Abstracts

RATIONALE: Objective: At the end of this activity participants should be able to recognize the importance of Obstructive Sleep Apnea and Periodic Limb Movements of Sleep in seizure type and control.
Shouse found distorted sleep in feline kindled epilepsy. However, no studies prove that seizure escalations result. In contrast, epilepsy is negatively affected by Obstructive Sleep Apnea (OSA). To date, the associated sleep disruption has not been correlated to seizure severity or epilepsy type.
Further, Periodic Limb Movements Disorder of Sleep (PLMS) has not been adequately studied in epilepsy.
METHODS: We reviewed polysomnograms (PSGs) on 233 epilepsy patients with abnormal sleep histories seen from 1990 to 1999. Apnea/Hypopnea Index (AHI) and Periodic Limb Movements Index (PLMI), defined three study groups: OSA (19 patients, 15 men), PLMS (22 patients, 8 men) and Combined Sleep Disorders (CSD): OSA/PLMS (6 patients, 5 men). Controls were defined as those with normal values for AHI and PLMI. They were age-/sex- matched to each study group, then compared for PSG findings, epilepsy type, number of seizures during the preceding year and number of antiepileptic drugs.
RESULTS: The prevalence of OSA among men with epilepsy was 17%, more than 4 times the rate found in general population studies. The rate for women was 4%, more than 2 times the population rate.
The prevalence of PLMS was 11% in men and 13% in women.
Total Sleep Time, Sleep Efficiency, REM Sleep and Stages 3-4 were decreased in patients with OSA (p[lt]0.04, 0.01, 0.001, 0.04) and PLMS (p[lt]0.004, 0.003, 0.02, 0.01). Stage I and Total Arousal Index were increased in patients with OSA (p=0.007, 0.0001) and PLMS (p=0.045, 0.0001).
The percentage of partial seizure patients was significantly higher in OSA (85%), PLMS (70%) and CSD (100%) than controls (56%, 48%, 50%) [p[lt]0.05 for all].
Nocturnal seizures were over-represented in OSA patients (p[lt]0.025), but not in PLMS patients.
The number of seizures during the preceding year (21.6 vs. 5.5) and the number of antiepileptics drugs used (2.1 vs. 1.3) were significantly greater than controls in the OSA group (p[lt]0.05, 0.02).
CONCLUSIONS: There is a high prevalence of OSA in men with Epilepsy, especially Partial Epilepsy. OSA is strongly deleterious to sleep, which in turn worsens seizure control, possibly playing a major role in the intractability usually found in Partial Epilepsy. PLMS, slightly more prevalent among women than men, has a milder exacerbating effect on seizure control.