Archive | 2021
Seizure likelihood varies with day-to-day variations in sleep duration in patients with refractory focal epilepsy: A longitudinal EEG investigation.
Abstract
Background: While the effects of prolonged sleep deprivation (>24 hours) on seizure occurrence has been thoroughly explored, little is known about the effects of day-to-day variations in the duration and quality of sleep on seizure probability. A better understanding of the interaction between sleep and seizures may help to improve seizure management. Methods: To explore how sleep and epileptic seizures are associated, we analysed continuous intracranial EEG recordings collected from 10 patients with refractory focal epilepsy undergoing ordinary life activities. A total of 4340 days of sleep-wake data were analysed (average 434 days per patient). EEG data were sleep scored using a semi-automated machine learning approach into wake, stages one, two, and three non-rapid eye movement sleep, and rapid eye movement sleep categories. Findings: Seizure probability changes with day-to-day variations in sleep duration. Logistic regression models revealed that an increase in sleep duration, by 1.66 +/- 0.52 hours, lowered the odds of seizure by 27% in the following 48 hours. Following a seizure, patients slept for longer durations and if a seizure occurred during sleep, then sleep quality was also reduced with increased time spent aroused from sleep and reduced REM sleep. Interpretation: Our results demonstrate that day-to-day deviations from regular sleep duration correlates with changes in seizure probability. Sleeping longer, by 1.66 +/- 0.52 hours, may offer protective effects for patients with refractory focal epilepsy, reducing seizure risk. Furthermore, the occurrence of a seizure may disrupt sleep patterns by elongating sleep and, if the seizure occurs during sleep, reducing its quality. Funding: Australian National Health and Medical Research Council, US National Institutes of Health and Czech Technical University in Prague and Epilepsy Foundation of America Innovation Institute