Sleep disturbances are common in late-onset epilepsy of unknown origin

The bidirectional relationship between epilepsy and sleep is well established. People with epilepsy frequently experience sleep and wake disturbances, which may be more frequent in older adults. With 15%-20% of epilepsy cases presenting as late-onset epilepsy of unknown etiology (LOEU), this study aimed to assess subjective sleep quality and daytime sleepiness in LOEU patients compared to older adults without neurological and psychiatric diseases.

This observational study included 78 LOEU patients (55.1% males, mean age 68.29 ± 8.01 y.o.) diagnosed at Epilepsy Centers in Rome Tor Vergata, Perugia, and Chieti, and 55 older controls (38.2% males, mean age 69.76 ± 14.99 y.o.). Patients and controls completed the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI), and a subgroup of patients also answered the Quality of Life in Epilepsy Inventory (QOLIE-31) and the Beck Depression Inventory-II (BDI-II).

Following the adjustment for age and epilepsy centers, LOEU patients showed significantly poorer global sleep quality (p = .046) and lower sleep quality and efficiency (p < .001) compared to controls. ESS scores were similar between groups. Patients with generalized seizures reported lower sleep quality than patients with other types of seizures. BDI-II scores correlated positively with poor sleep quality and negatively with quality of life.

LOEU patients reported lower subjective sleep quality than older controls. Sleep disturbances correlated with depressive symptoms, which in turn were associated with a more impaired quality of life. These findings highlight the importance of addressing sleep issues in this population to prevent seizure recurrence and to improve well-being and quality of life.