Severity of self-reported insomnia in adults with epilepsy is related to comorbid medical disorders and depressive symptoms

May 14, 2016Epilepsy & behavior : E&B

Insomnia severity in adults with epilepsy is linked to other health problems and depression

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Abstract

Sixty-five point five percent of adults with epilepsy reported insomnia, with 28.9% experiencing moderate to severe insomnia.

Good agreement was found between standard clinical diagnostic criteria for insomnia and the Insomnia Severity Index in patients with low and high ISI scores.
Significant relationships were observed between insomnia severity and depression scores as well as self-reported total sleep duration.
Multiple regression analysis identified predictors of higher insomnia severity scores, including decreased total sleep duration, head trauma, sedative-hypnotic use, AED polytherapy, and asthma/COPD.
In patients with focal epilepsy, increased depressive symptoms, decreased total sleep duration, asthma/COPD, and history of epilepsy surgery were significant predictors of higher insomnia severity.
A trend indicated that patients with temporal lobe epilepsy may experience greater insomnia severity compared to those with extra-temporal lobe epilepsy.

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BACKGROUND: Few studies have systematically investigated insomnia in adults with epilepsy.

METHODS: We performed a prospective cross-sectional investigation of the prevalence, severity, and comorbidities of insomnia in 90 adults with epilepsy using a battery of self-reported instruments and polysomnography. We quantified insomnia severity using the Insomnia Severity Index (ISI).

RESULTS: Fifty-nine of 90 (65.5%) adults with epilepsy reported insomnia (ISI≥8), moderate or severe (ISI≥15) in 28.9%. Good agreement between standard clinical diagnostic criteria and ISI was found for patients with ISI scores <8 and ≥15. Scores on the modified Beck Depression Inventory (mBDI) (r=0.25, p=0.021), the original BDI (r=0.32, p=0.002), and self-reported total sleep duration (TSD) (r=-0.3, p=0.006) were significantly related to ISI score. A multiple regression model found that decreased TSD (ß=-0.93, p=0.007), head trauma (ß=4.37, p=0.003), sedative-hypnotic use (ß=4.86, p=0.002), AED polytherapy (ß=3.52, p=0.005), and asthma/COPD (ß=3.75, p=0.014) were predictors of a higher ISI score. For 63 patients with focal epilepsy, an increased mBDI (ß=0.24, p=0.015), decreased TSD (ß=-1.11, p=0.008), asthma/COPD (ß=4.19, p=0.02), and epilepsy surgery (ß=5.33, p=0.006) were significant predictors of an increased ISI score. Patients with temporal lobe epilepsy (TLE) showed a trend for greater severity compared with those with extra-TLE (ß=-2.92, p=0.054).

CONCLUSIONS: Our findings indicate that severity of insomnia in adults with epilepsy is more likely to be associated with comorbid medical and depressive symptoms and less likely to be directly related to epilepsy. Good agreement between standard clinical diagnostic criteria for insomnia and the ISI for subjects without insomnia symptoms and for those with moderate-to-severe symptoms supports the use of this instrument in epilepsy research.

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Severity of self-reported insomnia in adults with epilepsy is related to comorbid medical disorders and depressive symptoms

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