title: Impact of sleep duration on seizure frequency in adults with epilepsy: a sleep diary study.
abstract: BACKGROUND
  Prolonged sleep deprivation activates epileptiform EEG abnormalities and seizures in people with epilepsy. Few studies have addressed the effect of chronic partial sleep deprivation on seizure occurrence in populations with epilepsy. We tested the primary hypothesis that partial sleep deprivation over 24- and 72-hour periods increases seizure occurrence in adults with epilepsy.
  
  
  METHODS
  Forty-four subjects completed a series of self-reported instruments, as well as 1-month sleep and seizure diaries, to characterize their sleep and quality of life. Diaries were used to determine the relationship between seizure occurrence and total sleep time 24 and 72h before seizure occurrence using random effects models and a logistic regression model fit by generalized estimating equations.
  
  
  RESULTS
  A total of 237 seizures were recorded during 1295 diary days, representing 5.5±7.0 (mean±SD) seizures per month. Random effects models for 24- and 72-hour total sleep times showed no clinically or statistically significant differences in the total sleep time between preseizure periods and seizure-free periods. The average 24-hour total sleep time during preseizure 24-hour periods was 8min shorter than that during seizure-free periods (p=0.51). The average 72-hour total sleep time during preseizure periods was 20min longer than that during seizure-free periods (p=0.86). The presence of triggers was a significant predictor of seizure occurrence, with stress/anxiety noted most often as a trigger. Mean total sleep time was 9h, and subjects took an average of 12±10 naps per month, having a mean duration of 1.9±1.2h. Daytime sleepiness, fatigue, and insomnia symptoms were commonly reported.
  
  
  CONCLUSIONS
  Small degrees of sleep loss were not associated with seizure occurrence in our sample of adults with epilepsy. Our results also include valuable observations of the altered sleep times and frequent napping habits of adults with refractory epilepsy and the potential contribution of these habits to quality of life and seizure control.
authors.affiliation: Multicare Tacoma Family Medicine, USA; Cleveland Clinic Neurological Institute, USA. Electronic address: maurine.cobabe@multicare.org.
authors.forename: Maurine M
authors.initials: MM
authors.lastname: Cobabe
authors.affiliation: Cleveland Clinic Department of Outcomes Research, USA.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: Cleveland Clinic Department of Quantitative Health Sciences, USA.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nowacki
authors.affiliation: Cleveland Clinic Department of Quantitative Health Sciences, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: O'Rourke
authors.affiliation: Cleveland Clinic Neurological Institute, USA.
authors.forename: Noah
authors.initials: N
authors.lastname: Andrews
authors.affiliation: Cleveland Clinic Neurological Institute, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Foldvary-Schaefer
mesh_terms: D000328:Adult; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017286:Polysomnography; D011788:Quality of Life; D012640:Seizures / Q000150:complications* / Q000453:epidemiology; D012890:Sleep; D012892:Sleep Deprivation / Q000150:complications / Q000503:physiopathology*; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Epilepsy; Health-related quality of life; Seizure triggers; Sleep deprivation; Sleep diary; Sleep disorders; Sleep duration; Stress