Risk Factors for Sleep-Disordered Breathing in Epilepsy, Psychogenic Nonepileptic Seizures Identified

woman sleeping with CPAP
woman sleeping with CPAP
Up to 26.5% of participants had moderate to severe SDB as defined by an apnea-hypopnea index of ≥15.

In a cross-sectional study of consecutive patients with epilepsy and psychogenic nonepileptic seizures (PNES) who were admitted for inpatient video-electroencephalography monitoring, polysomnography was effective for identifying patients with undiagnosed sleep-disordered breathing (SDB). Factors predictive of moderate to severe SDB in epilepsy include pathologic daytime sleepiness, older age, and a higher body mass index. These findings were published in Neurology.

Patients with epilepsy (n=255) or PNES (n=93) or both (n=22) who were admitted to The Royal Melbourne Hospital in Australia for inpatient video-electroencephalography monitoring were enrolled. During the monitoring period, patients underwent polysomnography, neurocognitive testing, and screening that assessed daytime somnolence, sleep quality, and quality of life. On the final night of hospital admission, patients also underwent overnight diagnostic polysomnography, which was performed following the reinstatement of antiepileptic drugs.

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Up to 26.5% of participants had moderate to severe SDB as defined by an apnea-hypopnea index of ≥15. The proportion of patients with moderate to severe SDB did not differ among patients with epilepsy (26.3%), PNES (29.0%), or both (18.2%; P =.610). In the adjusted analysis, pathologic daytime sleepiness was found to be predictive of moderate to severe SDB in people with epilepsy (odds ratio [OR] 10.35; 95% CI, 2.09-51.39; P =.004). Additionally, older age (OR 1.07; 95% CI, 1.04-1.10; P <.001) and higher body mass index (OR 1.06; 95% CI, 1.01-1.11; P =.029) represented independent predictors for moderate to severe SDB in epilepsy. For those with PNES, older age (OR 1.10; 95% CI, 1.03-1.16; P =.002) was an independent predictor for moderate to severe SDB.

Limitations of the study include its relatively small number of participants as well as the inclusion of only Australian patients.

“The specific, long-term, clinical implications of SDB within this population, such as risk of cardiovascular related morbidity and mortality,” the researchers added, “need to be investigated.”


Sivathamboo S, Farrand S, Chen Z, et al. Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring. Neurology. 2019;92(3):e194-e204.