Correlational study of sleep quality, excessive daytime sleepiness and quality of life in patients with epilepsy

• Main Authors: Ray-Chang Tzeng, 曾瑞昌
• Other Authors: Chung-Yao Hsu
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/50206458274486537903

碩士 === 高雄醫學大學 === 醫學系神經學科碩士班 === 96 === Backgroung: Epilepsy is a chronic neurological disorder caused by abnormal and repetitive electric firing of brain cells. Sleep disturbance (including poor sleep quality, excessive daytime sleepiness and sleep apnea etc.) is common in patients with epilepsy. It could affect their working ability. social activity and quality of life. It may also worsen the course of the disease by increasing the frequency of attack, aggravating cognitive disability and behavior problems. However, there was only a few publications in the literature about it. The influencing factors on the health-related quality of life include frequency of epilepsy, type of epilepsy, side effect of anticonvulsants, change of sleep architecture, and related sleep disorders. Recent studies regarding the quality of sleep and health-related quality of life in patient with epilepsy are inconclusive. It is probably related to the cross-culture difference and different sampling method. The goal of this study was to investigate the difference of sleep quality, excessive daytime sleepiness and health-related quality of life between medically refractory and nonrefractory epilepsy and their correlation. Method: Eighty-eight patients with epilepsy ( 32 refractory and 56 nonrefractory epilepsy patients) were recruited by purposive sampling. The demographic data including sex, age and clinical manifestations including the duration of epilepsy, type of seizure, frequency of seizure within half year, cause of the epilepsy, comorbidity, the anticonvulsant within two months and neuroimage study were collected. After obtaining the informed consent, the patients completed the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS) and the short form-36 survey (SF-36). All patients received electrocephalography (EEG or video EEG monitoring). Twenty five of them also agreed to receive polysomnography (PSG). Forty-six patients with primary insomnia were also recruited for comparison. Result: There was no significant difference on sleep quality and excessive daytime sleepiness between the patients with medically refractory epilepsy (PMRE) and the patients with medically nonrefractory epilepsy (PMNE), but PMRE had relatively poorer sleep quality and more excessive daytime sleepiness than PMNE. In health-related quality of life, PMRE had significantly lower score on social functioning (p<0.001), role limitation due to emotional problems (p=0.016) and mental component summary (MCS) (p=0.019) than PMNE. There was significant correlation between sleep quality and health-related quality of life, especially on the mental health component in PMNE. After adjusting the confounding factors, age (p<0.001), sleep quality (p<0.001) and excessive daytime sleepiness (p=0.017) were independently associated with mental health of health-related quality of life and age (p<0.001) was the only independent factor associated with physical health of health-relted quality of life. In comparison with patients with primary insomnia (PPI), in general the PPI had significantly poorer sleep quality and poorer health-related quality of life than PMRE and PMNE. The PSG study revealed that PMRE had shorter REM sleep than PMNE (P=0.031). Conclusion: In general, PMRE have poorer mental health of health-related quality of life than PMNE. Sleep quality was significantly correlated with the mental component of health-related quality of life, especially in PMNE. The age, sleep quality and excessive daytime sleep were the major influcing factors on mental component of health-related quality of life. The influencing factors on quality of life in patients with epilepsy were different in different publications. The possible reasons were the individual variation ( such as type of seizure, frequency of seizure, age of onset and anticonvulsant) and the corss-cultural difference (such as family support and religious belief) in epilepsy. A large-scaled study should be conducted to clarify these findings.