25 Sep Epilepsy and Obstructive Sleep Apnoea (OSA)
How many people have it?
A recent meta-analysis of 26 studies conducted in 2017 concluded that 33.4% of people with epilepsy also had obstructive sleep apnoea. The prevalence of OSA and epilepsy combined was not significantly different with regards to seizure types and the types and number of antiepileptic medications prescribed.
What is Obstructive sleep apnoea?
Obstructive sleep apnoea is sleep disorder where the upper airway narrows or collapses during sleep causing the upper airway to become blocked. The repetitive obstruction of the upper airway causes fragmented sleep and decreased blood oxygen levels.
What is Epilepsy?
Epilepsy is a neurological condition where certain regions of the brain become imbalanced “excited” and “inhibited”, this causes a misfiring of signals resulting in seizures. There are multiple causes for epilepsy such a structural, genetic and metabolic. Seizures present in various forms such as;
- Focal (impaired awareness)
- Clonic (rhythmic jerking of a group of muscles)
- Tonic (muscle contractions/stiffening).
How do they interlink?
There are currently two main hypotheses as to how epilepsy and OSA interrelate.
- The hypoxemia (low blood oxygen) theory: This theory states that the intermittent low oxygen levels created by OSA causes oxidative stress on the cells in the brain. This in turns increases neuron excitability causing seizure activity. However, further study is still required to confirm this theory.
- The sleep fragmentation theory: This theory hypothesises that sleep deprivation/fragmented sleep caused by OSA increases excitability within the brain, with one study showing that sleep deprivation increased the brains excitability. However, once again further research is required to confirm this hypothesis.
Treatment:
If you are a person with epilepsy, it may be worth seeking a referral to a sleep physician to undergo testing for OSA to minimise the risk of nocturnal seizures, as some people are unaware they have seizure activity during sleep. Treatment options may include:
- CPAP devices
- Mandibular splint devices (to treat OSA)
- Antiepileptic medications (to manage epilepsy).
References
Balestrini, S., Arzimanoglou, A., Blümcke, I., Scheffer, I. E., Wiebe, S., Zelano, J., & Walker, M. C. (2021). The aetiologies of epilepsy. Epileptic Disorders, 23(1), 1–16. https://doi.org/10.1684/epd.2021.1255
Goyal, M., Mishra, P., & Jaseja, H. (2023, August 15). Obstructive sleep apnea and epilepsy: understanding the pathophysiology of the comorbidity. https://pmc.ncbi.nlm.nih.gov/articles/PMC10509561/
Lin, Z., Si, Q., & Xiaoyi, Z. (2016). Obstructive sleep apnoea in patients with epilepsy: a meta-analysis. Sleep and Breathing, 21(2), 263–270. https://doi.org/10.1007/s11325-016-1391-3
Natteru, P., Rupareliya, C., Zhou, X., & Bollu, P. C. (2017). Obstructive sleep apnea presenting as non-epileptic spells: a unique combination. Cureus. https://doi.org/10.7759/cureus.1800
Phabphal, K., Sripradit, M., F, G. A., Wongsritrang, K., Chongsuvivatwong, T., Suwanlaong, K., & Sithinamsuwan, P. (2022). Identifying obstructive sleep apnea in patients with epilepsy: A cross-sectional multicenter study. Seizure, 100, 87–94. https://doi.org/10.1016/j.seizure.2022.06.017
Sarmast, S. T., Abdullahi, A. M., & Jahan, N. (2020). Current classification of seizures and epilepsies: scope, limitations and recommendations for future action. Cureus. https://doi.org/10.7759/cureus.10549
Vera-González, A. (2022). Pathophysiological mechanisms underlying the etiologies of seizures and epilepsy. In Exon Publications eBooks. https://doi.org/10.36255/exon-publications-epilepsy-pathopysiology