Differences in factors associated with insomnia symptoms between patients with epilepsy with and without depressive symptoms

May 24, 2024Epilepsy & behavior : E&B

Factors linked to insomnia symptoms in epilepsy patients with and without depression

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Abstract

Among 282 adults with epilepsy, 23.4% exhibited depressive symptoms.

Patients with depressive symptoms were significantly more likely to have insomnia, with 56.1% scoring above the threshold for insomnia severity compared to 9.3% of those without depressive symptoms.
Uncontrolled seizures, excessive daytime sleepiness, and a history of psychiatric disorders were identified as significant factors associated with insomnia severity, but only in patients without depressive symptoms.
The use of perampanel was associated with a lower likelihood of severe insomnia in patients with depressive symptoms.
Female sex was associated with a higher likelihood of severe insomnia specifically in patients with depressive symptoms.

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OBJECTIVE: To determine if insomnia-related factors differ depending on the presence of depression in patients with epilepsy.

METHODS: This cross-sectional multicenter study collected data on depressive symptoms, insomnia symptoms, and excessive daytime sleepiness, which were defined as a Patient Health Questionnaire-9 (PHQ-9) score of ≥ 10, an Insomnia Severity Index (ISI) score of ≥ 15, and an Epworth Sleepiness Scale (ESS) of ≥ 11, respectively. Further, uncontrolled seizures were defined as one or more seizures per month during antiseizure medications treatment. A stepwise logistic regression analysis was conducted, with a logistic regression with interaction terms performed to identify differences in insomnia-related factors depending on depressive symptoms.

RESULTS: Of 282 adults with epilepsy (men, 58 %; mean age, 40.4 ± 13.9 years), a PHQ-9 score ≥ 10, an ISI score ≥ 15, an ESS score ≥ 11 were noted in 23.4 % (n = 66), 20.2 % (n = 57), and 12.8 % (n = 36), respectively. More patients with depressive symptoms had an ISI score ≥ 15 (56.1 % vs. 9.3 %; p < 0.001) than those without. In multiple logistic regression, uncontrolled seizures (odds ratio [OR], 4.896; p < 0.01), daytime sleepiness (OR, 5.369; p < 0.05), and a history of psychiatric disorders (OR, 3.971; p < 0.05) were identified as significant factors that were more likely to be associated with an ISI score ≥ 15; however, this was only true in patients without depressive symptoms. In contrast, use of perampanel (OR, 0.282; p < 0.05) was less likely associated, while female sex (OR, 3.178; p < 0.05) was more likely associated with an ISI score ≥ 15 only in patients with depressive symptoms.

CONCLUSIONS: Insomnia-related factors in patients with epilepsy may differ between patients with and without depression. Our findings of different insomnia-related factors based on the presence of depression may facilitate the management of patients with epilepsy.

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Differences in factors associated with insomnia symptoms between patients with epilepsy with and without depressive symptoms

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