as having epilepsy in a questionnaire database of patients undergoing polysomnography (PSG) at the Massachusetts General Hospital Sleep Laboratory. Our metric for sleep misperception was the difference between subjective and objective sleep latency (S–O SL) and subjective and objective total sleep time (S–O TST) with subjective values based on questionnaire and objective values based on PSG.We confirmed 64 patients with epilepsy. We then selected age- and sex-matched diagnostic PSG data for comparison from 50 patients with insomnia symptoms but no obstructive sleep apnea (OSA) and another 50 patients with OSA but no insomnia symptoms. In our cohort with epilepsy, the median SL overestimation was 20min (p<0.05), and the median TST underestimation was 45min (p<0.05). Sleep misperception was similar regardless of potential confounding factors such as categorical epilepsy refractoriness, cognitive impairment, or psychiatric comorbidity.Our findings suggest that sleep misperception occurs similarly in patients with epilepsy as in patients without epilepsy with insomnia. Our findings further support the potential clinical utility of objective PSG testing in patients with epilepsy, as this may not only identify occult OSA but also disclose sleep misperception.