Sleep architecture in drug-naïve adult patients with epilepsy: Comparison between focal and generalized epilepsy

AbstractObjective: Sleep impairment is one of the most common comorbidities affect-ing people with epilepsy (PWE). The bidirectional relation between epilepsy andsleep has been widely established. Several studies investigated subjective sleepquality and daytime vigilance in PWE, highlighting frequent complaints of sleepfragmentation, difficulties in falling asleep, and daytime sleepiness. The presentstudy aimed to evaluate sleep structure in drug-naive PWE, distributed on thebasis of epilepsy type, and compared with controls.Methods: This observational study included adult patients newly diagnosedwith epilepsy and drug-naive as well as a control group of healthy subjects. AllPWE and controls underwent a dynamic 24-h EEG with signals for sleep record-ing to evaluate sleep architecture, structure, continuity, and fragmentation.Results: Twenty-four PWE were included and distributed in two groups basedon epilepsy type. Eleven patients were included in the generalized epilepsygroup (63.6% male; 34.91 ± 9.80 years) and 13 patients in the focal epilepsy group(53.8% male; 38.69 ± 12.74 years). The control group included 16 subjects (56.3%male; 32.75 ± 12.19 years). Patients with generalized or focal epilepsy had a sig-nificantly lower sleep efficiency than controls. Moreover, both patient groupspresented the alteration of markers of sleep fragmentation and loss of continuity,with higher indices of sleep stage transitions and arousal. Finally, the two patientgroups presented less REM sleep than controls.Significance: This study highlighted the alteration of sleep quality, continuity,and stability in both patients with focal or generalized epilepsy compared withcontrols, also in the absence of ictal events. This sleep impairment resulted inthe reduction of REM sleep. Therefore, these findings may be explained by theincrease in awakenings and sleep stage shifts, which may be attributed to both AbstractObjective: Sleep impairment is one of the most common comorbidities affect-ing people with epilepsy (PWE). The bidirectional relation between epilepsy andsleep has been widely established. Several studies investigated subjective sleepquality and daytime vigilance in PWE, highlighting frequent complaints of sleepfragmentation, difficulties in falling asleep, and daytime sleepiness. The presentstudy aimed to evaluate sleep structure in drug-naive PWE, distributed on thebasis of epilepsy type, and compared with controls.Methods: This observational study included adult patients newly diagnosedwith epilepsy and drug-naive as well as a control group of healthy subjects. AllPWE and controls underwent a dynamic 24-h EEG with signals for sleep record-ing to evaluate sleep architecture, structure, continuity, and fragmentation.Results: Twenty-four PWE were included and distributed in two groups basedon epilepsy type. Eleven patients were included in the generalized epilepsygroup (63.6% male; 34.91 ± 9.80 years) and 13 patients in the focal epilepsy group(53.8% male; 38.69 ± 12.74 years). The control group included 16 subjects (56.3%male; 32.75 ± 12.19 years). Patients with generalized or focal epilepsy had a sig-nificantly lower sleep efficiency than controls. Moreover, both patient groupspresented the alteration of markers of sleep fragmentation and loss of continuity,with higher indices of sleep stage transitions and arousal. Finally, the two patientgroups presented less REM sleep than controls.Significance: This study highlighted the alteration of sleep quality, continuity,and stability in both patients with focal or generalized epilepsy compared withcontrols, also in the absence of ictal events. This sleep impairment resulted inthe reduction of REM sleep. Therefore, these findings may be explained by theincrease in awakenings and sleep stage shifts, which may be attributed to both