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Norton SE, Hunt C, Lah S. Fear of sleep in people with epilepsy. Epilepsy Res 2023; 192:107124. [PMID: 36940587 DOI: 10.1016/j.eplepsyres.2023.107124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
More than one third of people with epilepsy (PWE) report experiencing insomnia. This is highly concerning given that sleep loss both triggers and exacerbates seizures. It is therefore paramount that we understand the underlying mechanisms of insomnia in PWE. Nevertheless, research in this area remains limited, with little understanding of the emerging or maintaining factors of insomnia in PWE. Therefore, the current study sought to explore fear of sleep as a novel explanation for the increased rate of insomnia in PWE, and whether fear of sleep was related to post-seizure trauma. We recruited 184 PWE and 197 healthy controls via social media and collected data using a series of online questionnaires. We found that fear of sleep did not significantly differ between the epilepsy and control group. In the epilepsy group, fear of sleep seemed to be largely driven by trauma, especially post-seizure trauma but also non-seizure related trauma, along with anxiety and higher seizure frequency. Fear of sleep in the control group was also largely driven by trauma, but also anxiety and depression. Finally, we found more severe and prevalent insomnia in PWE relative to controls, and in both groups, fear of sleep was the most significant contributor to insomnia. Our novel findings carry important clinical implications. First, they point to the central role of trauma in fear of sleep not only in PWE but also in the general population. Our findings also indicate that fear of sleep is an important maintaining factor of insomnia. Ultimately, these results suggest that all individuals with insomnia may benefit from insomnia interventions targeted at trauma, depression, anxiety, and fear of sleep. PWE are likely to benefit from additional treatment components for seizure-related trauma and seizure management. To better understand the reliability and generalisability of our novel findings, future research should further assess fear of sleep and its role in maintaining insomnia in the epilepsy population.
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Affiliation(s)
- Shanae Ella Norton
- Department of Psychology, University of Sydney, Camperdown, Sydney, Australia
| | - Caroline Hunt
- Department of Psychology, University of Sydney, Camperdown, Sydney, Australia
| | - Suncica Lah
- Department of Psychology, University of Sydney, Camperdown, Sydney, Australia.
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Karakis I, Boualam N, Moura LM, Howard DH. Quality of life and functional limitations in persons with epilepsy. Epilepsy Res 2023; 190:107084. [PMID: 36657252 DOI: 10.1016/j.eplepsyres.2023.107084] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Epilepsy can reduce quality of life (QOL), functionality, and social participation, but these effects have not been adequately quantified in large, population-based, controlled studies. We sought to evaluate the impact of epilepsy on patients' QOL and employment outcomes. METHODS In this cross-sectional study we used nationally representative, pooled data from the Medical Expenditure Panel Survey (MEPS) household component files for 2010-2018. MEPS is a population-based survey of U.S. community-dwelling persons. We included respondents with condition file records for epilepsy. We also analyzed respondents with records for seizure. The primary outcomes were short form-12 physical and mental health scores. Secondary outcomes included self-rated health status, employment status, educational attainment, school/household/work limitations, and missed workdays. We compared these outcomes between persons with epilepsy (PWE) and age- and gender-matched controls. RESULTS We identified 1078 people with epilepsy, 2344 seizure cases, and 3422 cases of either condition (persons with epilepsy and/or seizures). Epilepsy was associated with a decrease of - 4.0 (95% CI: -5.1 to -2.8) points in SF-12 physical health scores and - 3.1 (95% CI: -4.2 to -1.9) in SF-12 mental health scores. Epilepsy was also associated with decreases in the likelihood of reporting good/very good/excellent health status (-13.3 [95% CI: -16.1 to -10.4] percentage points). Epilepsy was also associated with adverse employment-related outcomes. Specifically, PWE were 17.9 (95% CI: 14.3-21.4) percentage points more likely to report that they had work or household limitations. The associations between outcomes and epilepsy were, in most cases, larger than those between outcomes and other common, chronic conditions. SIGNIFICANCE Epilepsy is associated with worse quality of life and employment-related outcomes. Interventions should aim to improve functioning and patients' ability to maintain employment.
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Affiliation(s)
- Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
| | - Nada Boualam
- Department of Health Policy, Emory University School of Medicine, Atlanta, Georgia
| | - Lidia Mvr Moura
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts. Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - David H Howard
- Department of Health Policy, Emory University School of Medicine, Atlanta, Georgia
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Paardekooper D, Thayer Z, Miller L, Nikpour A, Gascoigne MB. Group-based cognitive behavioral therapy program for improving poor sleep quality and quality of life in people with epilepsy: A pilot study. Epilepsy Behav 2020; 104:106884. [PMID: 31982831 DOI: 10.1016/j.yebeh.2019.106884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/18/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
Abstract
Sleep difficulties are commonly reported by patients with epilepsy and can have a detrimental impact on overall quality of life. The purpose of this pilot study was to assess the efficacy of a psychotherapeutic approach, namely Cognitive Behavioral Therapy for Insomnia (CBT-I), in improving sleep quality in patients with epilepsy. Twenty outpatients with epilepsy who reported poor sleep quality were randomized to either a control or CBT-I treatment group, which involved four group-based CBT-I sessions, delivered on a weekly basis. In addition to completing a range of standardized measures related to sleep quality and quality of life, participants also monitored their sleep with a self-completed sleep diary over a two-week period, on two separate occasions. Following CBT-I treatment, no between-group difference was found on any sleep or quality of life measure. However, both the treatment and control groups improved on measures of sleep quality, quality of life, sleep hygiene behaviors, and dysfunctional beliefs about sleep. These findings suggest that sleep monitoring alone may have the potential for prompting healthy behavior change in this clinical population.
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Affiliation(s)
- Diana Paardekooper
- School of Psychological Sciences, Australian College of Applied Psychology, Sydney, Australia
| | - Zoe Thayer
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Laurie Miller
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Armin Nikpour
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael B Gascoigne
- School of Psychological Sciences, Australian College of Applied Psychology, Sydney, Australia; School of Psychology, The University of Sydney, Australia.
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Dinkelacker V. Obstructive sleep apnea in drug-resistant epilepsy: A significant comorbidity warranting diagnosis and treatment. Rev Neurol (Paris) 2016; 172:361-70. [DOI: 10.1016/j.neurol.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/18/2016] [Indexed: 11/08/2022]
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Al-Biltagi MA. Childhood epilepsy and sleep. World J Clin Pediatr 2014; 3:45-53. [PMID: 25254184 PMCID: PMC4162437 DOI: 10.5409/wjcp.v3.i3.45] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/16/2014] [Accepted: 06/10/2014] [Indexed: 02/06/2023] Open
Abstract
Sleep and epilepsy are two well recognized conditions that interact with each other in a complex bi-directional way. Some types of epilepsies have increased activity during sleep disturbing it; while sleep deprivation aggravates epilepsy due to decreased seizure threshold. Epilepsy can deteriorate the sleep-related disorders and at the same time; the parasomnias can worsen the epilepsy. The secretion of sleep-related hormones can also be affected by the occurrence of seizures and supplementation of epileptic patients with some of these sleep-related hormones may have a beneficial role in controlling epilepsy.
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Pornsriniyom D, Shinlapawittayatorn K, Fong J, Andrews ND, Foldvary-Schaefer N. Continuous positive airway pressure therapy for obstructive sleep apnea reduces interictal epileptiform discharges in adults with epilepsy. Epilepsy Behav 2014; 37:171-4. [PMID: 25042599 DOI: 10.1016/j.yebeh.2014.06.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/03/2014] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
Abstract
Obstructive sleep apnea (OSA) is highly prevalent, affecting 25% of men and 10% of women. We recently reported a prevalence of OSA of 30% among 130 adults with epilepsy unselected for sleep disorder complaints, including 16% with moderate-to-severe disease, rates that markedly exceed general population estimates. Treatment of OSA with continuous positive airway pressure (CPAP) therapy or upper airway surgery reduces seizures in many cases. A single study reported a reduction in interictal spike rate with CPAP in 6 patients with OSA. We explored the effect of CPAP therapy on spike rate in 9 adults with epilepsy and OSA. Interictal epileptiform discharges were quantified during a diagnostic polysomnogram (PSG) and a second PSG using therapeutic CPAP. Spike rates were calculated for each recording during wake and sleep stages. Continuous positive airway pressure therapy was associated with significant reductions in median (quartiles) spike rate overall (77.9 [59.7-90.7] %), in wakefulness (38.5 [0.3-55] %), and in sleep (77.7 [54.8-94.7] %) but not in REM sleep. Continuous positive airway pressure therapy also produced a significant improvement in oxygen saturation and arousals. Our work extends a single prior observation demonstrating beneficial effects of CPAP therapy on interictal EEG in patients with epilepsy with comorbid OSA and supports the hypothesis that sleep fragmentation due to OSA contributes to epileptogenicity.
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Affiliation(s)
- Darakul Pornsriniyom
- Cleveland Clinic Neurological Institute, Sleep Disorders and Epilepsy Centers, Cleveland, OH, USA; Sleep Disorders Center, Department of Neurology, Bangkok Hospital Pattaya, Bangkok Hospital Group, Thailand.
| | - Krekwit Shinlapawittayatorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Thailand
| | - Joanna Fong
- Cleveland Clinic Neurological Institute, Sleep Disorders and Epilepsy Centers, Cleveland, OH, USA
| | - Noah D Andrews
- Cleveland Clinic Neurological Institute, Sleep Disorders and Epilepsy Centers, Cleveland, OH, USA
| | - Nancy Foldvary-Schaefer
- Cleveland Clinic Neurological Institute, Sleep Disorders and Epilepsy Centers, Cleveland, OH, USA
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Titiz AS, Mahoney JM, Testorf ME, Holmes GL, Scott RC. Cognitive impairment in temporal lobe epilepsy: role of online and offline processing of single cell information. Hippocampus 2014; 24:1129-45. [PMID: 24799359 DOI: 10.1002/hipo.22297] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 12/31/2022]
Abstract
Cognitive impairment is a common comorbidity in temporal lobe epilepsy (TLE) and is often considered more detrimental to quality of life than seizures. While it has been previously shown that the encoding of memory during behavior is impaired in the pilocarpine model of TLE in rats, how this information is consolidated during the subsequent sleep period remains unknown. In this study, we first report marked deficits in spatial memory performance and severe cell loss in the CA1 layer of the hippocampus lower spatial coherence of firing in TLE rats. We then present the first evidence that the reactivation of behavior-driven patterns of activity of CA1 place cells in the hippocampus is intact in TLE rats. Using a template-matching method, we discovered that real-time (3-5 s) reactivation structure was intact in TLE rats. Furthermore, we estimated the entropy rate of short time scale (∼250 ms) bursting activity using block entropies and found that significant, extended temporal correlations exist in both TLE and control rats. Fitting a first-order Markov Chain model to these bursting time series, we found that long sequences derived from behavior were significantly enriched in the Markov model over corresponding models fit on randomized data confirming the presence of replay in shorter time scales. We propose that the persistent consolidation of poor spatial information in both real time and during bursting activity may contribute to memory impairments in TLE rats.
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Affiliation(s)
- A S Titiz
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Insomnia in central neurologic diseases – Occurrence and management. Sleep Med Rev 2011; 15:369-78. [DOI: 10.1016/j.smrv.2011.01.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 11/21/2022]
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Bruni O, Novelli L, Luchetti A, Zarowski M, Meloni M, Cecili M, Villa M, Ferri R. Reduced NREM sleep instability in benign childhood epilepsy with centro-temporal spikes. Clin Neurophysiol 2010; 121:665-71. [PMID: 20097604 DOI: 10.1016/j.clinph.2009.12.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Revised: 12/17/2009] [Accepted: 12/20/2009] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To analyze sleep architecture and NREM sleep instability by means of the cyclic alternating pattern (CAP) in children with benign epilepsy with rolandic spikes (BERS). METHODS Ten children with BERS, drug free at the time of the study and 10 age-matched normal controls were included in this study. Sleep was visually scored for sleep architecture and CAP using standard criteria. RESULTS Sleep architecture in BERS showed only few significant differences vs. controls with a reduction of total sleep time, sleep efficiency, and REM sleep percentage. CAP analysis revealed several significant differences: reduced total CAP rate, mainly in sleep stage 2, and reduced EEG slow oscillations and arousals during stages N1 and N2. CONCLUSIONS Sleep architecture is not importantly affected in BERS but CAP analysis reveals a decrease of NREM instability, mainly in sleep stage 2. Since there is a spindle-related spike activation in BERS, we speculate that the decrease of CAP and of EEG slow oscillations and arousals might be linked with the inhibitory action of spindling activity and spikes on arousals. SIGNIFICANCE CAP analysis discloses sleep structure abnormalities in children with BERS not shown by the classical sleep scoring. Spike activity and CAP A1 subtypes seem to be mutually exclusive probably because centro-temporal spikes disturb the physiological synchronization mechanisms needed for the generation of slow-wave components of CAP.
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Affiliation(s)
- Oliviero Bruni
- Pediatric Sleep Center, Department Developmental Neurology and Psychiatry, Sapienza University, Rome, Italy.
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Tomás Vila M, Miralles Torres A, Beseler Soto B, Revert Gomar M, Sala Langa MJ, Uribelarrea Sierra AI. [Sleep patterns and sleep disturbances among schoolchildren in the town of Gandia]. An Pediatr (Barc) 2008; 68:250-6. [PMID: 18358136 DOI: 10.1157/13116705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Knowledge of sleep patterns and sleep disturbances among healthy children is interesting, particularly, amongst other things, for carrying out comparative studies with children with certain diseases. The objective of the present study was to study sleep patterns and the prevalence of sleep disturbances among schoolchildren. METHODS We used the Spanish version of the Pediatric Sleep Questionnaire, which was given out to a representative sample of Gandia Town. RESULTS The prevalence of sleep disturbances were as follows: insomnia 10.5 %, daytime sleepiness 13 %, a positive score for sleep-disorder breathing 5.7 %, snoring 5.7 %, enuresis 5.3 %, sleepwalking 12.5 %, night terrors 18.4 %, nightmares 12.8 %. As regards sleep patterns, the average time for getting up was 7:45 am, the average time for going to bed was 22:13 pm, and the average sleep duration was 9 hours and 30 minutes. CONCLUSIONS Comparison among different populations studies is difficult due to the use of different instruments to measure the same variables. Our results are similar to other studies, with the exception of sleep-disorder breathing and snoring, where the prevalences are lower in our study. The sleep patterns also did not show any differences between other published studies.
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Affiliation(s)
- M Tomás Vila
- Servicio de Pediatría, Hospital Francesc de Borja, Po. de Les Germanies 71, Gandia, Spain.
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