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Epilepsy and sleep apnea syndrome

Department of Neurology (Drs. Devinsky and Luciano, and H.S. Abramson), New York University Medical Center, Hospital for Joint Diseases, New York, NY; the Department of Neurology (Dr. Ehrenberg), Tufts-New England Medical Center, Boston, MA; and Mt. Sinai Center for Sleep Medicine (Dr. Barthlen), New York, NY.

We identified seven patients with refractory partial epilepsy and sleep apnea. Treatment of the sleep apnea with nasal continuous positive airway pressure (CPAP), protriptyline, trazodone, acetazolamide, or tracheostomy reduced seizure frequency and severity in six patients. Success with CPAP depended largely on compliance. Four of five patients had a clear reduction in seizure frequency with the use of CPAP. Sleep apnea may exacerbate epilepsy by causing sleep disruption and deprivation, hypoxemia, and decreased cerebral blood flow. In epilepsy patients with risk factors (eg, obesity) or markers (eg, habitual snoring, daytime somnolence) for sleep apnea, a careful sleep history should be elicited and a polysomnogram obtained when indicated. Treatment of the sleep disorder can improve seizure control.

Address correspondence and reprint requests to Dr. Orrin Devinsky, Department of Neurology, Hospital for Joint Diseases, 301 E. 17 St., New York, NY 10003.

Received March 24,1994. Accepted in final form April 29, 1994.

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