Impact of comorbid sleep disorders in patients with epilepsy on mortality risk
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Authors
Lazaj, Marion
Date
2024-09-04
Type
thesis
Language
eng
Keyword
mortality risk , SUDEP , epilepsy , sleep disorders , comorbidity
Alternative Title
Abstract
Background: Pooled mortality is nearly three times higher in people with epilepsy (PWE), with epilepsy-related deaths, including sudden unexpected death in epilepsy (SUDEP), status epilepticus, and drowning, being more prevalent than other causes. Approximately 80% of SUDEP events occur during sleep, and sleep abnormalities are common in PWE, including disruptions in quality and architecture. Primary sleep disorders like sleep-disordered breathing and insomnia disorder are prevalent in both the general population and PWE. Currently, research is extensively exploring SUDEP risk evaluation and biomarkers, with limited studies investigating the connection between sleep and SUDEP/all-cause mortality risk in epilepsy. This study aims to assess the relationship between mortality risk in epilepsy and the diagnosis of primary sleep disorders.
Methods: The study included consecutive patients with active epilepsy from a Canadian epilepsy clinic over a 4-year period. The database collected demographic, clinical, neurophysiological, and sleep information, along with accident and hospitalization records. Mortality risk was evaluated using the modified SUDEP-7 scale, and primary sleep disorder diagnoses were made by a qualified sleep physician based on ICSD-3 criteria. Patients were categorized into two groups: those without comorbid sleep disorders (Group 1) and those with sleep disorders (Group 2). Statistical analyses were conducted to compare mortality risk-related variables between the two groups.
Results: The study enrolled 1506 PWE, with Group 1 (1130 patients) and Group 2 (376 patients). Both groups showed similar average epilepsy duration, epilepsy type distribution, and the percentage of PWE seizure-free for over a year. However, Group 2 exhibited a significantly higher proportion of PWE with high mortality risk, increased incidence of all-cause mortality, accidents, and poorer employment status. The most common sleep disorder in Group 2 was obstructive sleep apnea (54%), followed by insomnia disorder (29%) and restless legs syndrome (12%).
Conclusion: Comorbid primary sleep disorders are associated with significantly higher SUDEP risk and all-cause mortality risk in epilepsy. PWE with these sleep disorders also face an elevated risk of accidents and unemployment. This study offers valuable insights for developing more accurate predictive models and tools for assessing mortality risk.
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Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
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This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivatives 4.0 International
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivatives 4.0 International