A Study Of Correlation Between Epilepsy And Sleep

Objective:Our study aims to learn correlation between epilepsy and sleep, as well as how anti epilepsy drugs possibly effect patients’sleep.Material and Methods:Patients with epilepsy who visited outpatient clinic of Department of Neurology, Huashan Hospital, Fudan University between Jun,2012to Jan,2013were included in our study. Patients’basic information and medical history were taken, including sex, age, occupation, education background, onset age, duration of epilepsy, seizure frequency, medication, past history, personal history and sleeping habit. Seizure patterns were classified according to the seizure classification introduced by International League Against Epilepsy,1981. Patients with sleep disorder were assessed by sleep-related scales. Statistical methods were used to analyze correlation between epilepsy and sleep, as well as anti epilepsy drugs and sleep.Results:1. Demographic data:889patients with epilepsy were included in our study, including516man (58.04%) and373women (41.96%), and the ratio of male to female was1.383:1. The age of patients ranged from4to86years (median age25years). We learned about830patients’occupation (249patients are school students,350patients are in work,164patients are jobless and72patients are retired). We learned about851patients’education background. Among602patients who had finished study, there are60patients have primary education,184patients have junior high school degree,96patients have senior high school degree,39patients have technical secondary school degree,114patients have college degree,98patients have bachelor degree and11patients have master degree.2. Clinical characteristics of epilepsy:patients onset age ranged from at birth to86years (median onset age18years). We learned about881patients’duration of epilepsy which ranged from1month to61years (median5years). We learned about860patients’seizure type, that is,241patients with generalized seizure and619patients with partial seizure. Among patients with partial seizure,26patients have simple partial seizure only,98patients have complex partial seizure only and495patients have both partial seizure and secondary generalized seizure. After excluding patients who visited doctor within half of year after onset of first seizure, we learned about851patients’seizure frequency. Among them,147patients didn’t have a seizure for over1year,315patients experienced1-11episode of seizure per year,238patients experienced1-3episode of seizure per month,78patients experienced1-6episode of seizure per week and73patients experienced seizure every day. Among704patients who experienced at least1episode of seizure per year,415patients mainly experienced seizure when they were awake,219patients mainly experienced seizure when they were asleep and70patients didn’t have special rhythm of seizure. After excluding patients who frequently experienced seizure but didn’t receive standard treatment, and the ones who frequently experienced seizure under standard treatment but had a duration of epilepsy less than2years, we found that there were107patients belonged to refractory epilepsy and701patients didn’t belong to refractory epilepsy.4. Correlation between epilepsy and sleep:(l)Seizure pattern and sleep:patients were divided into two groups:generalized seizure group and partial seizure group. Compared to patients with partial seizure, patients with generalized seizure had shorter sleep onset latency (p=0.044), longer total sleep time (p=0.000), higher sleep efficiency (p=0.000), better sleep quality (p=0.008) and lower proportion of patients who felt low on energy during the day (p=0.022). Bedtime, proportion of patients who felt drowsy during the day and results of sleep-related scales were not statistically significant between the2groups. Patients with partial seizure were further divided into3group, that is, simple partial seizure, complex partial seizure and secondary generalized seizure. Characteristics of sleep and results of sleep-related scales were not statistically significant among the3groups.(2)Seizure frequency and epilepsy:patients were divided into5group by seizure frequency (1.patients didn’t have a seizure for over1year,2.patients experienced1-11episode of seizure per year,3.patients experienced1-3episode of seizure per month,4.patients experienced1-6episode of seizure per week and5.patients experienced seizure every day). Bedtime:patients in group1went to bed later than patients in group3(p=0.002) and group5(p=0.013), and patients in group2wentto bed later than patients in group3(p=0.011). Total sleep time:patients in group5had longer total sleep time than patients in group1(p=0.023), patients in group2(p=0.004) and patients in group3(p=0.026). Sleep efficiency:patients in group1had higher sleep efficiency than patients in group3(p=0.001). Sleep quality:patients in group1had better sleep quality than patients in group2(p=0.009), patients in group3(p=0.000), patients in group4(p=0.000) and patients in group5(p=0.001). Performance during the day:proportion of patients who felt drowsy during the day among groups was not statistically significant (p=0.019), and patients in group1had lower proportion of patients who felt low on energy during the day than patients in group3(p=0.000) and patients in group4(p=0.000).(3)Occurrence time of seizure and epilepsy:according to occurrence time of seizure, patients were divided into3groups (seizure occurred when patients were awake, seizure occurred when patients were asleep and irregular seizure). Characteristics of sleep and results of sleep-related scales were not statistically significant among these groups.(4)Refractory epilepsy and sleep:patients were divided into2groups (patients who belong to refractory epilepsy and patients who don’t belong to refractory epilepsy). Compared to patients who don’t belong to refractory epilepsy, patients who belong to refractory epilepsy had longer total sleep time (p=0.001), worse sleep quality (p=0.021), higher proportion of patients who felt low on energy during the day (p=0.004). Bedtime, sleep onset latency, sleep efficiency, proportion of patients who felt drowsy during the day and results of sleep-related scales were not statistically significant between the2groups.4. Correlation between anti epilepsy drugs and sleep:(1)Medications and sleep:among the889patients,160patients took no medication,23patients used traditional Chinese medicine or irregularly took anti epilepsy drugs,397patients took1anti epilepsy drug and309patients took more than2anti epilepsy drugs. Sleep characteristics of patients who took no medication (group1), patients who took1anti epilepsy drug (group2) and patients who took more than2anti epilepsy drugs (group3) were analyzed. We found that patients in group3had longer total sleep time than patients in group1(p=0.045) and patients in group2(p=0.006), patients in group2had better sleep quality than patients in group1(p=0.023) and patients in group3(p=0.015), and patients in group3had higher proportion of patients who felt low on energy during the day than patients in group2(p=0.001). Bedtime, sleep onset latency, sleep efficiency, proportion of patients who felt drowsy during the day and results of sleep-related scales were not statistically significant among the3groups.(2)Anti epilepsy drugs monotherapy and sleep:medications of397patients who took1anti epilepsy drug were analyzed. We found that94patients took carbamazepine,1patient took clonazepam,1patient took gabapentin,26patients took levetiracetam,43patients took lamotrigine,64patients took oxcarbazepine,6patients took phenobarbitone,16patients took phenytoin,22patients took topiramate and124patients took valproate. We analyzed sleep characteristics of patients who took7drugs as follow, carbamazepine, levetiracetam, lamotrigine, oxcarbazepine, phenytoin, topiramate and valproate and found that patients who carbamazepine had higher proportion of patients who felt drowsy during the day than patients who took levetiracetam (p=0.006), oxcarbazepine (p=0.038) and topiramate (p=0.030), patients who took phenytoin had higher proportion of patients who felt low on energy during the day than patients who took carbamazepine (p=0.018), levetiracetam (p=0.003), lamotrigine (p=0.002), oxcarbazepine (p=0.004) and valproate (p=0.031), and patients who took topiramate had higher proportion of patients who felt low on energy during the day than patients who took lamotrigine (p=0.049). Bedtime, sleep onset latency, total sleep time, sleep efficiency, sleep quality and results of sleep-related scales were not statistically significant among these drugs.Conclusion:our study suggested a relationship between epilepsy and sleep. Patients with generalized seizure showed better sleep than patients with partial seizure. The former fell asleep more easily, had longer sleep time and better sleep efficiency, sleep quality and energy during the day. Patients with higher seizure frequency had better sleep behavior than patients with lower seizure frequency, that is, they went to bed earlier and had longer total sleep time. However, the former had worse sleep efficiency and quality, and felt drowsy during the day more easily. Patients of refractory epilepsy had longer total sleep time than patients who didn’t belong to refractory epilepsy, but had worse sleep quality and felt low on energy during the day. The anti epilepsy drugs also had some effect on sleep. Patients with multi-drug therapy had longer total sleep time than patients with monotherapy and patients who didn’t took any drug, but had worse sleep quality than patients with monotherapy and felt low on energy during the day. Patients with monotherapy had better sleep quality than patients without medication. When used as monotherapy, carbamazepine makes patients drowsy during the day more easily than levetiracetam, oxcarbazepine and topiramate, phenytonin makes patients low on energy during the day more easily than carbamazepine, levetiracetam, lamotrigine, oxcarbazepine and valproate, and topiramate makes patients low on energy during the day more easily than lamotrigine.