Abstracts

Rationale: Poor sleep is a frequent complaint in patients with psychogenic non-epileptic seizures (PNES). However, few studies have examined sleep problems in this population. The aim of this study was to compare sleep-wake patterns in patients with PNES to those with epilepsy. Methods: Subjects were recruited through the Brigham and Women’s Epilepsy Monitoring Unit (EMU) between 2/27/2018 and 5/22/2018 as part of an ongoing prospective study on sleep in the EMU. Subjects were diagnosed as having PNES (either documented or possible) or epilepsy by experts using video-electroencephalography. Sleep-wake patterns were objectively monitored using a wrist-worn device (actigraphy) during EMU admission. Subjects also completed several validated self-report questionnaires on their sleep, including the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Morningness-Eveningness Questionnaire, and Nightmare Distress Questionnaire. Group comparisons were performed on objective and subjective sleep data using independent t-test (or nonparametric Mann-Whitney test) and chi-square test.  Results: Eighteen subjects, including 10 with PNES (documented, n=5; possible, n=5; mean age, 40.0 ± 13.5 years; 8 women) and 8 with epilepsy (mean age, 46.5 ± 16.9 years; 5 women) were enrolled in the study. Compared to controls with epilepsy, PNES subjects showed reduced sleep efficiency (percentage of time spent asleep: 80.3 ± 10.6% vs 89.8 ± 2.4%; p=0.02), and a trend towards shorter total sleep time (394.1 ± 101.1 min vs 475.6 ± 39.6 min; p=0.06). Subjectively, PNES subjects reported reduced sleep quality (p=0.01) and sleep duration (p=0.03), as well as more severe nightmare distress (p=0.007) relative to controls with epilepsy. PNES subjects also more frequently reported moderate-to-severe insomnia (60% vs 13%, p=0.04) and were more likely to use sleeping medications than epilepsy subjects (60% vs 0%, p=0.007). No differences between the groups were found for the Epworth Sleepiness Scale and the Morningness-Eveningness Questionnaire. Conclusions: Subjectively, patients with PNES more frequently report sleep problems relative to their counterparts with epilepsy. However, our study provides preliminary data suggesting that it may not be all subjective: objective sleep measures also support reduced sleep quality in patients with PNES. In addition to educating patients on the importance of maintaining good sleep habits, clinicians should address these sleep complaints as effective pharmacological and non-pharmacological treatments are available and may improve overall health. Funding: This study was supported by the Canadian Institutes of Health Research and the Endowed A.J. Trustey Epilepsy Research Fund.