Obstructive sleep apnea in people with epilepsy: Modifying risk

Area of Science:

• Neurology
• Sleep Medicine
• Public Health

Background:

• Obstructive sleep apnea (OSA) is prevalent but often overlooked in people with epilepsy (PWE).
• OSA is increasingly recognized as a potential contributor to epilepsy outcomes, not just a comorbidity.
• Associations exist between OSA and increased seizure burden, epileptiform discharges, late-onset epilepsy (LOE), and sudden unexpected death in epilepsy (SUDEP).

Purpose of the Study:

• To critically review the literature on the association between OSA and epilepsy outcomes.
• To evaluate the evidence linking OSA to seizure severity, incident LOE, and SUDEP risk using the Bradford Hill criteria.
• To advocate for viewing OSA as a modifiable risk factor in PWE.

Main Methods:

• A critical literature review was conducted.
• The Bradford Hill criteria for causation were applied to appraise the evidence connecting OSA with seizure severity, incident LOE, and SUDEP risk.
• Limitations such as confounding, bias, and lack of randomized evidence were considered.

Main Results:

• OSA supports eight of the nine Bradford Hill criteria for causation (strength, consistency, temporality, biological gradient, plausibility, coherence, analogy, experiment), though not specificity.
• Evidence suggests OSA may be linked to increased seizure severity, incident LOE, and SUDEP risk.
• Continuous positive airway pressure (CPAP) treatment for OSA may improve seizure control.

Conclusions:

• OSA should be considered a significant, modifiable risk factor for people with epilepsy.
• Systematic screening for OSA and evidence-based treatment should be integrated into routine epilepsy care.
• Further randomized controlled trials are needed to confirm the impact of OSA treatment on epilepsy incidence, severity, and SUDEP.