Risk and determinant factors for obstructive sleep apnea in patients with epilepsy

Abstract

Objective: To evaluate the prevalence of risk of having obstructive sleep apnea (OSA) and its determinants in patients with epilepsy (PE). Method: 98 adult PE were prospectively screened for risk of OSA by Berlin questionnaire. Data was also collected about excessive daytime sleepiness, depression, anxiety, clinical and socio-demographic characteristics. Results: The PE main characteristics: 59-men/39-women, mean age=39.97, SD=12.3, range 18-66. The prevalence of the risk of OSA was 55.1% (CI 95%, 0.45-0.65). The high risk for OSA was related with body mass index (BMI) (p=0.000), neck circumference (NC) (p=0.000), arterial hypertension (AH) (p=0.000), and anxiety (p=0.006), without relationship with number of seizures, number of antiepileptic drugs, age or depression. The NC was statistically significant regarding risk of OSA, mainly in men. Conclusion: We found a high risk of OSA in this sample. The main implicated measures were the large NC, high BMI and anxiety. The anthropometric variables were more relevant than those related to epilepsy itself and similar to those of the general population. Key words: obstructive sleep apnea, epilepsy, obesity.Risco e determinantes para apneia obstrutiva do sono em pacientes com epilepsia RESUMO Objetivo: Avaliar riscos e fatores determinantes para síndrome da apneia obstrutiva do sono (SAOS) em pacientes com epilepsia (PCE). Método: 98 PCE adultos foram avaliados prospectivamente para risco de SAOS pelo questionário Clínico de Berlim, e também para sonolência excessiva diurna, depressão, ansiedade, características socioeconômico e demográficas. Resultados: 98 PCE foram estudados (59-homens / 39-mulheres, idade média=39,97, DP=12,3, 18-66 anos). A prevalência de risco para SAOS foi de 55,1% (CI 95%, 0,45-0,65). O alto risco de SAOS estava relacionado com índice de massa corporal (IMC) (p=0,000), circunferência do pescoço (CP) (p=0,000), hipertensão arterial (p=0,000) e ansiedade (p=0,006), sem relação com número de crises, drogas antiepiléptica, idade ou depressão. A CP foi estatisticamente significativa na relação com SAOS, principalmente em homens. Conclusão: Encontrou-se alta prevalência de risco de SAOS nesta população. As medidas mais relevantes foram CP principalmente em homens, IMC e ansiedade. As variáveis antropométricas foram mais importantes que aquelas relacionadas à própria epilepsia, o que foi similar à população em geral. Palavras-Chave: síndrome de apneia obstrutiva do sono, epilepsia, obesidade. Obstructive sleep apnea (OSA) and epilepsy are conditions that can be interrelated 1 . The prevalence of OSA in the general adult population in USA (ages 30 to 60) is 24% in men, and 9% in women according to Chihorek et al.2 . The literature reports that in older adults with epilepsy the presence of OSA is associated with sei-

Excessive Daytime Sleepiness and Epilepsy: A Systematic Review

“…The most common sleep-related complaints in PWE were maintenance insomnia and EDS [ 13 , 14 , 16 ]. Sleepiness in PWE may have a multifactorial origin and studies show that symptoms of OSA and RLS are independent predictors of an ESS score >10 [ 2 , 3 , 20 ]. This has been also demonstrated in patients of older age and by the fact that the treatment of OSA with continuous positive airway pressure (CPAP) can improve EDS and seizure control [ 21 ].…”

Expert opinion on diagnosis and management of epilepsy‐associated comorbidities

“…14,15 Various risk factors related to sleep-wake disorders and obstructive sleep apnea (OSA) should also be considered including older age, longer duration of epilepsy, higher body mass index (BMI), history of hypertension, a higher score on the Sleep Apnea Scale of the Sleep Disorders Questionnaire, larger neck circumference, hypertonia, congestive heart failure, and therapy with benzodiazepines or opiates (Table 1). 16,17 Comorbid conditions such as anxiety and depression may also increase the risk of sleep wake disorders. 18 Other important considerations include risk factors for restless legs syndrome/ periodic limb movement syndrome, low-ferritin levels, nephropathic diseases, rheumatoid arthritis, polyneuropathy, diabetes mellitus, and neuroleptic or antidepressant medications.…”

Sleep Disorders in Epilepsy: Current Trends and Future Perspectives

“…The most consistent predictors of sleep apnea in PWE mirror risk factors for development of sleep apnea in the general population, including increasing age [58][59][60] and male gender [58,59,66]. There was less consistent data regarding association with higher body mass index [58,67], neck circumference [67], increased seizure frequency [24, 58-60, 66, 68], nocturnal seizures [58,59,66], and dental problems [60].…”