Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring

Shobi Sivathamboo, Sarah Farrand, Zhibin Chen, Elise J. White, Andrew Andreas Pattichis, Callum Hollis, John Carino, Caitlin J. Roberts, Thomas Minogue, Nigel C. Jones, Raju Yerra, Christopher French, Piero Perucca, Patrick Kwan, Dennis Velakoulis, Terence J. O'Brien, Jeremy Goldin

Research output: Contribution to journalArticleResearchpeer-review

Abstract

OBJECTIVE: To examine the prevalence and risk factors of sleep-disordered breathing (SDB) in individuals with epilepsy and psychogenic nonepileptic seizures (PNES). METHODS: We conducted a cross-sectional study of consecutive patients admitted for inpatient video-EEG monitoring at The Royal Melbourne Hospital, Australia, between December 1, 2011, and July 31, 2017. Participants underwent routine clinical investigations during their monitoring period including polysomnography, neurocognitive testing, and screening instruments of daytime somnolence, sleep quality, and quality of life. RESULTS: Our study population consisted of 370 participants who received a diagnosis of epilepsy (n = 255), PNES (n = 93), or both disorders (n = 22). Moderate to severe SDB (defined by an apnea-hypopnea index ≥15) was observed in 26.5% (98/370) of individuals, and did not differ across subgroups: epilepsy 26.3% (67/255), PNES 29.0% (27/93), or both disorders 18.2% (4/22; p = 0.610). Following adjustment for confounders, pathologic daytime sleepiness predicted moderate to severe SDB in epilepsy (odds ratio [OR] 10.35, 95% confidence interval [CI] 2.09-51.39; p = 0.004). In multivariable analysis, independent predictors for moderate to severe SDB in epilepsy were older age (OR 1.07, 95% CI 1.04-1.10; p < 0.001) and higher body mass index (OR 1.06, 95% CI 1.01-1.11; p = 0.029), and in PNES older age (OR 1.10, 95% CI 1.03-1.16; p = 0.002). CONCLUSION: Polysomnography during inpatient video-EEG monitoring identified a substantial number of patients with undiagnosed SDB. This was remarkable in the subgroup with PNES, who were often female and obese. Identification of risk factors may improve management of SDB in these populations. The association with pathologic daytime sleepiness suggests that SDB may be an important contributor to these common and disabling symptoms in patients with epilepsy.

Original languageEnglish
Pages (from-to)e194-e204
Number of pages11
JournalNeurology
Volume92
Issue number3
DOIs
Publication statusPublished - 15 Jan 2019

Cite this

Sivathamboo, Shobi ; Farrand, Sarah ; Chen, Zhibin ; White, Elise J. ; Pattichis, Andrew Andreas ; Hollis, Callum ; Carino, John ; Roberts, Caitlin J. ; Minogue, Thomas ; Jones, Nigel C. ; Yerra, Raju ; French, Christopher ; Perucca, Piero ; Kwan, Patrick ; Velakoulis, Dennis ; O'Brien, Terence J. ; Goldin, Jeremy. / Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring. In: Neurology. 2019 ; Vol. 92, No. 3. pp. e194-e204.
@article{3fd537d7cdcd4dea9201d4ec67a3cdb0,
title = "Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring",
abstract = "OBJECTIVE: To examine the prevalence and risk factors of sleep-disordered breathing (SDB) in individuals with epilepsy and psychogenic nonepileptic seizures (PNES). METHODS: We conducted a cross-sectional study of consecutive patients admitted for inpatient video-EEG monitoring at The Royal Melbourne Hospital, Australia, between December 1, 2011, and July 31, 2017. Participants underwent routine clinical investigations during their monitoring period including polysomnography, neurocognitive testing, and screening instruments of daytime somnolence, sleep quality, and quality of life. RESULTS: Our study population consisted of 370 participants who received a diagnosis of epilepsy (n = 255), PNES (n = 93), or both disorders (n = 22). Moderate to severe SDB (defined by an apnea-hypopnea index ≥15) was observed in 26.5{\%} (98/370) of individuals, and did not differ across subgroups: epilepsy 26.3{\%} (67/255), PNES 29.0{\%} (27/93), or both disorders 18.2{\%} (4/22; p = 0.610). Following adjustment for confounders, pathologic daytime sleepiness predicted moderate to severe SDB in epilepsy (odds ratio [OR] 10.35, 95{\%} confidence interval [CI] 2.09-51.39; p = 0.004). In multivariable analysis, independent predictors for moderate to severe SDB in epilepsy were older age (OR 1.07, 95{\%} CI 1.04-1.10; p < 0.001) and higher body mass index (OR 1.06, 95{\%} CI 1.01-1.11; p = 0.029), and in PNES older age (OR 1.10, 95{\%} CI 1.03-1.16; p = 0.002). CONCLUSION: Polysomnography during inpatient video-EEG monitoring identified a substantial number of patients with undiagnosed SDB. This was remarkable in the subgroup with PNES, who were often female and obese. Identification of risk factors may improve management of SDB in these populations. The association with pathologic daytime sleepiness suggests that SDB may be an important contributor to these common and disabling symptoms in patients with epilepsy.",
author = "Shobi Sivathamboo and Sarah Farrand and Zhibin Chen and White, {Elise J.} and Pattichis, {Andrew Andreas} and Callum Hollis and John Carino and Roberts, {Caitlin J.} and Thomas Minogue and Jones, {Nigel C.} and Raju Yerra and Christopher French and Piero Perucca and Patrick Kwan and Dennis Velakoulis and O'Brien, {Terence J.} and Jeremy Goldin",
year = "2019",
month = "1",
day = "15",
doi = "10.1212/WNL.0000000000006776",
language = "English",
volume = "92",
pages = "e194--e204",
journal = "Neurology",
issn = "0028-3878",
publisher = "AAN Enterprises",
number = "3",

}

Sivathamboo, S, Farrand, S, Chen, Z, White, EJ, Pattichis, AA, Hollis, C, Carino, J, Roberts, CJ, Minogue, T, Jones, NC, Yerra, R, French, C, Perucca, P, Kwan, P, Velakoulis, D, O'Brien, TJ & Goldin, J 2019, 'Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring' Neurology, vol. 92, no. 3, pp. e194-e204. https://doi.org/10.1212/WNL.0000000000006776

Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring. / Sivathamboo, Shobi; Farrand, Sarah; Chen, Zhibin; White, Elise J.; Pattichis, Andrew Andreas; Hollis, Callum; Carino, John; Roberts, Caitlin J.; Minogue, Thomas; Jones, Nigel C.; Yerra, Raju; French, Christopher; Perucca, Piero; Kwan, Patrick; Velakoulis, Dennis; O'Brien, Terence J.; Goldin, Jeremy.

In: Neurology, Vol. 92, No. 3, 15.01.2019, p. e194-e204.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Sleep-disordered breathing among patients admitted for inpatient video-EEG monitoring

AU - Sivathamboo, Shobi

AU - Farrand, Sarah

AU - Chen, Zhibin

AU - White, Elise J.

AU - Pattichis, Andrew Andreas

AU - Hollis, Callum

AU - Carino, John

AU - Roberts, Caitlin J.

AU - Minogue, Thomas

AU - Jones, Nigel C.

AU - Yerra, Raju

AU - French, Christopher

AU - Perucca, Piero

AU - Kwan, Patrick

AU - Velakoulis, Dennis

AU - O'Brien, Terence J.

AU - Goldin, Jeremy

PY - 2019/1/15

Y1 - 2019/1/15

N2 - OBJECTIVE: To examine the prevalence and risk factors of sleep-disordered breathing (SDB) in individuals with epilepsy and psychogenic nonepileptic seizures (PNES). METHODS: We conducted a cross-sectional study of consecutive patients admitted for inpatient video-EEG monitoring at The Royal Melbourne Hospital, Australia, between December 1, 2011, and July 31, 2017. Participants underwent routine clinical investigations during their monitoring period including polysomnography, neurocognitive testing, and screening instruments of daytime somnolence, sleep quality, and quality of life. RESULTS: Our study population consisted of 370 participants who received a diagnosis of epilepsy (n = 255), PNES (n = 93), or both disorders (n = 22). Moderate to severe SDB (defined by an apnea-hypopnea index ≥15) was observed in 26.5% (98/370) of individuals, and did not differ across subgroups: epilepsy 26.3% (67/255), PNES 29.0% (27/93), or both disorders 18.2% (4/22; p = 0.610). Following adjustment for confounders, pathologic daytime sleepiness predicted moderate to severe SDB in epilepsy (odds ratio [OR] 10.35, 95% confidence interval [CI] 2.09-51.39; p = 0.004). In multivariable analysis, independent predictors for moderate to severe SDB in epilepsy were older age (OR 1.07, 95% CI 1.04-1.10; p < 0.001) and higher body mass index (OR 1.06, 95% CI 1.01-1.11; p = 0.029), and in PNES older age (OR 1.10, 95% CI 1.03-1.16; p = 0.002). CONCLUSION: Polysomnography during inpatient video-EEG monitoring identified a substantial number of patients with undiagnosed SDB. This was remarkable in the subgroup with PNES, who were often female and obese. Identification of risk factors may improve management of SDB in these populations. The association with pathologic daytime sleepiness suggests that SDB may be an important contributor to these common and disabling symptoms in patients with epilepsy.

AB - OBJECTIVE: To examine the prevalence and risk factors of sleep-disordered breathing (SDB) in individuals with epilepsy and psychogenic nonepileptic seizures (PNES). METHODS: We conducted a cross-sectional study of consecutive patients admitted for inpatient video-EEG monitoring at The Royal Melbourne Hospital, Australia, between December 1, 2011, and July 31, 2017. Participants underwent routine clinical investigations during their monitoring period including polysomnography, neurocognitive testing, and screening instruments of daytime somnolence, sleep quality, and quality of life. RESULTS: Our study population consisted of 370 participants who received a diagnosis of epilepsy (n = 255), PNES (n = 93), or both disorders (n = 22). Moderate to severe SDB (defined by an apnea-hypopnea index ≥15) was observed in 26.5% (98/370) of individuals, and did not differ across subgroups: epilepsy 26.3% (67/255), PNES 29.0% (27/93), or both disorders 18.2% (4/22; p = 0.610). Following adjustment for confounders, pathologic daytime sleepiness predicted moderate to severe SDB in epilepsy (odds ratio [OR] 10.35, 95% confidence interval [CI] 2.09-51.39; p = 0.004). In multivariable analysis, independent predictors for moderate to severe SDB in epilepsy were older age (OR 1.07, 95% CI 1.04-1.10; p < 0.001) and higher body mass index (OR 1.06, 95% CI 1.01-1.11; p = 0.029), and in PNES older age (OR 1.10, 95% CI 1.03-1.16; p = 0.002). CONCLUSION: Polysomnography during inpatient video-EEG monitoring identified a substantial number of patients with undiagnosed SDB. This was remarkable in the subgroup with PNES, who were often female and obese. Identification of risk factors may improve management of SDB in these populations. The association with pathologic daytime sleepiness suggests that SDB may be an important contributor to these common and disabling symptoms in patients with epilepsy.

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U2 - 10.1212/WNL.0000000000006776

DO - 10.1212/WNL.0000000000006776

M3 - Article

VL - 92

SP - e194-e204

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 3

ER -