Sleep Disorders

Hypersomnia

Hypersomnia Outcomes in Adults With Epilepsy (N = 127)

2000 – 2008

ESS = Epworth Sleepiness Scale, MSL = mean sleep latency

People with epilepsy are at increased risk for sleep disorders including OSA, insomnia, and self-reported daytime sleepiness, which further impact quality of life in this vulnerable population. In this prospective study of adults with epilepsy (AWE) consecutively recruited without foreknowledge of sleep/wake complaints, polysomnography (PSG) with 18-channel electroencephalography (EEG) followed by multiple sleep latency testing (MSLT) was performed. Among 127 AWE (mean age: 38.7 ± 13.7 years), abnormal mean sleep latency (MSL; < 8 min) was observed in 49.6% and MSL < 5 min in 31.5%. While 78% reported feeling sleepy during the day on a single-item question, only 24% had elevated scores on the Epworth Sleepiness Scale (ESS; > 10/24). The ESS score was associated with MSL even after adjusting for seizure frequency, antiseizure medication (ASM) standardized dose and number, age, gender, depression, and insomnia symptom severity, and apnea-hypopnea index (AHI) and total sleep time on PSG (95% CI: -0.26 [-0.48, -0.05], P = 0.018). The area under the curve (AUC) of the ESS ROC predicting MSL < 8 min and MSL < 5 min were similar: 0.62 (95% CI: 0.52-0.72) and 0.62 (95% CI: 0.51-0.74). Overall, subjective and objective daytime sleepiness was highly prevalent in AWE and not explained by seizure frequency, ASM burden, symptoms of insomnia/depression, or PSG findings although those with MSL < 5 min were more likely to have OSA. Pathologic sleepiness with MSL < 8 min was present in half of AWE. Nearly one-third of AWE unselected for sleep/wake complaints had MSL < 5 min, a range typical of narcolepsy. These findings present a crucial opportunity to further elucidate mechanisms underlying hypersomnia in AWE and develop trials to treat it.