Sleep quality and its correlates in people with epilepsy: A multicenter cross-sectional study in Germany

Sleep disturbances and epilepsy are closely interrelated. This study aimed to examine associations between sleep quality, affective symptoms, and quality of life (QoL) in people with epilepsy (PWE), and to identify clinical and sociodemographic factors linked to impaired sleep.

We conducted a multicenter cross-sectional study of adult PWE across four tertiary epilepsy centers in Germany. We assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI), affective symptoms with the Hospital Anxiety and Depression Scale (HADS), and epilepsy-specific QoL with the 31-item Quality of Life in Epilepsy (QOLIE-31) inventory. We evaluated sociodemographic and clinical predictors of sleep quality and QoL using univariable and multivariable analyses. Comparisons were made with normative data from the general German population and individuals with chronic migraine.

Of 449 individuals (mean age 39.9 years, 58.1% women), 221 (49.2%) were identified as "poor sleepers," significantly exceeding rates in the general population (35.9%, p < .001). In multivariable analysis, poor sleep quality was independently associated with female sex (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.36-3.01, p = .001), unemployment (OR 1.74, 95% CI = 1.10-2.73, p = .017), anxiety (OR = 3.79, 95% CI = 2.39-6.04, p < .001), and depression (OR = 2.19, 95% CI = 1.36-3.54, p = .001). In addition, daily seizures were linked to worse sleep quality (OR = 2.55, 95% CI = 1.03-6.30, p = .042). Poor sleep was independently associated with lower epilepsy-related QoL after adjusting for affective symptoms and seizure frequency (OR = 1.79, 95% CI = 1.20-2.68, p = .005).

Sleep quality in PWE is significantly impaired and strongly associated with anxiety, depression, and sociodemographic variables in addition to epilepsy-specific factors. Poor sleep independently correlates with diminished QoL, supporting the value of routine screening for affective symptoms and sleep disturbances in epilepsy care.