title: Insomnia in epilepsy is associated with continuing seizures and worse quality of life.
abstract: OBJECTIVE
  To evaluate how insomnia is associated with seizure control and quality of life in patients with epilepsy.
  
  
  METHODS
  Consecutive patients with epilepsy attending clinical visits were surveyed with the Insomnia Severity Index (ISI). Patients had to be treated with at least one anticonvulsant and could not have had documented psychogenic pseudoseizure. The presence or absence of seizures and quality of life (QOLIE-P-10) within the past 4 weeks was recorded. Other variables included demographic and clinical data, sleep-wake timing, the Hörne-Östberg Morningness-Eveningness Questionnaire (MEQ), sleepiness (Epworth Sleepiness Scale (ESS), and mood (Center for Epidemiologic Studies Depression Scale, CES-D).
  
  
  RESULTS
  207 patients completed surveys. 43% had clinically significant insomnia, and 51% had at least mild insomnia. 58% were seizure free. Mean ISI scores were significantly worse for those with continuing seizures, and more severe ISI scores correlated strongly with worse QOL. Younger age, shorter duration of epilepsy, use of sedative/hypnotics, medical and sleep comorbidities, delayed sleep timing and chronotype, excessive sleepiness, and depression were all associated with more severe insomnia. Those with unexpected health care visits over the most recent 4 weeks had worse insomnia. After adjustment for these covariates, more severe insomnia remained significantly associated with lack of seizure freedom and with worse QOL.
  
  
  CONCLUSIONS
  Insomnia is common in epilepsy, and is associated with short term poor seizure control and worse QOL. Future studies must evaluate cause-and-effect relationships. Assessment of insomnia may be important in the comprehensive care of epilepsy and may influence control of epileptic seizures.
authors.affiliation: Department of Neurology, Comprehensive Epilepsy Program, University of Virginia, Charlottesville, VA 22908, USA. Electronic address: quigg@virginia.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Quigg
authors.affiliation: College of Arts and Sciences, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Gharai
authors.affiliation: College of Arts and Sciences, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Ruland
authors.affiliation: College of Arts and Sciences, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Schroeder
authors.affiliation: School of Medicine, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hodges
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Ingersoll
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Frances P
authors.initials: FP
authors.lastname: Thorndike
authors.affiliation: Department of Public Health Sciences, Biostatistics Section, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Guofen
authors.initials: G
authors.lastname: Yan
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Ritterband
mesh_terms: D000328:Adult; D000367:Age Factors; D000927:Anticonvulsants / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000453:epidemiology; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012640:Seizures / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: Circadian delayed phase sleep syndrome; Depression; Epilepsy; Insomnia; Quality of life