Sleep disorders in patients with epilepsy and their impact on quality of life

Epilepsy,one ofthe most commonneurologicaldiseases, leads to significantemotional, physical and sociallimitations inthe lives ofpatients. Epilepsy patients often reportsleep-related problems. The most common of these sleep problems are excessivedaytimesleepiness, fatigue, difficulty falling asleep, waking up frequently at night and difficultywaking up in the morning. In addition to epilepsy and the side-effects ofantiepileptic drugs, sleeping difficulty also impairspatients'quality of life. In recent years,the maingoal in thetreatment ofepilepsy has been toimprove patients? qualityof life, as well as to establishseizure control. Following ethical committee approval, our study was performed with 151 patients consulting the KTU Neurology Clinic with a definitive diagnosis of epilepsy between June 2010 and March 2011 and 151 healthy controls. Patients were non-drug resistant individuals experiencing seizures at least once a year and whose seizures were reduced by 50% with appropriate antiepileptic treatment. The patientand control groups were administered the KTU Department of Neurologyoutpatientexaminationform, the InsomniaSeverity Index (ISI), the EpworthSleepiness Scale (ESS), the Beck Depression Inventory (BDI), the Pittsburgh Sleep QualityIndex (PSQI), the Restless Legs SyndromeSeverity Scale and the Short Form-36 (SF-36)quality of life questionnaire. Patients with a sleep disorder (such as parasomnia, REM sleep disorder or idiopathic hypersomnia) were applied a routine PSG examination. One hundred fifty-one patients with epilepsy and an equal number of healthy controls with similar demographic characteristics were compared to evaluate types of sleep disorders and the severity, frequency and effects of these on patients with epilepsy and their quality of life. Analysis of epilepsy patients? clinical features revealed a duration ofepilepsy of12.69± 8.9years, 76.4% of patients hadfocal onsetseizures, 41.7 % of patients had seizures during sleep. Seizure frequency was one or more per month in 58.9% of patients, and 64.9% were receivingmonotherapy.The most commonsleep disordersin patients with epilepsy were insomnia(47.7%), parasomnia (7.3%), RLS(4.6%), and Obstructive SleepApnea Syndrome (OSAS)(4%). Apart from insomnia, no significant difference was determined in terms of frequency of sleep disorders between the epilepsy patients and the control group. Insomnia were significantly higher in the patients with epilepsy than in the control group. In terms of risk factors for sleep disorders in patients with epilepsy, we determined more sleep disorders in patients with seizures more than once per month and in patients with seizures during sleep. A logistic regression model was applied to identify risk factors affecting insomnia in patients with epilepsy revealed that seizures during sleep and seizure frequency (once or more in a month in our study) were independent risk factors for insomnialogistic regression model for factors affecting poor sleep quality revealed that, the frequency of seizures, seizures during sleep and depression, were significant risk factors in the deterioration of quality of sleep. When we compared epilepsy patients with sleep disorders to those without and to the normal controls, quality of life in epilepsy patients with sleep disorders changed in a negative direction. We determined a significant negative correlation between PSQI, ISI, ESS and BDI scores in epilepsy patients and quality of life SF-36 global scores. Quality of life decreased with worsening of sleep quality, increasing insomnia severity, excessive day time sleepiness and increasing depression severity.Among the clinical factures of patients with epilepsy, higher seizure frequency and depression were factors that negatively impact on quality of life. We discuaged our data obtained in the light of the current literatureWe think that psychiatric comorbid conditions and sleep disorders should be recognised and treated with the aim of achieving more successful treatment of epilepsy and improving the quality of life of epilepsy patients.We think that psychiatric comorbid conditions and sleep disorders should be early recognised and treated for achieving more successful treatment of epilepsy and improving the quality of life of epilepsy patients. We conclude that sleep disorders affect quality of life and make treatment difficult. Patients should therefore be asked in detail about their sleep and polysomnographic tests should be applied necessery. Contributing to the treatment of primary disease and improving quality of life should be the objective in epilepsy patients with sleep disorders.