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Obstructive sleep apnea is associated with seizure occurrence in older adults with epilepsy

From the Sleep Disorders Division (A.M.C., B.A.M.) and Epilepsy Division (B.A.-K.), Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN.

Address correspondence and reprint requests to Dr. Beth A. Malow, Vanderbilt University, Department of Neurology, Medical Center North, Room A-0118, 1161 21st Avenue South, Nashville, TN 37232-2551 beth.malow{at}vanderbilt.edu

Background: Although epileptic seizures occur more commonly in older adults, their occurrence in this age group is often unexplained. One unexplored precipitant of seizures in older adults is obstructive sleep apnea (OSA), which is also more common in this age group. Our objective was to investigate whether OSA is associated with seizure exacerbation in older adults with epilepsy.

Methods: Polysomnography was performed in older adult patients with late-onset or worsening seizures (Group 1, n = 11) and those who were seizure-free or who had improvement of seizures (Group 2, n = 10).

Results: Patients in Group 1 had a significantly higher apnea-hypopnea index than patients in Group 2 (p = 0.002). Group 1 patients also had higher Epworth Sleepiness Scale scores (p = 0.009) and higher scores on the Sleep Apnea Scale of the Sleep Disorders Questionnaire (p = 0.04). The two groups were similar in age, body mass index, neck circumference, number of antiepileptic drugs currently used, and frequency of nocturnal seizures.

Conclusions: Obstructive sleep apnea is associated with seizure exacerbation in older adults with epilepsy, and its treatment may represent an important avenue for improving seizure control in this population.

GLOSSARY: AED = antiepileptic drug; AHI = apnea-hypopnea index; CPAP = continuous positive airway pressure; EDS = excessive daytime sleepiness; ESS = Epworth Sleepiness Scale; OSA = obstructive sleep apnea; PSG = polysomnography; SA-SDQ = Sleep Apnea section of the Sleep Disorder Questionnaire.

Editorial, see page 1814

Supported by the Vanderbilt General Clinical Research Center (M01-RR00095 from the National Center for Research Resources, NIH) and the Epilepsy Foundation of America Clinical Research and Training Fellowship Program through the Roger F. and Edna F. Evans Fund (to A.M.C.).

Disclosure: The authors report no conflicts of interest.

Received November 22, 2006. Accepted in final form April 6, 2007.

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