Sleep apnea, hypoxia, and late-onset epilepsy: the Atherosclerosis Risk in Communities study

Christopher M Carosella; Rebecca F Gottesman; Anna Kucharska-Newton; Pamela L Lutsey; Adam P Spira; Naresh Punjabi; Andrea L C Schneider; Kelsie M Full; Emily L Johnson

doi:10.1093/sleep/zsad233

Sleep apnea, hypoxia, and late-onset epilepsy: the Atherosclerosis Risk in Communities study

Sleep. 2023 Sep 6:zsad233. doi: 10.1093/sleep/zsad233. Online ahead of print.

Authors

Christopher M Carosella¹, Rebecca F Gottesman², Anna Kucharska-Newton^{3

4}, Pamela L Lutsey⁵, Adam P Spira^{6

7

8}, Naresh Punjabi⁹, Andrea L C Schneider^{10

11}, Kelsie M Full⁵, Emily L Johnson¹

Affiliations

¹ Johns Hopkins School of Medicine, Department of Neurology, Baltimore, MD, USA.
² National Institutes of Health, National Institute for Neurologic Disorders and Stroke Intramural Research Program, Bethesda, MD, USA.
³ University of North Carolina, Department of Epidemiology, Chapel Hill, NC, USA.
⁴ University of Kentucky, Department of Epidemiology, Lexington, KY, USA.
⁵ University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA.
⁶ Johns Hopkins School of Public Health, Department of Mental Health, Baltimore, MD, USA.
⁷ Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences.
⁸ Johns Hopkins Center on Aging and Health, Baltimore, MD, USA.
⁹ University of Miami, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Miami, FL, USA.
¹⁰ University of Pennsylvania, Department of Neurology, Philadelphia, PA, USA.
¹¹ University of Pennsylvania, Department of Biostatistics, Epidemiology, and Informatics Philadelphia, PA, USA.

PMID: 37672002
DOI: 10.1093/sleep/zsad233

Abstract

Study objective: Sleep apnea is associated with unexplained epilepsy in older adults in small studies. We sought to determine the relationship between sleep apnea and additional sleep characteristics and late-onset epilepsy, adjusting for comorbidities, using data from the large, prospective Atherosclerosis Risk in Communities (ARIC) Study cohort.

Methods: We used Medicare claims to identify cases of late-onset epilepsy (LOE) in ARIC participants. We used polysomnography data from 1309 ARIC participants who also participated in the Sleep Heart Health Study in 1995-1998, and demographic and comorbidity data from ARIC. Later risk of LOE was evaluated using survival analysis with a competing risk of death. We also used survival analysis in 2672 ARIC participants to identify the association between self-reported obstructive sleep apnea (2011-2013), and the risk of subsequent LOE.

Results: Late-midlife oxygen desaturation to less than 80% during sleep was associated with subsequent development of LOE, adjusted subhazard ratio 3.28 (1.18-9.08), but the apnea-hypopnea index was not related. Participant report of diagnosis of sleep apnea in 2011-2013 was also associated with subsequent LOE, adjusted subhazard ratio 2.59 (1.24-5.39).

Conclusions: Sleep apnea and oxygen saturation nadir during sleep are associated with LOE, independently of hypertension and other comorbidities. These potentially modifiable risk factors could have large clinical implications for LOE.

Keywords: Epilepsy; Hypoxia; Late Onset Epilepsy; Sleep Apnea.

Abstract

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