Epilepsi Hastalarında Rastlanılan Uyku Bozuklukları: Anketle Vaka-Kontrol Çalışması

Abstract

Interaction of epilepsy and sleep and increased frequency of sleeping disorders in epileptic patients with respect to healthy people are well known issues. However, in our country and in literature real frequency of sleeping disorders that we see in epileptic patients of our daily clinical practice is not known exactly. There are few studies with objective results investigating large number of patients compared with healthy controls. We decided to study frequency of sleeping disorders in epileptic patients admitted to our centre. 208 epileptic patients admitted to our clinic without any systemic or neurologic disorder that may cause sleeping abnormality and 212 matched healthy controls are included in our study. A questionnaire form with 132 questions composed of tests that are used in international studies and can give objective results like Epworth Sleepiness Scale, Berlin Sleep Questionnaire, Beck Depression Index for Primary Care (BDI-PC) and Pittsburgh Sleep Quality İndex determined by Turkish Sleep Medical Association are applied to patients and controls. Patients are divided into three groups according to their type of epileptic syndrome as undetermined type (n=67), generalized epilepsy (n=33) and focal epilepsy (n=108). Difficulty in falling asleep (p<0.01), interruptions of sleeps (p=0.01), difficulty in falling asleep after awakening (p=0.04) and symptoms of chronic insomnia (p<0.01) were more frequent in patients. Risks of hypersomnia (p<0.01) and sleep apnea (p=0.07) were higher in patients according to Berlin Sleep Questionnaire. The sleep quality was worse in patients (p<0.01) and major depression findings were more frequent (p<0.01). But contrast to previously reported knowledge, frequency of Excessive Daytime Sleepiness (EDS) according to Epworth Sleepiness Scale were same in patients and controls. Furthermore sleep apnea risk was more frequent in focal epilepsy while comparing the type of epilepsies (p=0.03). The history of at least two-year seizure free period, presence of nocturnal seizures and epileptiform abnormality on EEG and the number of antiepileptic drug (AED) affect the appearance of sleep disorder. Finally, bad sleep quality and high risk of chronic insomnia and sleep apnea were noticed in epileptic patients.The duration of seizure free period, presence of epileptiform activity on EEG and usage of polytherapy were found as significative factors. According to these findings, appearance of sleep disorders can be prevented by effective epilepsy treatment, having a long seizure free period and decreasing of epileptiform activity on EEG. All these will improve the quality of life besides treatment of primary disease in epilepsy patients. İn future, the treatment choices can be increased by lightening of the similar studies related to investigation of interaction of both disorders in epilepsy patients.