Sleep quality in drug resistant epilepsy patients

Abstract

Sleep and psychiatric disorders are frequent comorbidities in patients with epilepsy. Sleep quality is affected by anxiety or depressive conditions which worsen the seizures control. Reciprocally, epilepsy itself determines sleep disturbances, although mechanisms are not well known. The aim of our study was to evaluate sleep quality in patients admitted to the Epilepsy Monitoring Unit (EMU) of our centre for diagnostic purposes. Parameters to be considered were gender, age, epilepsy type, antiepileptic drug (AED) therapy, anxious and depressive scores and quality of life index. 92 Patients over 18 years-old with drug resistant epilepsy were analysed. The day of admission at EMU, all patients completed the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Quality of Life in Epilepsy Inventory (QOLIE-10). Patients with pseudoseizures were excluded. Univariate and multivariate linear regression models were calculated to assess variables associated with PSQI. Patients evaluated at EMU showed a lower sleep quality on PSQI (6.79 ± 3.81, cut-off value of 5). Also the quality of life measured by QOLIE-10 (normal index < 21) was reduced (26.71 ± 8.17). Significant differences in PSQI according to gender ( F = 52; M = 40), age (39 ± 12 years) or epilepsy form (generalized = 9; temporal = 55; frontal = 13; occipital = 7; other = 8) were not found. Correlations between sleep quality and antiepileptic therapy could not be established. The univariate analysis showed a positive correlation between PSQI and depression and anxiety scores. Nevertheless, the multivariate analysis established a stronger correlation between PSQI and HADS-anxiety index (8.45 ± 4.14). Patients with drug resistant epilepsy have reduced sleep quality and quality of life. Anxiety seems to be the most important condition over sleep quality in pharmacoresistant epilepsy patients. In order to establish correlations between sleep disturbances and epilepsy form or AED therapy, new clinical trials should be developed. Epilepsy Monitoring Unit Team, Hospital del Mar.