title: Sleep-wake pattern, chronotype and seizures in patients with epilepsy.
abstract: OBJECTIVE
  Although mounting evidence suggests that sleep and epilepsy are reciprocal and seizures influence circadian rhythms, sleep-wake pattern and seizure control have not been widely researched. This study aimed to investigate the association of sleep-wake pattern, sleep quality, and chronotype with seizures in patients with epilepsy (PWE).
  
  
  METHODS
  160 consecutive PWE (aged 20-49 years, focal epilepsy, FE: generalized epilepsy, GE=127:33) and 130 age-gender matched healthy controls (HC) were enrolled. All subjects completed a sleep diary for more than 2 weeks, Pittsburgh Sleep Quality Index (PSQI), Epworth sleepiness scale (ESS), and the Morningness-Eveningness questionnaire (MEQ). Detailed seizure history was reviewed for the last 1 year.
  
  
  RESULTS
  Sleep-wake patterns on workdays were different between PWE and HC (p<0.001), although PSQI, ESS, and MEQ did not differ. Social jetlag (difference of mid-sleep time between workdays and free days) was more evident in PWE (1.4h) than HC (0.7h, p<0.001). GE showed lower MEQ, later mid-sleep time on both workdays and free days, and larger social jetlag than FE. Higher seizure frequency was positively correlated with higher PSQI and ESS after adjusting for age, gender, and number of antiepileptic drugs (p<0.05). PWE with lower MEQ presented worse sleep quality.
  
  
  CONCLUSIONS
  Contrary to HC, PWE maintained sleep-wake patterns more regularly during workdays and free days. GE patients reported more eveningness-preference; however, their sleep quality was not worse than FE. Although sleep quality may affect seizure frequency, sleep-wake patterns and chronotype were not related to seizures in PWE.
authors.affiliation: Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute (SBRI), Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, South Korea; Department of Nursing, Department of Clinical Nursing Science, Samsung Medical Center, Graduate School of Clinical Nursing Science, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, South Korea. Electronic address: sujungchoi@hanmail.net.
authors.forename: Su Jung
authors.initials: SJ
authors.lastname: Choi
authors.affiliation: Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute (SBRI), Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, South Korea. Electronic address: ejoo@skku.edu.
authors.forename: Eun Yeon
authors.initials: EY
authors.lastname: Joo
authors.affiliation: Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute (SBRI), Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, South Korea. Electronic address: sbhong@skku.edu.
authors.forename: Seung Bong
authors.initials: SB
authors.lastname: Hong
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004828:Epilepsies, Partial / Q000188:drug therapy / Q000503:physiopathology*; D004829:Epilepsy, Generalized / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000503:physiopathology; D012890:Sleep; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Chronotype; Epilepsy; Seizures; Sleep quality; Sleep–wake pattern