A Study Of The Association Of Sleep Disorders With Difficulties In Emotion Regulation And Stigma In Adult People With Epilepsy

ObjectiveEpilepsy as a common neurological chronic disease,is caused by the comprehensive effects of neurobiology,cognition,psychology,and social consequences.In addition focusing on the control of clinical seizures,clinicians are also working to solve the mental and psychological problems of the patients,and strive to improve their quality of life.Adult people with epilepsy（PWE）often face more complex social,psychological and emotional problems.Many studies have focused on sleep disorders,depression,anxiety,and other comorbidities manifested by PWE,while studies on the underlying problems of emotion regulation（ER）and stigma are relatively rare.PWE have a high prevalence of combined sleep disorders,not only affect their working life but also have a certain relationship with their clinical attacks.ER refers to the strategies people use to change their emotional responses.Difficulties in ER is not a pathological definition but may evolve into anxiety or depression in the long run.The stigma of PWE derives mainly from the onset of the disease,the misconceptions and negative attitudes of society,and the negative psychology of the patients themselves.This study investigated the correlation between sleep disorders and emotion regulation and stigma in PWE without anxiety and depression.Methods125 PWE were included,and another 80 healthy people matched for gender and age were recruited as a control group to complete the evaluation.Two groups excluded subjects with depression and anxiety completed Pittsburgh Sleep Quality Index（PSQI）,Epworth Sleepiness Scale（ESS）,and the Chinese version of Difficulties in Emotion Regulation Scale（DERS）.PWE also completed the self-edited questionnaire on relevant demographic data and clinical characteristics,the Chinese version of The Kilifi Stigma Scale for Epilepsy（KSSE）,and The Quality of Life in Epilepsy Inventory-31（QOLIE-31）.The prevalence of sleep disorders and daytime sleepiness in PWE were calculated and compared with healthy people.Univariate analysis and Spearman correlation were used to explore the influence of various demographic and clinical characteristics of PWE on sleep disorders and sleepiness.Finally,multivariate linear regression was applied to evaluate the combination of factors that best explained their sleep disorders.Results（1）About 51.2% of 125 PWE had comorbid sleep disorders,PSQI scores of 64 patients were higher than five points,indicating poor sleep quality,and 40.8% had excessive daytime sleepiness,which was much higher than the control group;（2）Correlation analysis showed that the degree of daytime sleepiness in PWE was significantly positively correlated with seizure frequency（rho=0.273,P=0.002）,and significantly negatively correlated with quality of life（rho=-0.225,P=0.012）;（3）multiple linear regression analysis suggested that difficulties in ER（t=2.217,P=0.029）,stigma（t=2.072,P=0.041）and frequent seizures（t=2.939,P=0.004）in PWE were significantly positively associated with sleep disorders,and quality of life（t =-2.572,P=0.011）was significantly negatively associated with sleep disorders.ConclusionSleep disorders are common in PWE and are closely associated with difficulties in ER,and the two are linked by a bidirectional relationship.Emotional dysregulation combined with higher stigma,poorer quality of life,and frequent episodes affects the quality of sleep of patients.Therefore,clinicians should provide better emotional support for patients during consultation,advocate for the public to eliminate misconceptions about people with epilepsy,and advocate for fairer education and employment opportunities,to improve sleep quality and provide a better living environment for patients.