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Rypicz Ł, Witczak I, Šupínová M, Salehi HP, Jarabicová O. Alarm fatigue and sleep quality in medical staff-a Polish-Czech-Slovak study on workplace ergonomics. Front Public Health 2024; 12:1345396. [PMID: 39145177 PMCID: PMC11322343 DOI: 10.3389/fpubh.2024.1345396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Background Alarms are crucial in informing Healthcare Workers (HCWs) about critical patient needs, but unmanaged frequency and noise of alarms can de-sensitize medical staff and compromise patient safety. Alarm fatigue is identified as the major cause of the clinical alarm management problem. It occurs when the medical staff is overwhelmed by the number of clinical alarms. Methods The survey was conducted online using Google's form-making tools from June to July 2023. There were three parts to the survey used in the study: a socio-demographic metric, the Alarm Fatigue Assessment Questionnaire (AFAQ), and The Pittsburgh Sleep Quality Index (PSQI). A significance level of 0.05 was used in the analysis. Results The survey included 756 medical professionals from three European countries (Slovakia, the Czech Republic and Poland). The participants in the study were 42 years old on average, and they had 12 years of work experience. 603 out of 756 survey participants had poor sleep quality, 147 had good sleep quality, and 6 did not provide an answer. This study analyzed the alarm fatigue levels of respondents in every country. In the Czech Republic, Poland and Slovakia, a statistically significant association (p = 0.039, p = 0.001, p < 0.001) was found between alarm fatigue and sleep quality in medical staff. Conclusion Based on our study, alarm fatigue and sleep quality of HCWs are correlated. Therefore, alarm fatigue and sleep hygiene should be monitored.
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Affiliation(s)
- Łukasz Rypicz
- Department of Population Health, Division of Public Health, Faculty of Health Sciences, Medical University, Wroclaw, Poland
| | - Izabela Witczak
- Department of Population Health, Division of Public Health, Faculty of Health Sciences, Medical University, Wroclaw, Poland
| | - Mária Šupínová
- Faculty of Health Sciences, Catholic University in Ružomberok, Ružomberok, Slovakia
| | - Hugh Pierre Salehi
- Department of Biomedical, Industrial, and Human Factors Engineering, Wright State University, Dayton, OH, United States
| | - Oľga Jarabicová
- Department of Nursing, Faculty of Health Studies, Jan Evangelista Purkyne University in Ústí nad Labem, Ústí nad Labem, Czechia
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Arvin A, Taebi M, Khazaeipour Z, Najafi A, Tafakhori A, Ranji-Bourachaloo S, Amirifard H. Sleep profiles in epilepsy patients undergoing monotherapy and polytherapy: A comparative cross-sectional study. Epilepsy Behav 2024; 155:109799. [PMID: 38642528 DOI: 10.1016/j.yebeh.2024.109799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/14/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE Sleep disturbances commonly reported among epilepsy patients have a reciprocal relationship with the condition; While epilepsy and anti-seizure medications (ASMs) can disrupt sleep structure, disturbed sleep can also exacerbate the frequency of seizures. This study explored subjective sleep disturbances and compared sleep profiles in patients who underwent ASM monotherapy and polytherapy. METHODS We enrolled 176 epilepsy patients who completed a structured questionnaire containing demographic and clinical information and the Persian versions of the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Patient Health Questionnaire-9 (PHQ-9) to evaluate sleep quality, insomnia, excessive daytime sleepiness (EDS), and depressive symptoms, respectively. Chi-square and Mann-Whitney U tests were employed to analyze the association between variables, and logistic regression analysis was conducted to identify factors predicting sleep disturbances. RESULTS Comparative analysis of mono/polytherapy groups revealed a significantly higher prevalence of insomnia and EDS among patients on polytherapy compared to monotherapy. However, no significant difference was found in sleep quality between the two groups. Logistic regression analysis revealed that a depressive mood serves as a robust predictor for sleep issues, whereas treatment type did not emerge as an independent predictor of sleep disturbances. CONCLUSION Our findings suggest that an increased number of ASMs does not inherently result in a higher incidence of sleep issues. Therefore, multiple ASMs may be prescribed when necessary to achieve improved seizure control. Furthermore, this study underscores the importance of comprehensive management that addresses seizure control and treating affective symptoms in individuals with epilepsy.
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Affiliation(s)
- Alireza Arvin
- School of Medicine, Tehran University of Medical Sciences (TUMS), Iran; Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Morvarid Taebi
- School of Medicine, Tehran University of Medical Sciences (TUMS), Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Khazaeipour
- Brain & Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Ranji-Bourachaloo
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Amirifard
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Charlebois CM, Anderson DN, Smith EH, Davis TS, Newman BJ, Peters AY, Arain AM, Dorval AD, Rolston JD, Butson CR. Circadian changes in aperiodic activity are correlated with seizure reduction in patients with mesial temporal lobe epilepsy treated with responsive neurostimulation. Epilepsia 2024; 65:1360-1373. [PMID: 38517356 PMCID: PMC11138949 DOI: 10.1111/epi.17938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Responsive neurostimulation (RNS) is an established therapy for drug-resistant epilepsy that delivers direct electrical brain stimulation in response to detected epileptiform activity. However, despite an overall reduction in seizure frequency, clinical outcomes are variable, and few patients become seizure-free. The aim of this retrospective study was to evaluate aperiodic electrophysiological activity, associated with excitation/inhibition balance, as a novel electrographic biomarker of seizure reduction to aid early prognostication of the clinical response to RNS. METHODS We identified patients with intractable mesial temporal lobe epilepsy who were implanted with the RNS System between 2015 and 2021 at the University of Utah. We parameterized the neural power spectra from intracranial RNS System recordings during the first 3 months following implantation into aperiodic and periodic components. We then correlated circadian changes in aperiodic and periodic parameters of baseline neural recordings with seizure reduction at the most recent follow-up. RESULTS Seizure reduction was correlated significantly with a patient's average change in the day/night aperiodic exponent (r = .50, p = .016, n = 23 patients) and oscillatory alpha power (r = .45, p = .042, n = 23 patients) across patients for baseline neural recordings. The aperiodic exponent reached its maximum during nighttime hours (12 a.m. to 6 a.m.) for most responders (i.e., patients with at least a 50% reduction in seizures). SIGNIFICANCE These findings suggest that circadian modulation of baseline broadband activity is a biomarker of response to RNS early during therapy. This marker has the potential to identify patients who are likely to respond to mesial temporal RNS. Furthermore, we propose that less day/night modulation of the aperiodic exponent may be related to dysfunction in excitation/inhibition balance and its interconnected role in epilepsy, sleep, and memory.
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Affiliation(s)
- Chantel M. Charlebois
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Daria Nesterovich Anderson
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, Utah, USA
- School of Biomedical Engineering, University of Sydney, Darlington, NSW, Australia
| | - Elliot H. Smith
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Tyler S. Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Blake J. Newman
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Angela Y. Peters
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Amir M. Arain
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Alan D. Dorval
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - John D. Rolston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Neurosurgery, Brigham & Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher R. Butson
- Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, Utah, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
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Kang HJ, Torres K, Kim MS. Differences in health-related quality of life and somatic symptoms in employed and unemployed patients with epilepsy. Epilepsy Behav Rep 2024; 26:100663. [PMID: 38708365 PMCID: PMC11067481 DOI: 10.1016/j.ebr.2024.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 05/07/2024] Open
Abstract
This study compared overall and specific aspects of health-related quality of life (HRQOL) and self-report of somatic, anxiety, and depressive symptoms between employed (n = 71) and unemployed (n = 48) patients with epilepsy (PWE). The Quality of Life in Epilepsy (QOLIE-89) and the Personality Assessment Inventory (PAI) were examined. The unemployed group reported significantly worse overall HRQOL including aspects of HRQOL related to epilepsy, physical health, mental health, and cognitive function. Among these four, physical health related HRQOL revealed the most difference between groups. While there were no differences between the groups in the level of social support and social isolation, the unemployed group reported worse social function with respect to work and driving. The unemployed group reported significantly greater somatic symptoms, but not anxiety and depressive symptoms. When specifically examining the subscales of the Somatic Concerns scale, conversion and health concerns, but not somatization, were greater in the unemployed group. Among the Depression subscales, the unemployed group reported greater physiologically manifested depressive symptoms. These findings suggest that along with optimizing seizure control, identifying and addressing presence of physical limitations, dysfunction, and somatic symptoms are also of importance in the care of PWE, particularly for those who are unemployed.
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Affiliation(s)
- Hyun Jin Kang
- Department of Neurology, University of Washington, United States
| | - Karen Torres
- Department of Neurology, University of Washington, United States
| | - Michelle S. Kim
- Department of Neurology, University of Washington, United States
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Gabryelska A, Turkiewicz S, Białasiewicz P, Grzybowski F, Strzelecki D, Sochal M. Evaluation of daytime sleepiness and insomnia symptoms in OSA patients with a characterization of symptom-defined phenotypes and their involvement in depression comorbidity-a cross-sectional clinical study. Front Psychiatry 2024; 15:1303778. [PMID: 38495904 PMCID: PMC10940440 DOI: 10.3389/fpsyt.2024.1303778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Recent research highlights the significance of insomnia and sleepiness, shifting from obstructive sleep apnea (OSA) severity and sleep structure, in defining OSA phenotypes. Objectives This study aimed to characterize insomnia and sleepiness associated with OSA phenotypes and assess their involvement in depression symptoms (DS) in OSA. Materials and methods This cross-sectional, clinical study included 181 participants who underwent polysomnography (PSG) and filled out questionnaires, including the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Index (BDI). They were categorized into phenotypes: insomnia-sleepiness (I + S; ESS ≥ 11; ISI ≥ 15; n = 20), sleepiness (S; ESS ≥ 11; ISI < 15; n = 22), insomnia (I; ESS < 11; ISI ≥ 15), and asymptomatic (A; ESS < 11; ISI<15; n=55). Results A linear regression model for the BDI score (R2 = 0.357, p < 0.001) included ISI score and subjective-to-objective sleep latency ratio. The ISI score was a predictive factor for mild and moderate DS [OR = 1.23 (95% CI: 1.09-1.38), p < 0.001 and OR = 1.39 (95% CI: 1.13-1.72), p = 0.002]. The I and I + S phenotypes are characterized by higher BDI scores (p < 0.001 and p = 0.02), longer subjective sleep latency (p = 0.008 and p = 0.04), and shorter subjective total sleep time (TST; p = 0.049 and p = 0.006) compared to A. Furthermore, the I and I + S groups had shorter subjective TST than S (p = 0.03 and p = 0.047). The I and I + S had higher BDI scores than A (p < 0.001 and p = 0.02, respectively) and S (p < 0.001 and p = 0.02, respectively). The I phenotype was associated with the risk of mild and moderate DS (OR = 5.61 (95% CI: 1.91-16.53), p < 0.001 and OR = 9.55 (95% CI: 1.81-50.48), p = 0.008 respectively). Moreover, the I + S phenotype presented an even greater risk for mild DS (OR = 10.29 (95% CI: 2.95-35.85), p < 0.001). Conclusion Using clinical features for OSA phenotyping holds promise for finding OSA individuals with increased risk for DS occurrence.
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Affiliation(s)
- Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Szymon Turkiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Filip Grzybowski
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
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Dell'Isola GB, Tascini G, Vinti V, Tulli E, Dini G, Mencaroni E, Ferrara P, Di Cara G, Striano P, Verrotti A. Effect of melatonin on sleep quality and EEG features in childhood epilepsy: a possible non-conventional treatment. Front Neurol 2023; 14:1243917. [PMID: 37780697 PMCID: PMC10538564 DOI: 10.3389/fneur.2023.1243917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Background Sleep and epilepsy are characterized by a bidirectional relationship. Indeed, epilepsy predisposes to the development of sleep disorders, while sleep deprivation may exacerbate epilepsy. In addition, antiseizure medication can disrupt normal sleep architecture. Therefore, adequate sleep hygiene could lead to improvement in seizure control. The present study aimed to evaluate the effect of melatonin on seizure frequency, EEG tracing, and sleep in children with focal idiopathic epilepsy. Methods This observation study evaluated the effect of 4 mg oral melatonin in ameliorating sleep-wake cycle, seizure frequency, and EEG features in children with focal idiopathic epilepsy of infancy. Twenty children were enrolled from September 2020 to August 2021. The study consisted of serial controls at enrollment (t0), at 3 months (t1), and at 6 months (t2) including neurological examination, questionnaire about sleep disturbances (CSHQ), and EEG. Results A significant improvement in sleep quality and daytime sleepiness was observed after melatonin supplementation. Furthermore, we observed a noteworthy improvement in EEG tracing at t2 that exhibited a significant correlation with improvements in CSHQ scores. Conclusion The studies conducted so far to evaluate the effect of melatonin in persons with epilepsy do not lead to definitive conclusions. Despite the small population sample and the study design, we report sleep and EEG improvement after melatonin administration in our cohort. Larger studies are needed to further study the neuroprotective and anticonvulsant properties of melatonin.
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Affiliation(s)
| | - Giorgia Tascini
- Unit of Pediatrics, Città di Castello Hospital, Città di Castello, Italy
| | - Valerio Vinti
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | - Eleonora Tulli
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | - Gianluca Dini
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | - Pietro Ferrara
- Unit of Pediatrics, Campus Bio-Medico University, Rome, Italy
| | | | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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Li Y, Que M, Wang X, Zhan G, Zhou Z, Luo X, Li S. Exploring Astrocyte-Mediated Mechanisms in Sleep Disorders and Comorbidity. Biomedicines 2023; 11:2476. [PMID: 37760916 PMCID: PMC10525869 DOI: 10.3390/biomedicines11092476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Astrocytes, the most abundant cells in the brain, are integral to sleep regulation. In the context of a healthy neural environment, these glial cells exert a profound influence on the sleep-wake cycle, modulating both rapid eye movement (REM) and non-REM sleep phases. However, emerging literature underscores perturbations in astrocytic function as potential etiological factors in sleep disorders, either as protopathy or comorbidity. As known, sleep disorders significantly increase the risk of neurodegenerative, cardiovascular, metabolic, or psychiatric diseases. Meanwhile, sleep disorders are commonly screened as comorbidities in various neurodegenerative diseases, epilepsy, and others. Building on existing research that examines the role of astrocytes in sleep disorders, this review aims to elucidate the potential mechanisms by which astrocytes influence sleep regulation and contribute to sleep disorders in the varied settings of brain diseases. The review emphasizes the significance of astrocyte-mediated mechanisms in sleep disorders and their associated comorbidities, highlighting the need for further research.
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Affiliation(s)
- Yujuan Li
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.L.); (M.Q.); (X.W.); (G.Z.); (Z.Z.)
| | - Mengxin Que
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.L.); (M.Q.); (X.W.); (G.Z.); (Z.Z.)
| | - Xuan Wang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.L.); (M.Q.); (X.W.); (G.Z.); (Z.Z.)
| | - Gaofeng Zhan
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.L.); (M.Q.); (X.W.); (G.Z.); (Z.Z.)
| | - Zhiqiang Zhou
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.L.); (M.Q.); (X.W.); (G.Z.); (Z.Z.)
| | - Xiaoxiao Luo
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Shiyong Li
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China; (Y.L.); (M.Q.); (X.W.); (G.Z.); (Z.Z.)
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Sun S, Wang H. Clocking Epilepsies: A Chronomodulated Strategy-Based Therapy for Rhythmic Seizures. Int J Mol Sci 2023; 24:ijms24044223. [PMID: 36835631 PMCID: PMC9962262 DOI: 10.3390/ijms24044223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Epilepsy is a neurological disorder characterized by hypersynchronous recurrent neuronal activities and seizures, as well as loss of muscular control and sometimes awareness. Clinically, seizures have been reported to display daily variations. Conversely, circadian misalignment and circadian clock gene variants contribute to epileptic pathogenesis. Elucidation of the genetic bases of epilepsy is of great importance because the genetic variability of the patients affects the efficacies of antiepileptic drugs (AEDs). For this narrative review, we compiled 661 epilepsy-related genes from the PHGKB and OMIM databases and classified them into 3 groups: driver genes, passenger genes, and undetermined genes. We discuss the potential roles of some epilepsy driver genes based on GO and KEGG analyses, the circadian rhythmicity of human and animal epilepsies, and the mutual effects between epilepsy and sleep. We review the advantages and challenges of rodents and zebrafish as animal models for epileptic studies. Finally, we posit chronomodulated strategy-based chronotherapy for rhythmic epilepsies, integrating several lines of investigation for unraveling circadian mechanisms underpinning epileptogenesis, chronopharmacokinetic and chronopharmacodynamic examinations of AEDs, as well as mathematical/computational modeling to help develop time-of-day-specific AED dosing schedules for rhythmic epilepsy patients.
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Affiliation(s)
- Sha Sun
- Center for Circadian Clocks, Soochow University, Suzhou 215123, China
- School of Biology and Basic Medical Sciences, Suzhou Medical College, Soochow University, Suzhou 215123, China
| | - Han Wang
- Center for Circadian Clocks, Soochow University, Suzhou 215123, China
- School of Biology and Basic Medical Sciences, Suzhou Medical College, Soochow University, Suzhou 215123, China
- Correspondence: or ; Tel.: +86-186-0512-8971
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Alenizi AA, Eskandrani AM, Asiri SA, Ba Maqdom FA, Al Hameed MH, Al Harbi RA, Aldraihem MO, Aldosari MM. Sleep quality, daytime sleepiness, and insomnia in patient with epilepsy: A single center experience from Saudi Arabia. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2023; 28:19-26. [PMID: 36617446 PMCID: PMC9987628 DOI: 10.17712/nsj.2023.1.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/05/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To measure the burden of insomnia and daytime sleepiness (DTS) and their effects on sleep quality, and the risk factors of poor quality of sleep. METHODS We conducted a cross-sectional study of 218 epilepsy patients. We administered well-validated and previously translated questionnaires to assess sleep quality, insomnia, and DTS using the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale, respectively. RESULTS Approximately 75% of participants reported poor sleep quality. Moreover, 42.2% did not have insomnia, while 37.6%, 17.9%, and 2.3% had subthreshold insomnia and clinical insomnia of moderate and severe severity, respectively. Roughly 64.2% of participants had normal sleep, 17.8% had an average amount of DTS, and 16.9% and 0.9% may and should seek medical attention, respectively. Compared to normal sleepers, patients with clinical insomnia were 5.45 times likely to experience poor sleep quality, whereas patients with an average amount of DTS and who were recommended to seek medical attention were 6.84 and 44.15 times likely to experience poor sleep quality, respectively. Patients who had seizures every month were 2.51 times likely to experience poor quality sleep, compared to patients who had seizures annually. CONCLUSION We found a higher prevalence of poor quality of sleep, insomnia, and excessive DTS in our sample of Saudi epilepsy patients.
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Affiliation(s)
- Asmaa A Alenizi
- From Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Alaa M Eskandrani
- From Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Safiyyah A Asiri
- From Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Fawaiyzah A Ba Maqdom
- From Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Majed H Al Hameed
- From Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Rayan A Al Harbi
- From Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Moneera O Aldraihem
- From Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mubarak M Aldosari
- From Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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10
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Gabryelska A, Turkiewicz S, Ditmer M, Karuga FF, Strzelecki D, Białasiewicz P, Sochal M. BDNF and proBDNF Serum Protein Levels in Obstructive Sleep Apnea Patients and Their Involvement in Insomnia and Depression Symptoms. J Clin Med 2022; 11:jcm11237135. [PMID: 36498709 PMCID: PMC9738137 DOI: 10.3390/jcm11237135] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Obstructive sleep apnea (OSA) is a disorder that, apart from somatic sequelae, increases the risk of developing psychiatric conditions. Brain-derived neurotrophic factor (BDNF) signaling pathway is involved in the pathophysiology of depression and insomnia. Therefore, the study aimed to investigate differences in concentrations of BDNF and proBDNF in patients with OSA and healthy individuals, to evaluate diurnal changes of these proteins, and to assess the correlations with psychiatric symptoms. Methods: Sixty individuals following polysomnography (PSG) were divided into two groups based on the apnea-hypopnea index (AHI): OSA patients (AHI ≥ 30; n = 30) and control group (AHI < 5; n = 30). Participants filled out questionnaires: Beck Depression Inventory (BDI), Athens Insomnia Scale (AIS), and Pittsburgh Sleep Quality Index (PSQI). Peripheral blood was collected before and after PSG. Protein concentrations were measured using ELISA. OSA group was divided into subgroups: AIS (−)/AIS (+) (AIS > 5), PSQI (−)/PSQI (+) (PSQI > 5), and BDI (−)/BDI (+) (BDI > 19). Results: No differences in BDNF and proBDNF protein levels were observed between OSA and the control groups. However, BDNF and proBDNF evening protein concentrations were higher in the AIS (+) and PSQI (+) groups (p < 0.001 for all). The BDI (+) group was characterized by lower morning levels of both proteins (p = 0.047 and p = 0.003, respectively). Conclusions: BDNF signaling pathway might be involved in the pathophysiology of depression and insomnia in patients with OSA. BDNF and proBDNF protein levels might be useful in defining OSA phenotypes.
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Affiliation(s)
- Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-419 Lodz, Poland
- Correspondence: (A.G.); (M.S.)
| | - Szymon Turkiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-419 Lodz, Poland
| | - Marta Ditmer
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-419 Lodz, Poland
| | - Filip Franciszek Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-419 Lodz, Poland
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 90-419 Lodz, Poland
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-419 Lodz, Poland
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-419 Lodz, Poland
- Correspondence: (A.G.); (M.S.)
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11
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Sahu M, Tripathi R, Jha NK, Jha SK, Ambasta RK, Kumar P. Cross talk mechanism of disturbed sleep patterns in neurological and psychological disorders. Neurosci Biobehav Rev 2022; 140:104767. [PMID: 35811007 DOI: 10.1016/j.neubiorev.2022.104767] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022]
Abstract
The incidence and prevalence of sleep disorders continue to increase in the elderly populace, particularly those suffering from neurodegenerative and neuropsychiatric disorders. This not only affects the quality of life but also accelerates the progression of the disease. There are many reasons behind sleep disturbances in such patients, for instance, medication use, nocturia, obesity, environmental factors, nocturnal motor disturbances and depressive symptoms. This review focuses on the mechanism and effects of sleep dysfunction in neurodegenerative and neuropsychiatric disorders. Wherein we discuss disturbed circadian rhythm, signaling cascade and regulation of genes during sleep deprivation. Moreover, we explain the perturbation in brainwaves during disturbed sleep and the ocular perspective of neurodegenerative and neuropsychiatric manifestations in sleep disorders. Further, as the pharmacological approach is often futile and carries side effects, therefore, the non-pharmacological approach opens newer possibilities to treat these disorders and widens the landscape of treatment options for patients.
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Affiliation(s)
- Mehar Sahu
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India
| | - Rahul Tripathi
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET) Sharda University, UP, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET) Sharda University, UP, India.
| | - Rashmi K Ambasta
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India
| | - Pravir Kumar
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India.
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12
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Xiao Y, Zhou J, Xiong W, Lu L, Zhou D. Gender differences in prevalence and risk factors of sleep disturbances in patients with epilepsy. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-021-00070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sleep disturbances are frequently observed in patients with epilepsy (PWE), with adversely effects on life quality and seizure control. The study aimed to assess the gender differences in incidence and factors of sleep disturbances in PWE.
Methods
PWE confirmed the diagnosis of epilepsy were consecutively enrolled in this cross-sectional study, with detailed information recorded. A group of healthy participants were recruited as the control. Sleep and mood disorders were evaluated with the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).
Results
One hundred and thirty-three patients (age: 30.2 ± 10.6 years, men: 51%) and 150 healthy subjects were recruited in this study. Compared with healthy controls, PWE had higher mean scores of the ISI and BDI (p < 0.001 and p = 0.01). There were no significant gender differences in the prevalence and scores of sleep disturbances in PWE. In the overall PWE, nocturnal seizures and focal epilepsy were respectively related to insomnia and poor sleep quality (OR = 3.35, p = 0.024; OR = 3.08, p = 0.013), and mood disorders were also important factors in sleep disturbances (p < 0.05). In the analysis by gender, depression, anxiety, nocturnal seizures and focal epilepsy were associated with insomnia and poor sleep quality in men. For women, however, depression mood was the only factor of sleep disturbances.
Conclusions
Though no gender difference was observed in the incidence of sleep disturbances, factors contributing to insomnia and sleep quality were different by gender. The factors and gender differences of sleep disturbances should be taken into account in the clinical treatment.
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Öz B, Şahin AK, Türay S, Sungur MA. Evaluation of sleep habits, sleep chronotype, and quality of life in children with drug-resistant epilepsy in Turkey. Epilepsy Behav 2022; 130:108675. [PMID: 35395515 DOI: 10.1016/j.yebeh.2022.108675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Drug-resistant epilepsy (DRE) is a condition that affects sleep habits and the quality of life of children unfavorably. The aim of our study was to evaluate the relationship of sleep habits and sleep chronotype with the quality of life and behavioral problems in children with DRE. MATERIALS AND METHODS In our study, 2-11-year-old children, who were either healthy or diagnosed with DRE, were evaluated. A sociodemographic data form was filled out to evaluate the general characteristics of children. The Children's Sleep Habits Questionnaire (CSHQ) and the Children's Chronotype Questionnaire (CCTQ) for sleep habits, the Pediatric Quality of Life Inventory (PedsQL) for the quality of life, and the Aberrant Behavior Checklist (ABC) for behavioral problems were filled out through face-to-face interviews with parents. RESULTS Thirty children with DRE and 31 healthy children were included in our study. Statistically significant differences were found in children with DRE compared to the control group in terms of the total and the subscale scores of CSHQ, including sleep onset delay, sleep duration, sleep anxiety, parasomnias, and sleep-disordered breathing (p < 0.001). There were no significant differences between the groups in terms of CCTQ total scores and sleep patterns (p > 0.05). Significant differences were found in PedsQL total and subscale scores, and ABC scores in children with DRE compared to the control group (p < 0.001). Children's Sleep Habits Questionnaire, PedsQL, and ABC scores were significantly correlated with each other in children with DRE. CONCLUSIONS Our results have shown that sleep habits and the quality of life are poor in children with DRE. Our study has shown that sleep disturbances, quality of life, and behavioral problems are strongly associated with each other in DRE. The recognition and appropriate treatment of sleep disturbances are important for improving the quality of life in children with DRE.
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Affiliation(s)
- Büşra Öz
- Department of Child and Adolescent Psychiatry, Duzce University Medical Faculty, Düzce, Turkey.
| | - Ayşenur Kübra Şahin
- Department of Child and Adolescent Psychiatry, Duzce University Medical Faculty, Düzce, Turkey
| | - Sevim Türay
- Department of Pediatric Neurology, Duzce University Medical Faculty, 81820 Duzce, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics and Medical Informatics, Duzce University Medical Faculty, Düzce, Turkey
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Tanveer M, Ahmed A, Iqbal M, Aslam F, Saqlain M, Ur Rehman I, Khurshid Hashmi F. Excessive Daytime Sleepiness and Sleep Quality and their Impact on Health-Related Quality of Life in People with Epilepsy: A study from Pakistan. Epilepsy Behav 2022; 128:108565. [PMID: 35104734 DOI: 10.1016/j.yebeh.2022.108565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epilepsy is one of the most common but manageable neurological disorder. The relation between epilepsy, sleep, and health-related quality of life (HRQoL) in culturally distinct environment of Pakistan remains unclear. The purpose of this study was to determine prevalence and predictors of excessive daytime sleepiness (EDS), poor sleep quality (SQ), and to analyze their association with HRQoL in people with epilepsy (PWE). METHODS A study was conducted among PWE attending two tertiary care hospitals of Islamabad and Rawalpindi, Pakistan. The EDS, SQ, and HRQoL were evaluated by Urdu versions of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31). RESULTS The study included 200 PWE and 51 healthy controls with mean (SD) ages of 33.1 ± 13.9, 32.9 ± 10.9, and a disease duration of 5.01 ± 6.17, respectively. The majority of the respondents (n = 130, 65%) had poor seizure control, and most of these (n = 88, 68%) were on combination antiepileptic drug (AED) therapy. In comparison to controls, a higher number of PWE had EDS by ESS (score ≥ 11, 10% vs. 40%, p-value 0.00), and poor SQ by PSQI (score > 5, 9% vs. 71%, p-value 0.00). A multiple logistic regression analysis reveals that the factors significantly associated with EDS were: female gender; increasing age; seizure control; duration of epilepsy; and combination AED therapy. A second multiple binary logistic regression analysis suggests that factors significantly associated with poor SQ were: increasing age; female gender; poor seizure control; and combination therapy. The Hierarchical multivariate analysis suggests that poor seizure control, EDS, and poor SQ were significant predictors of low HRQoL. CONCLUSION The findings suggest high prevalence of EDS and poor SQ in PWE in Pakistan. A significant negative association exists between sleep complaints and HRQoL. During routine clinical consultations, awareness about sleep hygiene practices must be provided to enhance HRQoL.
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Affiliation(s)
- Maria Tanveer
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, Pakistan.
| | - Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia
| | - Mansoor Iqbal
- Neurology Department, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Faiza Aslam
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan
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Mivalt F, Kremen V, Sladky V, Balzekas I, Nejedly P, Gregg N, Lundstrom B, Lepkova K, Pridalova T, Brinkmann BH, Jurak P, Van Gompel JJ, Miller K, Denison T, Louis ES, Worrell GA. Electrical brain stimulation and continuous behavioral state tracking in ambulatory humans. J Neural Eng 2022; 19:10.1088/1741-2552/ac4bfd. [PMID: 35038687 PMCID: PMC9070680 DOI: 10.1088/1741-2552/ac4bfd] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/17/2022] [Indexed: 11/11/2022]
Abstract
Objective.Electrical deep brain stimulation (DBS) is an established treatment for patients with drug-resistant epilepsy. Sleep disorders are common in people with epilepsy, and DBS may actually further disturb normal sleep patterns and sleep quality. Novel implantable devices capable of DBS and streaming of continuous intracranial electroencephalography (iEEG) signals enable detailed assessments of therapy efficacy and tracking of sleep related comorbidities. Here, we investigate the feasibility of automated sleep classification using continuous iEEG data recorded from Papez's circuit in four patients with drug resistant mesial temporal lobe epilepsy using an investigational implantable sensing and stimulation device with electrodes implanted in bilateral hippocampus (HPC) and anterior nucleus of thalamus (ANT).Approach.The iEEG recorded from HPC is used to classify sleep during concurrent DBS targeting ANT. Simultaneous polysomnography (PSG) and sensing from HPC were used to train, validate and test an automated classifier for a range of ANT DBS frequencies: no stimulation, 2 Hz, 7 Hz, and high frequency (>100 Hz).Main results.We show that it is possible to build a patient specific automated sleep staging classifier using power in band features extracted from one HPC iEEG sensing channel. The patient specific classifiers performed well under all thalamic DBS frequencies with an average F1-score 0.894, and provided viable classification into awake and major sleep categories, rapid eye movement (REM) and non-REM. We retrospectively analyzed classification performance with gold-standard PSG annotations, and then prospectively deployed the classifier on chronic continuous iEEG data spanning multiple months to characterize sleep patterns in ambulatory patients living in their home environment.Significance.The ability to continuously track behavioral state and fully characterize sleep should prove useful for optimizing DBS for epilepsy and associated sleep, cognitive and mood comorbidities.
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Affiliation(s)
- Filip Mivalt
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czechia
| | - Vaclav Kremen
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Vladimir Sladky
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
| | - Irena Balzekas
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic School of Medicine and the Mayo Clinic Medical Scientist Training Program, Rochester, MN, USA
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | - Petr Nejedly
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czech Republic
| | - Nick Gregg
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Brian Lundstrom
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kamila Lepkova
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Tereza Pridalova
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czechia
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
| | - Benjamin H. Brinkmann
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Pavel Jurak
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czech Republic
| | | | - Kai Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Timothy Denison
- Department of Biomedical Engineering, Oxford University, Oxford, UK
| | - Erik St Louis
- Center for Sleep Medicine, Departments of Neurology and Medicine, Divisions of Sleep Neurology & Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Gregory A. Worrell
- Bioelectronics Neurophysiology and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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16
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Patient Health Questionnaire (PHQ-9): A depression screening tool for people with epilepsy in Vietnam. Epilepsy Behav 2021; 125:108446. [PMID: 34839244 DOI: 10.1016/j.yebeh.2021.108446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is a common mental disorder in people with epilepsy. Depression has a negative impact on medical and surgical treatment of epilepsy thus affecting the quality of life. Despite its high prevalence, depression has been under-recognized and treated improperly. It may also lead to missed work, increased healthcare system utilization, and higher direct medical costs. OBJECTIVES This study aimed to evaluate the accuracy of the Vietnamese Patient Health Questionnaire (PHQ-9) as a screening tool for depression in people with epilepsy. METHODS This cross-sectional study was conducted prospectively at epilepsy clinic at Nguyen Tri Phuong hospital, Ho Chi Minh City, Viet Nam from December 2019 to March 2020. A total of 91 adult people with epilepsy were recruited. After completing the Vietnamese PHQ-9 questionnaires, each participant was interviewed in a structured clinical interview for DSM-5 (SCID-5) to establish a diagnosis of major depressive disorder. The diagnostic accuracy of the PHQ-9 was assessed using diagnostic efficiency statistics compared with the gold standard structured interview. RESULTS The prevalence of major depression in this sample was 25.3%. The areas under receiver operating characteristic (ROC) curve index of PHQ-9 had an estimated value of 0.91. The PHQ-9 at a cutoff point of 8 had the great overall balance of sensitivity (87.0%) and specificity (82.4%). At the cutoff point of 10, PHQ-9 had a higher specificity of 94.1%, but a lower sensitivity of 78.0%. CONCLUSIONS The Vietnamese version PHQ-9 is an efficient and valid screening tool for depression in people with epilepsy in clinic settings.
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17
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Bonilla-Jaime H, Zeleke H, Rojas A, Espinosa-Garcia C. Sleep Disruption Worsens Seizures: Neuroinflammation as a Potential Mechanistic Link. Int J Mol Sci 2021; 22:12531. [PMID: 34830412 PMCID: PMC8617844 DOI: 10.3390/ijms222212531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
Sleep disturbances, such as insomnia, obstructive sleep apnea, and daytime sleepiness, are common in people diagnosed with epilepsy. These disturbances can be attributed to nocturnal seizures, psychosocial factors, and/or the use of anti-epileptic drugs with sleep-modifying side effects. Epilepsy patients with poor sleep quality have intensified seizure frequency and disease progression compared to their well-rested counterparts. A better understanding of the complex relationship between sleep and epilepsy is needed, since approximately 20% of seizures and more than 90% of sudden unexpected deaths in epilepsy occur during sleep. Emerging studies suggest that neuroinflammation, (e.g., the CNS immune response characterized by the change in expression of inflammatory mediators and glial activation) may be a potential link between sleep deprivation and seizures. Here, we review the mechanisms by which sleep deprivation induces neuroinflammation and propose that neuroinflammation synergizes with seizure activity to worsen neurodegeneration in the epileptic brain. Additionally, we highlight the relevance of sleep interventions, often overlooked by physicians, to manage seizures, prevent epilepsy-related mortality, and improve quality of life.
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Affiliation(s)
- Herlinda Bonilla-Jaime
- Departamento de Biología de la Reproducción, Área de Biología Conductual y Reproductiva, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de Mexico CP 09340, Mexico;
| | - Helena Zeleke
- Neuroscience and Behavioral Biology Program, College of Arts and Sciences, Emory University, Atlanta, GA 30322, USA;
| | - Asheebo Rojas
- Department of Pharmacology and Chemical Biology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Claudia Espinosa-Garcia
- Department of Pharmacology and Chemical Biology, School of Medicine, Emory University, Atlanta, GA 30322, USA
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Dang B, Dicarlo J, Lukashov S, Hinds N, Reinen J, Wen B, Hao T, Bilal E, Rogers J. Development of a Smart Sleep Mask with Multiple Sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7058-7062. [PMID: 34892728 DOI: 10.1109/embc46164.2021.9630086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this work, we demonstrated a Smart Sleep Mask with several integrated physiological sensors such as 3-axis accelerometers, respiratory acoustic sensor, and an eye movement sensor. In particular, using infrared optical sensors, eye movement frequency, direction, and amplitude can be directly monitored and recorded during sleep sessions. We also developed a mobile app for data storage, signal processing and data analytics. Aggregation of these signals from a single wearable device may offer ease of use and more insights for sleep monitoring and REM sleep assessment. The user-friendly mask design can enable at-home use applications in the studies of digital biomarkers for sleep disorder related neurodegenerative diseases. Examples include REM Sleep Behavior Disorder, epilepsy event detection and stroke induced facial and eye movement disorder.Clinical Relevance-Many diseases such as stroke, epilepsy, and Parkinson's disease can cause significant abnormal events during sleep or are associated with sleep disorder. A smart sleep mask may serve as a simple platform to provide various physiological signals and generate clinical meaningful insights by revealing the neurological activities during various sleep stages.
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19
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Yang L, Wang Y, Chen X, Zhang C, Chen J, Cheng H, Zhang L. Risk Factors for Epilepsy: A National Cross-Sectional Study from National Health and Nutrition Examination Survey 2013 to 2018. Int J Gen Med 2021; 14:4405-4411. [PMID: 34408479 PMCID: PMC8364967 DOI: 10.2147/ijgm.s323209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study is to investigate the risk factors of epilepsy based on the National Health and Nutrition Examination Survey (NHANES). Methods The data in this study was obtained from the NHANES database between 2013 and 2018. It included 14,290 participants aged between 20 and 80. We defined people with epilepsy (PWE) when they self-reported took at least one treatment medication for seizures or epilepsy. Analysis of risk factors for epilepsy mainly includes Student’s t-test, chi-square test, univariate and multivariate logistic regression analysis. Results People aged 40–59 shared 1.8 times the risk of epilepsy than those who aged 20–39, P=0.034. People who never married had a 2.8-fold higher risk of epilepsy than those who married/living with partner, P<0.001. The risk of epilepsy in subjects with very good/good general health was 0.4 times than that of subjects with fair/poor general health, P<0.001. Moreover, subjects without sleep disorders had a 0.4-fold higher risk of epilepsy than those who had sleep disorders, P=0.042. Conclusion People who are older, unmarried, and have sleep disorders are at higher risk of epilepsy. In addition, good/good general health condition is associated with a lower risk of epilepsy.
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Affiliation(s)
- Lixiang Yang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Yue Wang
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, People's Republic of China
| | - Xun Chen
- Department of cognitive neurolinguistics, School of Foregin Language, East China University of Science and Techonology, Shanghai, 200237, People's Republic of China
| | - Can Zhang
- Department of Neurosurgery, The Second People's Hospital of HeFei, Hefei, People's Republic of China
| | - Junhui Chen
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, People's Republic of China
| | - Huilin Cheng
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Lihua Zhang
- Department of Pathology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, People's Republic of China
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20
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Alqahtani SS, Banji D, Banji OJF. A survey assessing sleep efficiency among Saudis during COVID-19 home confinement using the Pittsburgh sleep quality index: A call for health education. Saudi Pharm J 2021; 29:692-698. [PMID: 34400863 PMCID: PMC8347667 DOI: 10.1016/j.jsps.2021.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022] Open
Abstract
The COVID-19 pandemic has introduced uncertainties that have disrupted regular routines. Sleep may be adversely affected by stressful circumstances that jeopardize general health. Hence, the impact of home confinement on the sleep efficiency of the general population was assessed. An online survey was conducted by using the Pittsburgh sleep quality index (PSQI) to assess sleep duration, sleep efficiency, latency to fall asleep, and global PSQI score. Questions pertaining to demography, home confinement, and anxiety were included. Data was collected from the residents of the Southwestern region from April 15, 2020 to May 15, 2020. Data were analyzed through bivariate, multivariate logistic regression, and independent t tests. A total of 593 subjects responded to the survey. Males (OR 1.92 [1.3–2.7], p < 0.001), and subjects aged ≥51 years (OR 2.49 [1.3–4.4], p = 0.002) were more likely to be poor sleepers (<6 h). In hypertensive subjects, inadequate sleep was twice as high (OR 2.2 [1.1–4.4], p < 0.05) than other comorbidities. Males were less likely to have sleep latency (OR 0.58 [0.40–0.86], p = 0.005) but smoking increased the latency of falling asleep (OR 2.41 [1.47–4.0], p < 0.001). Sleep duration was significantly influenced by home confinement (p = 0.002), whereas sleep duration (p = 0.001), latency (p = 0.018), sleep efficiency (p = 0.005), and global PSQI scores (p = 0.005) were significantly affected by anxiety. In the southwestern region, we found sleep influenced by anxiety about COVID-19. Community pharmacists are the most accessible health care professionals and could play a pivotal role in educating the lay public on the importance of sleep hygiene through posters displayed in pharmacies and with the help of public education material.
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Affiliation(s)
- Saad S Alqahtani
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan, Saudi Arabia
| | - David Banji
- Pharmacy Practice Research Unit, Department of Pharmacology, College of Pharmacy, Jazan University, Saudi Arabia
| | - Otilia J F Banji
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan, Saudi Arabia
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21
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Purnell B, Murugan M, Jani R, Boison D. The Good, the Bad, and the Deadly: Adenosinergic Mechanisms Underlying Sudden Unexpected Death in Epilepsy. Front Neurosci 2021; 15:708304. [PMID: 34321997 PMCID: PMC8311182 DOI: 10.3389/fnins.2021.708304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/17/2021] [Indexed: 01/07/2023] Open
Abstract
Adenosine is an inhibitory modulator of neuronal excitability. Neuronal activity results in increased adenosine release, thereby constraining excessive excitation. The exceptionally high neuronal activity of a seizure results in a surge in extracellular adenosine to concentrations many-fold higher than would be observed under normal conditions. In this review, we discuss the multifarious effects of adenosine signaling in the context of epilepsy, with emphasis on sudden unexpected death in epilepsy (SUDEP). We describe and categorize the beneficial, detrimental, and potentially deadly aspects of adenosine signaling. The good or beneficial characteristics of adenosine signaling in the context of seizures include: (1) its direct effect on seizure termination and the prevention of status epilepticus; (2) the vasodilatory effect of adenosine, potentially counteracting postictal vasoconstriction; (3) its neuroprotective effects under hypoxic conditions; and (4) its disease modifying antiepileptogenic effect. The bad or detrimental effects of adenosine signaling include: (1) its capacity to suppress breathing and contribute to peri-ictal respiratory dysfunction; (2) its contribution to postictal generalized EEG suppression (PGES); (3) the prolonged increase in extracellular adenosine following spreading depolarization waves may contribute to postictal neuronal dysfunction; (4) the excitatory effects of A2A receptor activation is thought to exacerbate seizures in some instances; and (5) its potential contributions to sleep alterations in epilepsy. Finally, the adverse effects of adenosine signaling may potentiate a deadly outcome in the form of SUDEP by suppressing breathing and arousal in the postictal period. Evidence from animal models suggests that excessive postictal adenosine signaling contributes to the pathophysiology of SUDEP. The goal of this review is to discuss the beneficial, harmful, and potentially deadly roles that adenosine plays in the context of epilepsy and to identify crucial gaps in knowledge where further investigation is necessary. By better understanding adenosine dynamics, we may gain insights into the treatment of epilepsy and the prevention of SUDEP.
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Affiliation(s)
- Benton Purnell
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, United States
| | - Madhuvika Murugan
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, United States
| | - Raja Jani
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, United States
| | - Detlev Boison
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, United States
- Rutgers Neurosurgery H.O.P.E. Center, Department of Neurosurgery, Rutgers University, New Brunswick, NJ, United States
- Brain Health Institute, Rutgers University, Piscataway, NJ, United States
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Lallana S, Fonseca E, Restrepo JL, Quintana M, Seijo‐Raposo I, Abraira L, Santamarina E, Álvarez‐Sabín J, Toledo M. Medium-term effects of COVID-19 pandemic on epilepsy: A follow-up study. Acta Neurol Scand 2021; 144:99-108. [PMID: 33905117 PMCID: PMC8207097 DOI: 10.1111/ane.13439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/26/2021] [Accepted: 04/11/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To analyze the medium-term impact of the COVID-19 pandemic on epilepsy patients, focusing on psychological effects and seizure control. METHODS Prospective follow-up study to evaluate the medium-term effects of the COVID-19 pandemic on a cohort of epilepsy patients from a tertiary hospital previously surveyed during the first peak of the pandemic. Between July 1, 2020, and August 30, 2020, the patients answered an online 19-item questionnaire, HADS, and PSIQ scales. Short- and medium-term effects of the pandemic confinement and the perception of telemedicine were compared. RESULTS 153 patients completed the questionnaire, mean ± SD age, 47.6 ± 19.3 years; 49.7% women. Depression was reported by 43 patients, significantly more prevalent than in the short-term analysis (29.2% vs. 19.7%; p = .038). Anxiety (38.1% vs. 36.1%; p = 0.749) and insomnia (28.9% vs. 30.9%, p = .761) remained highly prevalent. Seventeen patients reported an increase in seizure frequency (11.1% vs. 9.1%, p = .515). The three factors independently associated with an increase in seizure frequency in the medium term were drug-resistant epilepsy (odds ratio [OR] = 8.2, 95% CI 2.06-32.52), depression (OR = 6.46, 95% CI 1.80-23.11), and a reduction in income (OR = 5.47, 95% CI 1.51-19.88). A higher proportion of patients found telemedicine unsatisfactory (11.2% vs. 2.4%), and a lower percentage (44.8% vs. 56.8%) found it very satisfactory (p = .005). CONCLUSIONS Depression rates increased significantly after the first wave. Depression, drug-resistant epilepsy, and a reduction in family income were independent risk factors for an increased seizure frequency. Perception of telemedicine worsened, indicating need for re-adaptation.
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Affiliation(s)
- Sofía Lallana
- Neurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
| | - Elena Fonseca
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Manuel Quintana
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Iván Seijo‐Raposo
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Laura Abraira
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Estevo Santamarina
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Manuel Toledo
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
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Sleep quality according to the Pittsburgh Sleep Quality Index in over 7000 pregnant women in Poland. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-021-00324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThe aim was to assess sleep quality in pregnant women, characterize sleep patterns in each trimester and to establish independent risk factors of poor sleep quality during gestation. A cross-sectional survey was conducted. The questionnaire included questions regarding sociodemographic data, information on the current pregnancy, sleep patterns and Pittsburgh Sleep Quality Index. 7202 respondents fulfilled the survey completely and only those were included. A total of 95.1% of the respondents in the first trimester, 93% in the second trimester and 94.8% in the third trimester had poor sleep quality. Significantly more women with poor sleep quality assessed their socioeconomic status as bad or sufficient (15.7 vs 8.8%; p < 0.001), stress level as higher (mean 4.7 points vs 3.9 points; p < 0.001), had lower relationship rating (mean 8.8 points vs 9.3 points; p < 0.001) or suffered from depression and anxiety disorders. Logistic regression revealed pregnancy ailments to be the strongest independent risk factors of poor sleep quality during gestation. Sleep disorders are common among pregnant women in Poland and increase significantly as the pregnancy progresses. Developing and introducing a simple and easily available screening tool to assess sleep quality in common practice might improve the quality of the health care of pregnant women.
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24
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Yeh WC, Lu SR, Wu MN, Lee KW, Chien CF, Fong YO, Li KY, Lai YL, Lin CJ, Li YS, Su CY, Wang YC, Lin YH, Chen TY, Tseng PT, Hsu CY. The impact of antiseizure medications on polysomnographic parameters: a systematic review and meta-analysis. Sleep Med 2021; 81:319-326. [PMID: 33756282 DOI: 10.1016/j.sleep.2021.02.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Oral antiseizure medications (ASMs) are first-line treatments for patients with epilepsy. However, ASMs may alter sleep architecture, adversely affecting patient outcomes. The meta-analysis aimed to elucidate the effect of ASMs on sleep architecture. METHODS PubMed, Embase, and Cochrane Central database (up to Febrary 2021) were searched for randomized control trials (RCT) with effects of ASMs on polysomnography parameters. A meta-analysis using a random-effects model was performed. We did not set limitation to the participants with underlying diagnosis of epilepsy. RESULTS Eighteen randomized-controlled trials fulfilled the eligibility criteria. The effects of five main groups of ASMs (sodium channel blockers, calcium channel blockers, GABA enhancers, synaptic vesicle glycoprotein 2A [SV2A] ligand, and broad-spetrum ASMs) on slow-wave sleep (SWS), rapid eye movement (REM) sleep, and sleep efficiency (SE) were analyzed. Compared with placebo, calcium channel blockers and GABA enhancers significantly increased SWS. GABA enhancers also decreased REM sleep percentage, whereas calcium channel blockers significantly increased SE. Sodium channel blockers, SV2A ligand and broad-spectrum ASMs did not affect SWS, REM sleep, or SE. The subgroup analysis revealed that gabapentin, pregabalin, and tiagabine increased the percentage of SWS. Tiagabine also decreased REM sleep, whereas pregabalin increased SE. Finally, levetiracetam did not affect SWS, REM sleep, and SE. CONCLUSIONS This meta-analysis indicated that ASMs can have a statistically significant effect on sleep parameters; the effect differs between ASMs.
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Affiliation(s)
- Wei-Chih Yeh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shiang-Ru Lu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuo-Wei Lee
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Ching-Fang Chien
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-On Fong
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Ying Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - You-Lin Lai
- Department of Neurology, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Chiu-Jung Lin
- Department of Neurology, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Ying-Sheng Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Yu Su
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chun Wang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Han Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Yaranagula SD, Asranna A, Nagappa M, Nayak CS, Pratyusha PV, Mundlamuri RC, Raghavendra K, Arivazhagan A, Malla BR, Bharath RD, Saini JS, Mahadevan A, Rajeswaran J, Shreedhara AS, Thennarasu K, Taly AB, Sinha S. Sleep profile and Polysomnography in patients with drug-resistant temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) and the effect of epilepsy surgery on sleep-a prospective cohort study. Sleep Med 2021; 80:176-183. [PMID: 33601230 DOI: 10.1016/j.sleep.2020.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We analyzed changes in sleep profile and architecture of patients with drug-resistant TLE-HS using three validated sleep questionnaires- Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), NIMHANS Comprehensive Sleep Disorders, and polysomnography (PSG). We studied the effect of epilepsy surgery in a subset of patients. METHODS In this prospective observational cohort study, sleep profile of 40 patients with drug-resistant TLE-HS was compared to 40 healthy matched controls. Sleep architecture of 22 patients was studied by overnight PSG and compared to 22 matched controls. Sleep profile was reassessed in 20 patients after a minimum period of three months after epilepsy surgery. RESULTS The mean PSQI was higher among patients compared to controls(P=0.0004) while mean ESS showed no difference. NCSDQ showed fewer patients feeling refreshed after a night's sleep compared to controls (p=0.006). PSG revealed a higher time in bed (p=0.0001), longer total sleep time (p=0.006) and more time spent in NREM stage 1 (p=0.001) and stage 2 (p=0.005) while spending less time in stage 3 (p=0.039) among TLE patients. Sleep efficiency was worse in patients on ≥3 ASMs compared to those on 2 ASMs (p-0.044). There was no change in mean ESS (p=0.48) or PSQI (p=0.105) after surgery. CONCLUSIONS Patients with drug-resistant TLE-HS have an altered sleep profile and architecture. Patients on ≥3 ASMs have a lower sleep efficiency. Reassessment at short intervals after epilepsy surgery did not reveal significant changes in sleep profile.
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Affiliation(s)
- Sai Deepak Yaranagula
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ajay Asranna
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Madhu Nagappa
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Chetan S Nayak
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - P V Pratyusha
- Departments of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ravindranadh C Mundlamuri
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - K Raghavendra
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - A Arivazhagan
- Departments of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Bhaskara Rao Malla
- Departments of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Rose Dawn Bharath
- Departments of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Jitender S Saini
- Departments of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Anita Mahadevan
- Departments of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Jamuna Rajeswaran
- Departments of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - A S Shreedhara
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - K Thennarasu
- Departments of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Arun B Taly
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sanjib Sinha
- Departments of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
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Yeh WC, Lai CL, Wu MN, Lin HC, Lee KW, Li YS, Hsu CY. Rapid eye movement sleep disturbance in patients with refractory epilepsy: A polysomnographic study. Sleep Med 2021; 81:101-108. [PMID: 33647761 DOI: 10.1016/j.sleep.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE/BACKGROUND Patients with epilepsy have disrupted sleep architecture and a higher prevalence of sleep disturbance. Moreover, obstructive sleep apnea (OSA) is more common among patients with refractory epilepsy. Few studies have compared subjective sleep quality, sleep architecture, and prevalence of OSA between patients with refractory epilepsy and those with medically controlled epilepsy. Therefore, this study aimed to evaluate the differences in sleep quality, sleep architecture, and prevalence of OSA between patients with refractory epilepsy and patients with medically controlled epilepsy. PATIENTS This retrospective case-control study included 38 patients with refractory epilepsy and 96 patients with medically controlled epilepsy. Sleep parameters and indices of sleep-related breathing disorders were recorded by standard in-laboratory polysomnography. The scores from sleep questionnaires on sleep quality and daytime sleepiness were compared between the two groups. RESULTS Patients with refractory epilepsy versus medically controlled epilepsy had statistically significantly decreased rapid eye movement (REM) sleep (13.5 ± 6.1% vs. 16.2 ± 6.1%) and longer REM latency (152.2 ± 84.1 min vs. 117.2 ± 61.9 min). Further, no differences were found in the prevalence of sleep-related breathing disorders, subjective sleep quality, prevalence of daytime sleepiness, and quality of life. Although not statistically significant, patients with refractory epilepsy have a lower rate of OSA compared with those with medically controlled epilepsy (21.1% vs. 30.2%). CONCLUSIONS Patients with refractory epilepsy had more disrupted REM sleep regulation than those with medically controlled epilepsy. Although patients with epilepsy have a higher risk of OSA, in this study patients with refractory epilepsy were not susceptible to OSA.
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Affiliation(s)
- Wei-Chih Yeh
- Department of Neurology, Kaohsiung Medical University Hospital, 100, Tzyou 1st Rd., Kaohsiung City, 80754, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung City, 80708, Taiwan.
| | - Chiou-Lian Lai
- Department of Neurology, Kaohsiung Medical University Hospital, 100, Tzyou 1st Rd., Kaohsiung City, 80754, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung City, 80708, Taiwan.
| | - Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, 100, Tzyou 1st Rd., Kaohsiung City, 80754, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung City, 80708, Taiwan.
| | - Hsun-Chang Lin
- Department of Neurology, Health and Welfare Ministry Pingtung Hospital, No. 270, Ziyou Rd., Pingtung City, Pingtung County, 900, Taiwan.
| | - Kuo-Wei Lee
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, No. 482, Shanming Rd., Siaogang Dist., Kaohsiung City, 812, Taiwan.
| | - Ying-Sheng Li
- Department of Neurology, Kaohsiung Medical University Hospital, 100, Tzyou 1st Rd., Kaohsiung City, 80754, Taiwan.
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, 100, Tzyou 1st Rd., Kaohsiung City, 80754, Taiwan; Department of Neurology, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung City, 80708, Taiwan.
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Safarpour Lima B, Zokaei A, Assarzadegan F, Hesami O, Zareh Shahamati S. Prevalence of sleep disorders in patients with epilepsy: A questionnaire-based cross-sectional study. Epilepsy Behav 2021; 114:107635. [PMID: 33309236 DOI: 10.1016/j.yebeh.2020.107635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sleep disturbance is a frequent finding in patients with epilepsy. As evaluation of sleep disorders and quality of sleep in patients with epilepsy may provide better management of these patients, we aimed to assess the prevalence of common sleep disorders in patients with epilepsy. METHODS Patients with epilepsy referred to an outpatient epilepsy clinic in Tehran during one year were included. Validated Persian questionnaires were used by an interviewer to assess Excessive daytime sleepiness (EDS), Restless leg syndrome (RLS), and insomnia. Also, patients' demographic features and clinical seizure-related characteristics were recorded. RESULTS Seventy patients (35 males) aged between 18 and 75 were enrolled. Among patients, 61.4, 35.7, and 28.6% suffered from insomnia, EDS, and RLS, respectively (mild to severe). When considering seizure characteristics, there was no significant correlation between either seizure frequency or its type and the prevalence of sleep disturbance (although sleep disturbance was more common among patients with higher seizure frequency and patients with generalized seizure). Interestingly, age had a positive correlation with EDS. CONCLUSION This study showed that sleep disturbance is a common finding in patients with epilepsy, which may become severe in some cases. Taking this into consideration, we suggest that routine evaluation of sleep disorders may help physicians to boost patients' sleep quality.
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Affiliation(s)
- Behnam Safarpour Lima
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Zokaei
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Assarzadegan
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Hesami
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Zareh Shahamati
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Eskut N, Tamer P, Delibas DH, Erdogan E. EVALUATION OF A GROUP OF EPILEPSY PATIENTS IN TERMS OF SLEEP QUALITY, FATIGUE AND DEPRESSION. SANAMED 2020. [DOI: 10.24125/sanamed.v15i3.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Sleep Deprivation and Neurological Disorders. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5764017. [PMID: 33381558 PMCID: PMC7755475 DOI: 10.1155/2020/5764017] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
Sleep plays an important role in maintaining neuronal circuitry, signalling and helps maintain overall health and wellbeing. Sleep deprivation (SD) disturbs the circadian physiology and exerts a negative impact on brain and behavioural functions. SD impairs the cellular clearance of misfolded neurotoxin proteins like α-synuclein, amyloid-β, and tau which are involved in major neurodegenerative diseases like Alzheimer's disease and Parkinson's disease. In addition, SD is also shown to affect the glymphatic system, a glial-dependent metabolic waste clearance pathway, causing accumulation of misfolded faulty proteins in synaptic compartments resulting in cognitive decline. Also, SD affects the immunological and redox system resulting in neuroinflammation and oxidative stress. Hence, it is important to understand the molecular and biochemical alterations that are the causative factors leading to these pathophysiological effects on the neuronal system. This review is an attempt in this direction. It provides up-to-date information on the alterations in the key processes, pathways, and proteins that are negatively affected by SD and become reasons for neurological disorders over a prolonged period of time, if left unattended.
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Sleep Quality and Associated Factors among Peoples with Epilepsy Who Have a Follow-Up at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia, 2019: An Institutional Based Cross-Sectional Study. PSYCHIATRY JOURNAL 2020; 2020:1402712. [PMID: 32775399 PMCID: PMC7399778 DOI: 10.1155/2020/1402712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022]
Abstract
Background Sleep is an active cyclic biological phenomenon and necessary for survival. Individuals who suffer from sleep disturbance are less productive, decreased performance, and negative effects on mental health. Despite there are different studies on sleep quality in Ethiopia, no studies have been conducted on magnitude and predictors of sleep quality among people with epilepsy in the study setting. Objective To assess sleep quality and associated factors among people with epilepsy who have a follow-up at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia, 2019. Method An institution-based cross-sectional study was employed from May-June 2019. Systematic random sampling following face to face interview technique was employed. Epi-data version 3.1 and SPSS version 25 statistical packages were used for data entry and analysis, respectively. Frequencies, proportions, means, SDs, and cross-tabulations were used to summarize descriptive statistics of the data and tables, texts, and graphs were used for data presentation. To identify association and significant predictor with the outcome variable, binary logistic regression was fitted. The variable which has statistical significance was identified on the basis of p values ≤ 0.05 and AOR with 95% confident intervals. Results A total of 423 participants have been enrolled to the study with a response rate of 98.1%. The prevalence of poor sleep quality among peoples live with epilepsy was found 65.4% (95% CI: 61.0, 69.9). Being female (AOR = 2.94; (95% CI; 1.79, 4.85)), having stress full life events (AOR = 2.38; (95% CI; 1.43, 3.97)), nonadherent to AED medication (AOR = 1.86; (95% CI; 1.05, 2.78), poly-therapy treatment (AOR = 2.24; (95% CI; 1.05, 2.78)), poor seizer control (AOR = 2.4; (95% CI; 2.21, 12.46)), comorbid medical illness (AOR = 2.6; (95% CI; 1.18, 5.61)), and anxiety (AOR = 2.54; (95% CI; 1.52,4.24)) were factors significantly associated with poor sleep quality. Conclusion This study revealed that more than half of the study participants were found to have poor sleep quality. So, considering the regular assessment of sleep quality and factors associated followed with appropriate intervention is recommended among peoples living with epilepsy.
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Tork MA, Rashed HR, Elnabil L, Salah-Eldin N, Elkhayat N, Abdelhady AA, Abdulghani MO, Abdulghani KO. Sleep pattern in epilepsy patients: a polysomnographic study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-019-0141-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sleep disorders and epilepsy commonly exist and affect each other. Patients with epilepsy often complain of poor sleep and on the other hand, poor sleep makes epilepsy control difficult.
Objectives
We aimed at comparing the sleep disturbances in a group of patients with medically controlled epilepsy versus another group with medically refractory epilepsy, from the electrophysiological standpoint.
Subjects and methods
Sixty epilepsy patients were included; half of them with controlled epilepsy were assigned as group I, and the other half with refractory epilepsy was assigned as group II. All patients had an overnight polysomnogram and sleep EEG done. We excluded any patient with abnormal general or neurological clinical examination.
Results
Patients in group II, had significantly delayed sleep onset latency and REM latency. However, higher arousal index, insomnia, and periodic limb movement index were found to be significantly higher in group I. Respiratory events; as light sleep durations, were observed to be higher in Group II, in addition to apnea-hypopnea index that was significantly higher in this group.
Conclusion
Epilepsy affects sleep architecture and sleep-related events. Patients with refractory epilepsy suffer from more disturbance in sleep patterns. Moreover, antiepileptic drugs can have a diverse effect on sleep architecture and quality in epileptic patients.
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Çilliler AE, Güven B. Sleep quality and related clinical features in patients with epilepsy: A preliminary report. Epilepsy Behav 2020; 102:106661. [PMID: 31766003 DOI: 10.1016/j.yebeh.2019.106661] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The relationship between sleep and epilepsy is complex and involves multiple mechanisms. Patients with epilepsy (PWE) often report fatigue and daytime sleepiness, and are often diagnosed with comorbid sleep disorders that are thought to be a direct corollary of seizures, adverse effects of antiepileptic drugs (AEDs), or a combination of these two factors. The emergence of depressive symptomatology in PWE can also lead to decreases in quality of life. The aim of this study was to investigate the relationship between sleep quality, clinical characteristics, excessive daytime sleepiness (EDS), fatigue, and depression in PWE. METHODS Seventy-five consecutive PWE were included in the study. Demographic data, type and frequency of seizures, treatment regimens, number of seizures in the last 12 months, and relationship between seizures and sleep quality were recorded. Sleep quality, fatigue, daytime sleepiness, and depression symptoms were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and Beck Depression Inventory (BDI), respectively. RESULTS Patients (43 females, 32 males) had a mean age of 31.3 ± 11 years, a mean age of epilepsy onset of 18 ± 11.4 years, and a mean disease duration of 13.2 ± 9.9 years. Thirty-two (42.7%) patients had poor sleep quality, while 44 (58.7%) had fatigue, 18 (24%) had daytime sleepiness, and 56 (74.7%) had depression. The FSS, ESS, and BDI scores of the patients with PSQI ≥5 were significantly higher (p = 0.048, p = 0.018, p < 0.001, respectively). Patients with poor sleep quality had more frequent seizures (p = 0.040). CONCLUSIONS Our study found that poor sleep quality in PWE may be associated with frequency of seizures and symptoms of fatigue, daytime sleepiness, and depression. Determining sleep disorders in PWE is essential as it may be a determinant of the patients' quality of life.
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Affiliation(s)
- Aslı Ece Çilliler
- Dışkapı Yıldırım Beyazıt Training and Research Hospital Neurology Department, Ankara, Turkey.
| | - Bülent Güven
- Dışkapı Yıldırım Beyazıt Training and Research Hospital Neurology Department, Ankara, Turkey
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Alshehri MM, Alenazi AM, Hoover JC, Alothman SA, Phadnis MA, Rucker JL, Befort CA, Miles JM, Kluding PM, Siengsukon CF. Effect of Cognitive Behavioral Therapy for Insomnia on Insomnia Symptoms for Individuals With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14647. [PMID: 31855189 PMCID: PMC6940863 DOI: 10.2196/14647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background Insomnia symptoms are a common form of sleep difficulty among people with type 2 diabetes (T2D) affecting sleep quality and health outcomes. Several interventional approaches have been used to improve sleep outcomes in people with T2D. Nonpharmacological approaches, such as cognitive behavioral therapy for insomnia (CBT-I), show promising results regarding safety and sustainability of improvements, although CBT-I has not been examined in people with T2D. Promoting sleep for people with insomnia and T2D could improve insomnia severity and diabetes outcomes. Objective The objective of this study is to establish a protocol for a pilot randomized controlled trial (RCT) to examine the effect of 6 sessions of CBT-I on insomnia severity (primary outcome), sleep variability, and other health-related outcomes in individuals with T2D and insomnia symptoms. Methods This RCT will use random mixed block size randomization with stratification to assign 28 participants with T2D and insomnia symptoms to either a CBT-I group or a health education group. Outcomes including insomnia severity; sleep variability; diabetes self-care behavior (DSCB); glycemic control (A1c); glucose level; sleep quality; daytime sleepiness; and symptoms of depression, anxiety, and pain will be gathered before and after the 6-week intervention. Chi-square and independent t tests will be used to test for between-group differences at baseline. Independent t tests will be used to examine the effect of the CBT-I intervention on change score means for insomnia severity, sleep variability, DSCB, A1c, fatigue, sleep quality, daytime sleepiness, and severity of depression, anxiety, and pain. For all analyses, alpha level will be set at .05. Results This study recruitment began in February 2019 and was completed in September 2019. Conclusions The intervention, including 6 sessions of CBT-I, will provide insight about its effect in improving insomnia symptoms, sleep variability, fatigue, and diabetes-related health outcomes in people with T2D and those with insomnia symptoms when compared with control. Trial Registration ClinicalTrials.gov NCT03713996; https://clinicaltrials.gov/ct2/show/NCT03713996 International Registered Report Identifier (IRRID) DERR1-10.2196/14647
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Affiliation(s)
- Mohammed M Alshehri
- University of Kansas Medical Center, Lenexa, KS, United States.,Jazan University, Jazan, Saudi Arabia
| | - Aqeel M Alenazi
- University of Kansas Medical Center, Kansas City, KS, United States.,Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Jeffrey C Hoover
- University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Milind A Phadnis
- University of Kansas Medical Center, Kansas City, KS, United States
| | - Jason L Rucker
- University of Kansas Medical Center, Kansas City, KS, United States
| | | | - John M Miles
- University of Kansas Medical Center, Kansas City, KS, United States
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The Interface Between Sleep and Epilepsy. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grayson LP, DeWolfe JL. Sleep Disorders in Epilepsy: Current Trends and Future Perspectives. CURRENT SLEEP MEDICINE REPORTS 2018. [DOI: 10.1007/s40675-018-0110-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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