Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(12): 772-777
DOI: 10.1590/0004-282X20200064
Article

Depression is a major determinant of sleep abnormalities in patients with epilepsy

A depressão é um dos principais determinantes das anormalidades do sono em pacientes com epilepsia
Edanur KARAPINAR 
1   Istanbul University, Istanbul School of Medicine, Department of Neurology, Fatih, İstanbul, Turkey.
,
Ceren YUNUSOĞLU 
1   Istanbul University, Istanbul School of Medicine, Department of Neurology, Fatih, İstanbul, Turkey.
,
Betül TEKIN 
2   University of Health Sciences Prof. Dr. Mazhar Osman Bakırköy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, Department of Neurology, Bakırköy, Istanbul, Turkey.
,
Hava Özlem DEDE 
1   Istanbul University, Istanbul School of Medicine, Department of Neurology, Fatih, İstanbul, Turkey.
,
Nerses BEBEK 
1   Istanbul University, Istanbul School of Medicine, Department of Neurology, Fatih, İstanbul, Turkey.
,
Betül BAYKAN 
1   Istanbul University, Istanbul School of Medicine, Department of Neurology, Fatih, İstanbul, Turkey.
,
Candan GÜRSES 
3   Koç University, Department of Neurology, Istanbul, Turkey.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Introduction: We aimed to identify sleep disorders in patients with epilepsy and compare this group with a healthy population. We also analyzed the features of sleep disorders in patients with epilepsy to demonstrate the effect of seizures and seizure types on sleep. Methods: Our study assessed 43 patients with epilepsy and 53 age- and gender-matched healthy controls. The demographic and clinical data of all participants were recorded. The Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI), International Restless Legs Syndrome Study Group Rating Scale, Berlin Questionnaire, and Beck Depression Inventory (BDI) were administered to all study subjects. The interview used to evaluate insomnia is based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition - DSM-5 diagnostic criteria. Results: Twenty-four patients (55.8%) and 26 controls (49.1%) are women. The mean age of patients and controls was 34.2±11.37 (16-71) and 34.6±11.28 (16-77), respectively. Patients with epilepsy had depression more often than controls, a result that was statistically significant (p<0.0001). We found no statistically significant difference between sleep parameters of patients and controls with normal BDI scores (p>0.05). Patients with depression had worse results on the Berlin Questionnaire and PSQI total score, with statistical significance (p=0.002). Nocturnal seizures, seizure type, and drug treatment had no effect on sleep (p>0.05). Conclusion: We concluded that depression rather than epilepsy negatively affects sleep, suggesting that all patients should be asked about their mood and sleep complaints.

RESUMO

Introdução: O objetivo deste estudo foi identificar distúrbios do sono em pacientes com epilepsia e compará-los com uma população saudável. Também foram examinadas as características dos distúrbios do sono em pacientes com epilepsia para demonstrar o efeito e os tipos de convulsões no sono. Métodos: O estudo consistiu em 43 pacientes com epilepsia e 53 controles saudáveis pareados por idade e sexo. Os dados demográficos e clínicos de todos os participantes foram registrados. Todos os participantes do estudo receberam a Escala de Sonolência de Epworth, o Índice de Qualidade do Sono de Pittsburgh (Pittsburch Sleep QUality Index - PSQI), o Questionário do Grupo Internacional de Estudos das Pernas Inquietas, o Questionário de Berlim e o Inventário de Depressão de Beck. A entrevista usada para avaliar a insônia é baseada nos critérios do DSM-V. Resultados: Vinte e quatro pacientes (55,8%) são do sexo feminino e vinte e seis do grupo controle (49,1%) são do sexo feminino. A média de idade dos pacientes e do grupo controle é de 34,2±11,37 (16-71) e 34,6±11,28 (16-77), respectivamente. Pacientes com epilepsia sofrem mais de depressão do que os controles e esse resultado é estatisticamente significativo (p<0,0001). Não houve diferença estatisticamente significativa entre os parâmetros do sono dos pacientes e dos controles que apresentaram escores de Beck normais (p>0,05). Pacientes com depressão apresentam resultados piores no escore total do PSQI de Berlim, o que é estatisticamente significativo (p=0,002). As convulsões noturnas, o tipo de convulsão e o tratamento medicamentoso não afetaram o sono (p>0,05). Conclusão: Determinamos que a depressão, e não a epilepsia, afeta negativamente o sono dos pacientes, sugerindo que todos os pacientes devem ser questionados sobre seu humor e queixas de sono.

Keywords:

Epilepsy - Seizures - Depression - Sleep - Prognosis

Palavras-chave:

Epilepsia - Convulsões - Depressão - Sono - Prognóstico

Authors’ contributions:

EK, CY and HÖD: performed data collection. BT: data analysis and interpretation. EK: primary author. CG: conceived the ideas. CG BB and NB: provided revisions to scientific consent of manuscript. CG, BB and NB: principal investigators.




Publication History

Received: 24 April 2020

Accepted: 27 May 2020

Article published online:
07 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 van Golde EG, Gutter T, de Weerd AW. Sleep disturbances in people with epilepsy; prevalence impact and treatment. Sleep Med Rev. 2011 Dec;15(6):357-68. https://doi.org/10.1016/j.smrv.2011.01.002
  • 2 Manni R, Terzaghi M. Comorbidity between epilepsy and sleep disorders. Epilepsy Res. 2010 Aug;90(3):171-7. https://doi.org/10.1016/j.eplepsyres.2010.05.006
  • 3 Quigg M, Gharai S, Ruland J, Schroeder C, Hodges M, Ingersoll KS, et al. Insomnia in epilepsy is associated with continuing seizures and worse quality of life. Epilepsy Res. 2016 May;122:91-6. https://doi.org/10.1016/j.eplepsyres.2016.02.014
  • 4 Belanger L, Harvey AG, Fortier-Brochu E, Beaulieu-Bonneau E, Eidelman P, Talbot L, et al. Impact of comorbid anxiety and depressive disorders on treatment response to cognitive behavior therapy for insomnia. J Consult Clin Psychol. 2016 Aug;84(8):659-67. https://doi.org/10.1037/ccp0000084
  • 5 Im HJ, Park SH, Baek SH, Chu MK, Yang KI, Kim WJ, et al. Associations of impaired sleep quality. insomnia. and sleepiness with epilepsy: a questionnaire-based case-control study. Epilepsy Behav. 2016 Apr;57(Pt A):55-9. https://doi.org/10.1016/j.yebeh.2016.01.022
  • 6 Salpekar JA, Mishra G, Hauptman AJ. Key issues in addressing the comorbidity of depression and pediatric epilepsy. Epilepsy Behav. 2015 May;46:12-8. https://doi.org/10.1016/j.yebeh.2015.02.036
  • 7 Yang KI, Grigg-Damberger M, Andrews N, O'Rourke C, Bena J, Foldvary-Schaefer N. Severity of self-reported insomnia in adults with epilepsy is related to comorbid medical disorders and depressive symptoms. Epilepsy Behav. 2016 Jul;60:27-32. https://doi.org/10.1016/j.yebeh.2016.03.023
  • 8 Moser D, Pablik E, Aull-Watschinger S, Pataraia E, Wöber C, Seidel S. Depressive symptoms predict the quality of sleep in patients with partial epilepsy--A combined retrospective and prospective study. Epilepsy Behav. 2015 Jun;47:104-10. https://doi.org/10.1016/j.yebeh.2015.04.021
  • 9 Johns MW. Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep. 1994 Dec;17(8):703-10. https://doi.org/10.1093/sleep/17.8.703
  • 10 Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J, et al. Restless Legs Syndrome D. Epidemiology workshop at the National Institutes of H. International Restless Legs Syndrome Study G. Restless legs syndrome: diagnostic criteria special considerations and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003 Mar;4(2):101-19. https://doi.org/10.1016/s1389-9457(03)00010-8
  • 11 Buysse DJ, Reynolds CF. 3rd , Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  • 12 Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999 Oct 5;131(7):485-91. https://doi.org/10.7326/0003-4819-131-7-199910050-00002
  • 13 Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996 Dec;67(3):588-97. https://doi.org/10.1207/s15327752jpa6703_13
  • 14 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5. ed. Washington, DC: APA; 2013.
  • 15 Stefanello S, Marin-Leon L, Fernandes PT, Min LL, Botega NJ, et al. Suicidal thoughts in epilepsy: a community-based study in Brazil. Epilepsy Behav. 2010 Apr;17(4):483-8. https://doi.org/10.1016/j.yebeh.2009.12.029
  • 16 Komolafe MA, Sunmonu TA, Ogunrin OA, Disu JO, Ezeala BA, Abubakar SA, et al. Sleep disturbances among patients with epilepsy in Nigeria. Ann Afr Med. 2015 Apr-Jun;14(2):103-8. https://doi.org/10.4103/1596-3519.149880
  • 17 DeJean D, Giacomini M, Vanstone M, Brundisini F. Patient experiences of depression and anxiety with chronic disease: a systematic review and qualitative meta-synthesis. Ont Health Technol Assess Ser. 2013 Sep;13(16):1-33.
  • 18 van Mill JG, Hoogendijk WJ, Vogelzangs N, van Dyck R, Penninx BW. Insomnia and sleep duration in a large cohort of patients with major depressive disorder and anxiety disorders. J Clin Psychiatry. 2010 Mar;71(3):239-46. https://doi.org/10.4088/JCP.09m05218gry
  • 19 Unterberger I, Gabelia D, Prieschl M, Chea K, Hofer M, Högl B, et al. Sleep disorders and circadian rhythm in epilepsy revisited: a prospective controlled study. Sleep Med. 2015 Feb;16(2):237-42. https://doi.org/10.1016/j.sleep.2014.09.021
  • 20 Macêdo P, Oliveira PS, Foldvary-Schaefer N, Gomes MM. Insomnia in people with epilepsy: A review of insomnia prevalence. risk factors and associations with epilepsy-related factors. Epilepsy Res. 2017 Sep;135:158-67. https://doi.org/10.1016/j.eplepsyres.2017.05.014
  • 21 Parrino L, Smerieri A, Spaggiari MC, Terzano MG. Cyclic alternating pattern (CAP) and epilepsy during sleep: how a physiological rhythm modulates a pathological event. Clin Neurophysiol. 2000 Sep;111(Suppl 2):S39-46. https://doi.org/10.1016/s1388-2457(00)00400-4
  • 22 Scarlatelli-Lima AV, Sukys-Claudino L, Watanabe N, Guarnieri R, Walz R, Lina K. How do people with drug-resistant mesial temporal lobe epilepsy sleep? A clinical and video-EEG with EOG and submental EMG for sleep staging study. eNeurologicalSci. 2016 Sep;4:34-41. https://doi.org/10.1016/j.ensci.2016.06.002
  • 23 Jain SV, Kothare SV. Sleep and epilepsy. Semin Pediatr Neurol. 2015 Jun;22(2):86-92. https://doi.org/10.1016/j.spen.2015.03.005
  • 24 Vaughn BV, Ali I. Sleep and epilepsy: opportunities for diagnosis and treatment. Neurol Clin. 2012 Nov;30(4):1249-74. https://doi.org/10.1016/j.ncl.2012.08.006
  • 25 Shen Y, Zhang M, Wang Y, Wang L, Xu X, Xiao G, et al. Subjective sleep disturbance in Chinese adults with epilepsy: associations with affective symptoms. Epilepsy Res. 2017 Sep;135:150-7. https://doi.org/10.1016/j.eplepsyres.2017.06.014
  • 26 Ismayilova V, Demir AU, Tezer FI. Subjective sleep disturbance in epilepsy patients at an outpatient clinic: a questionnaire-based study on prevalence. Epilepsy Res. 2015 Sep;115:119-25. https://doi.org/10.1016/j.eplepsyres.2015.06.009
  • 27 Nayak CS, Sinha S, Nagappa M, Kandavel T, Taly AB. Effect of carbamazepine on the sleep microstructure of temporal lobe epilepsy patients: a cyclic alternating pattern-based study. Sleep Med. 2016 Oct;27:80-5. https://doi.org/10.1016/j.sleep.2016.08.017
  • 28 Saraswati N, Nayak C, Sinha S, Nagappa M, Thennarasu K, Taly AB. Comparing sleep profiles between patients with juvenile myoclonic epilepsy and symptomatic partial epilepsy: Sleep questionnaire-based study. Epilepsy Behav. 2017 Jan;66:34-8. https://doi.org/10.1016/j.yebeh.2016.10.009