Effect of positive airway pressure therapy on seizure control in patients with epilepsy and obstructive sleep apnea

Darakul Pornsriniyom; Hu won Kim; James Bena; Noah D Andrews; Douglas Moul; Nancy Foldvary-Schaefer

doi:10.1016/j.yebeh.2014.07.005

Effect of positive airway pressure therapy on seizure control in patients with epilepsy and obstructive sleep apnea

Epilepsy Behav. 2014 Aug:37:270-5. doi: 10.1016/j.yebeh.2014.07.005. Epub 2014 Aug 12.

Authors

Darakul Pornsriniyom¹, Hu won Kim², James Bena³, Noah D Andrews⁴, Douglas Moul⁴, Nancy Foldvary-Schaefer⁵

Affiliations

¹ Cleveland Clinic Neurological Institute, Sleep Disorders and Epilepsy Centers, Cleveland, OH, USA; Sleep Disorders Center, Department of Neurology, Bangkok Hospital Pattaya, Bangkok Hospital Group, Thailand.
² Cleveland Clinic Neurological Institute, Sleep Disorders and Epilepsy Centers, Cleveland, OH, USA; Department of Neurology, Chosun University Hospital, Gwangju, Republic of Korea.
³ Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
⁴ Cleveland Clinic Neurological Institute, Sleep Disorders and Epilepsy Centers, Cleveland, OH, USA.
⁵ Cleveland Clinic Neurological Institute, Sleep Disorders and Epilepsy Centers, Cleveland, OH, USA. Electronic address: foldvan@ccf.org.

PMID: 25117208
DOI: 10.1016/j.yebeh.2014.07.005

Abstract

Previous studies suggest that treatment for obstructive sleep apnea (OSA) in patients with epilepsy can improve seizure control. We investigated the effect of positive airway pressure (PAP) therapy on seizures in adults with epilepsy referred to the Cleveland Clinic for polysomnography (PSG) from 1997 to 2010. Seizure outcome at baseline and 1 year later was compared in patients with no OSA (apnea-hypopnea index [AHI] <5), patients with PAP-treated OSA, and patients with untreated OSA. One hundred thirty-two subjects (age: 40.2±13 (18-76) years, 65.4% female) were included. Seventy-six (57.6%) subjects had OSA; of these, 43 (56.6%) were on PAP therapy, and 33 (43.4%) were not on PAP therapy (either PAP-intolerant or refused therapy). Of the group with PAP-treated OSA, 83.7% were adherent (use ≥4 h/night at least 5 nights/week). The percentage of subjects with ≥50% seizure reduction and the mean percentage of seizure reduction were significantly greater in the group with PAP-treated OSA (73.9%; 58.5%) than in subjects with untreated OSA (14.3%; 17.0%). There were significantly more subjects with successful outcomes (with ≥50% seizure reduction or seizure-free at both baseline and follow-up) in the group with PAP-treated OSA (83.7%) than in the groups with no OSA (53.6%) and untreated OSA (39.4%). After adjusting for age, gender, body mass index, AHI, and epilepsy duration, we found that the odds of successful outcomes in subjects in the group with PAP-treated OSA were 9.9 and 3.91 times those of the groups with untreated OSA and no OSA, respectively. The group with PAP-treated OSA had 32.3 times the odds of having a ≥50% seizure reduction compared with the group with untreated OSA and 6.13 times compared with the group with no OSA. Positive airway pressure therapy appears to produce beneficial effects on seizures in adult patients with epilepsy and OSA.

Keywords: Comorbidities; Epilepsy; Obstructive sleep apnea; Polysomnography; Positive airway pressure therapy; Seizure outcome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Body Mass Index
Continuous Positive Airway Pressure / methods*
Epilepsy / complications
Epilepsy / therapy*
Female
Humans
Male
Middle Aged
Polysomnography
Seizures / therapy*
Sleep Apnea, Obstructive / complications
Sleep Apnea, Obstructive / therapy*
Treatment Outcome