Does Treating Sleep Apnea Improve Seizure Outcomes?

WASHINGTON, DC—Treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) is associated with better one-year seizure outcomes in patients with epilepsy, according to a study presented at the 71st Annual Meeting of the American Epilepsy Society.

Prior research has suggested that sleep disturbances are more common in people with epilepsy than in age-matched controls and that more than 40% of people with epilepsy have OSA. PAP therapy has been associated with seizure reduction in small case series.

To compare long-term seizure control between patients with PAP-treated OSA, patients with untreated OSA, and patients without OSA, Thapanee Somboon, MD, a research fellow at the Sleep Disorders Center at Cleveland Clinic, and colleagues conducted a retrospective study of adults with epilepsy who underwent polysomnography at Cleveland Clinic between 1997 and 2015. Researchers compared patients’ seizure outcomes at one, three, and five years after polysomnography.

Thapanee Somboon, MD

The study included 197 people with epilepsy, 122 of whom had OSA (ie, an apnea–hypopnea index of 5 or greater). Of the patients with OSA, 73 received PAP therapy. Mean age was about 44, 58% were female, and 70% had focal epilepsy. Patients with OSA were more likely to be older, have a higher BMI, and be male than those without OSA.

At one year, 63% of patients treated with PAP had a 50% or greater reduction in seizures from baseline, compared with 14% of patients with OSA who were not treated and 44% of patients who did not have OSA. Researchers also assessed successful seizure outcomes, which were defined as not having seizures at baseline and remaining seizure-free for a year, or having seizures at baseline but reporting a 50% or greater reduction in seizures over one year. Successful outcomes occurred in 85% of patients who were treated with PAP, 55% of patients with OSA who were untreated, and 65% of patients who did not have OSA.

After adjusting for baseline seizure freedom and antiepileptic drug standardized dose, patients with treated OSA remained more likely to have successful outcomes at one year. Comparisons at three and five years included fewer patients, and the differences at those time points were not statistically significant.

—Jake Remaly