Excessive sleepiness and sleep patterns in patients with epilepsy: A case–control study Ronaldo Pizzatto a , Katia Lin a,c , Nancy Watanabe a , Giovanna Campiolo a , Maria Alice Horta Bicalho b , Ricardo Guarnieri a,b , Rinaldo Claudino c , Roger Walz a,b,c , Lucia Sukys-Claudino a,b,c, ⁎ a Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil b Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil c Serviço de Neurologia, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil abstract article info Article history: Received 24 April 2013 Revised 10 June 2013 Accepted 24 June 2013 Available online 10 August 2013 Keywords: Epilepsy Sleepiness Sleep disorders The aim of this study was to assess excessive daytime sleepiness (EDS), sleep quality, and sleep disorders in a cohort of patients with epilepsy in the city of Florianopolis in southern Brazil. One hundred and forty patients diagnosed with epilepsy were assessed by questionnaires that included demographic and clinical variables, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Stanford Sleepiness Scale (SSS), and the Fletcher & Luckett Adapted Questionnaire (FLAQ). These data were then compared to data from a control group (n = 85). Compared to controls, patients with epilepsy (PWE) had significantly higher scores on the ESS (p = 0.003), higher scores on the “daytime dysfunction” domain of the PSQI (p = 0.002), and more symptoms that suggested obstructive sleep apnea in the FLAQ (p b 0.001). By performing multiple lin- ear regression models, we demonstrated that age, male gender, the presence of secondarily generalized seizures, and phenobarbital use were slightly to moderately correlated with PSQI (r = 0.38) and FLAQ (r = 0.51) but not with SSS scores. We concluded that PWE had more EDS, daytime dysfunction, and sleep disorders compared to a control group. © 2013 Elsevier Inc. All rights reserved. 1. Introduction The relationship between sleep and epilepsy has been recognized since antiquity, including observations that some patients only had seizures during sleep [1]. Currently, it is known that sleep can have a direct effect on interictal epileptic discharges (IED) and that sleep deprivation can precipitate seizures. Interictal epileptic discharges are more frequent during NREM sleep, possibly due to the neuronal synchronization that is typical of this sleep stage [2]. Furthermore, idiopathic generalized epilepsies primarily involve thalamocortical synchronization mechanisms that can resemble, in some aspects, those observed in NREM sleep [3,4]. Patients with epilepsy (PWE) often complain of excessive daytime sleepiness (EDS), which has a serious impact on their quality of life [5]. This symptom may be caused by the acute effect of seizures during sleep, the chronic effect of epilepsy on sleep architecture, the use of antiepileptic drugs (AEDs), or the coexistence of primary sleep disorders [6]. Moreover, the prevalence of sleep disorders is higher in PWE. In fact, obstructive sleep apnea (OSA) syndrome can affect many symptomatic aspects of PWE, such as seizure control, mood disorders, cognitive dys- function, and quality of life [5,7,8]. Considering the frequent association between epilepsy and sleep disorders, the objectives of this study were to assess sleep quality and the symptoms of OSA in PWE and to evaluate their association with seizure frequency and AEDs. We also investigated the clinical, demographic, and pharmacological predictors for sleep quality and sleep disorder symptoms. 2. Methods 2.1. Patients One hundred forty adult PWE (over 18 years old, both genders) were consecutively recruited between August 2009 and August 2011 from two institutions: the Epilepsy Center of Santa Catarina (CEPESC) at Governador Celso Ramos Hospital (HGCR) and the Uni- versity Hospital of Federal University of Santa Catarina (HU-UFSC), Florianópolis City (southern Brazil). All patients had a definite diagno- sis of epilepsy according to the criteria proposed by ILAE [9] based on clinical history, seizure semiology, electroencephalographic (EEG) data, and structural magnetic resonance imaging (MRI) findings. Exclusion criteria entailed the presence of illiteracy, psychiatric comor- bidity, or a cognitive impairment that precluded the patient from com- pleting the questionnaire. Psychiatric comorbidity was excluded after Epilepsy & Behavior 29 (2013) 63–66 ⁎ Corresponding author at: Rodovia Admar Gonzaga, 440, sala 703, Florianópolis, Santa Catarina, Brazil. Fax: +55 30244060. E-mail addresses: lucia@neuromeddiagnosticos.com.br, lucia.claudino@ufsc.br (L. Sukys-Claudino). 1525-5050/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.yebeh.2013.06.029 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh