Treating sleep apnea decreases risk of epileptic seizures

Thapanee Somboon

Positive airway pressure therapy improved long-term seizure control in patients with epilepsy and obstructive sleep apnea, according to data presented at the American Epilepsy Society Annual Meeting.

“Obstructive sleep apnea (OSA) is highly prevalent among adults with epilepsy, with a prevalence rate around 40%, and is moderate-to-severe in 16%,” Thapanee Somboon, MD, from the Sleep Disorders Center at Cleveland Clinic, told Healio Internal Medicine. “OSA is associated with a number of adverse health consequences including mood and cognitive dysfunction, hypertension, cardiovascular disease, metabolic disorders and sudden death.”

“Given that OSA fragments sleep and produces a state of chronic sleep deprivation (which increase seizures), one would expect a benefit from routine screening for OSA in adults with epilepsy,” she said.

Somboon and colleagues conducted a study to determine how positive airway pressure impacts long-term seizure outcomes in adults with epilepsy. The researchers enrolled 197 patients with epilepsy (mean age, 43.9 years; 58% female; monthly seizure frequency, 0; 54% seizure-free at baseline) who underwent polysomnography at Cleveland Clinic between 1997 and 2015.

The researchers compared seizure outcomes, such as the mean percentage of seizure reduction, from baseline to 1-, 3- and 5-year post diagnostic polysomnography among patients with OSA on positive airway pressure therapy, those not on therapy, and those without OSA. Follow-up was conducted at a mean of 5.4 years.

A total of 62% of the patients were diagnosed with OSA, 60% of whom received positive airway pressure therapy. Patients without OSA were more likely to be younger, female and have a lower BMI, compared with those with OSA whether untreated or treated with positive airway pressure.

There was a greater reduction in seizures from baseline in patients treated with positive airway pressure therapy (63%) than those with untreated OSA (14%) and no OSA (44%). Additionally, positive airway pressure therapy-treated patients were more likely to achieve a 50% reduction in seizures or remain seizure-free at baseline and follow-up (85%), compared with those with untreated OSA (55%) and no OSA (65%), even after adjustment for baseline seizure freedom and antiepileptic drug standardized dose.

“All patients with epilepsy should be screened for OSA,” Somboon said. “OSA must be diagnosed by overnight polysomnography and can be treated by doctors from any discipline including neurologists, although sleep specialists are often involved in the management. Physicians should incorporate OSA screening in the routine care of adults with epilepsy, refer those who screen positive (snore, witnessed apnea in sleep) for polysomnography and treat patients with OSA confirmed on polysomnography, particularly those with drug-resistant seizures.” – by Alaina Tedesco

Reference:

Somboon T, et al. Long-term seizure control in epileptic patients with obstructive sleep apnea using positive airway pressure therapy. Presented at: American Epilepsy Society Annual Meeting; Dec. 1-5; Washington, D.C.

Disclosure: The authors report no relevant financial disclosures.