Women With Epilepsy Have Poorer Sleep Quality During Pregnancy

Pregnant women with epilepsy have worse sleep quality during pregnancy and postpartum compared with nonpregnant women with epilepsy.

Pregnant women with epilepsy are more likely to have poorer sleep quality during pregnancy and postpartum compared with women with epilepsy who are not pregnant, according to study findings published in Neurology.

Limited research has been conducted how sleep interacts with seizures in pregnant women. About one-third of people with epilepsy experience seizures during sleep. Sleep deprivation can increase seizures, yet women with epilepsy don’t tend to experience increased seizures during pregnancy. Sleep disturbances are frequent among pregnant women, and epilepsy is the most common neurologic condition pregnant women experience. Poor sleep during pregnancy can increase the risk for poor fetal growth and fetal death. 

For the study, researchers took a closer look at how sleep, epilepsy, and pregnancy influence each other.

They assessed data from 241 pregnant women with epilepsy, 74 healthy pregnant women, and 84 nonpregnant women with epilepsy who enrolled in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study. The study analyzed sleep quality during pregnancy, postpartum, or analogous time periods with the average Pittsburg Sleep Quality Index (PSQI). The highest PSQI scores possible, 21, represents the worst quality of sleep; scores above 5 signify low quality sleep.

In adjusted analyses, pregnancy and postpartum, pregnant women with epilepsy tended to have worse sleep during pregnancy (PSQI, 5.7; 95% CI, 5.4-6.0) and during the postpartum period (PSQI, 5.7; 95% CI, 5.4-6.0) compared with women with epilepsy who were not pregnant for a comparable time period (PSQI, 4.7 [95% CI, 4.2-5.3] vs 4.1 [95% CI, 3.6-4.7], respectively; P =.002 vs P <.001, respectively).

Understanding the interplay between epilepsy, pregnancy, and sleep provides pathways to improving sleep in pregnant [women with epilepsy], providing the opportunity to reduce sleep-related health risks in pregnant [women with epilepsy].

Healthy pregnant women alone had different sleep quality in pregnancy and postpartum stages (change in mean score, 0.8; 95% CI, 0.2-1.3; =.01).

Pregnant women with epilepsy only had significantly worse sleep scores during pregnancy compared with healthy pregnant women before researchers adjusted for covariates.

The researchers also assessed the potential effect of factors, like major depression, on sleep quality between pregnancy and postpartum in each study group. This was determined during an analysis period (yes/no), a diagnosis by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders mood module. Major depression during analysis period was associated with worse sleep during pregnancy (10.6; 95% CI, 9.1-12.2) and postpartum (8.7; 95% CI, 7.3-10.2; P <.001 ) periods, respectively.

Limitations of the study include small sample size, 1 subjective measure of sleep quality, and lack of analysis of other factors that could influence sleep quality.

The researchers concluded that “Understanding the interplay between epilepsy, pregnancy, and sleep provides pathways to improving sleep in pregnant [women with epilepsy], providing the opportunity to reduce sleep-related health risks in pregnant [women with epilepsy].”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Toprani S, Meador KJ, Robalino CP, et al. The effect of epilepsy on sleep quality during pregnancy and postpartumNeurol. Published online July 19, 2022. doi: 10.1212/WNL.0000000000200959