title: Severity of self-reported insomnia in adults with epilepsy is related to comorbid medical disorders and depressive symptoms.
abstract: Few studies have systematically investigated insomnia in adults with epilepsy.
  
  
  
  We performed a prospective cross-sectional investigation of the prevalence, severity, and comorbidities of insomnia in 90 adults with epilepsy using a battery of self-reported instruments and polysomnography. We quantified insomnia severity using the Insomnia Severity Index (ISI).
  
  
  
  Fifty-nine of 90 (65.5%) adults with epilepsy reported insomnia (ISI≥8), moderate or severe (ISI≥15) in 28.9%. Good agreement between standard clinical diagnostic criteria and ISI was found for patients with ISI scores <8 and ≥15. Scores on the modified Beck Depression Inventory (mBDI) (r=0.25, p=0.021), the original BDI (r=0.32, p=0.002), and self-reported total sleep duration (TSD) (r=-0.3, p=0.006) were significantly related to ISI score. A multiple regression model found that decreased TSD (ß=-0.93, p=0.007), head trauma (ß=4.37, p=0.003), sedative-hypnotic use (ß=4.86, p=0.002), AED polytherapy (ß=3.52, p=0.005), and asthma/COPD (ß=3.75, p=0.014) were predictors of a higher ISI score. For 63 patients with focal epilepsy, an increased mBDI (ß=0.24, p=0.015), decreased TSD (ß=-1.11, p=0.008), asthma/COPD (ß=4.19, p=0.02), and epilepsy surgery (ß=5.33, p=0.006) were significant predictors of an increased ISI score. Patients with temporal lobe epilepsy (TLE) showed a trend for greater severity compared with those with extra-TLE (ß=-2.92, p=0.054).
  
  
  
  Our findings indicate that severity of insomnia in adults with epilepsy is more likely to be associated with comorbid medical and depressive symptoms and less likely to be directly related to epilepsy. Good agreement between standard clinical diagnostic criteria for insomnia and the ISI for subjects without insomnia symptoms and for those with moderate-to-severe symptoms supports the use of this instrument in epilepsy research.
authors.affiliation: Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea.
authors.forename: Kwang Ik
authors.initials: KI
authors.lastname: Yang
authors.affiliation: Department of Neurology, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Grigg-Damberger
authors.affiliation: Sleep Disorders and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Noah
authors.initials: N
authors.lastname: Andrews
authors.affiliation: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: O'Rourke
authors.affiliation: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: James
authors.initials: J
authors.lastname: Bena
authors.affiliation: Sleep Disorders and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: foldvan@ccf.org.
authors.forename: Nancy
authors.initials: N
authors.lastname: Foldvary-Schaefer
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications*; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012720:Severity of Illness Index; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000503:physiopathology
chemical_list: D000927:Anticonvulsants
keywords: Comorbidities; Epilepsy; Insomnia; Insomnia Severity Index; Severity