Sleep Disorders and Psychiatry

Biography

A Voitiuk has graduated from Kharkiv National Medical University in 2013 with major in General Medicine. From 2013 till 2015 she studied as a Postgraduate student in Neurology at Kharkiv Medical Academy of Post-Graduate Education. During her residency she has shown interest and enthusiasm in treating patients with disorder of cerebral circulation, epilepsy and spinal diseases. She studied at the EAN Spring School and got a certificate about finishing in 2017. Currently she is a qualified Neurologist. She is an active participant in case report discussions and always ready to suggest original solutions. She takes active part in scientific conferences and has scientific publication.

 

Abstract

Introduction: Epilepsy is closely connected with the sleep-wake cycle: the disease often causes sleep disorder and its structure and this, in turn, worsens epilepsy. Sleep disorders often provoke the appearance of various paroxysmal conditions, which are then difficult to differentiate from epileptic phenomena. The objective of this study is to determine the nature of paroxysmal disorders occurring during sleep, and study the impact of antiepileptic drugs (AEDs) on sleep architecture.

 

Methods: Studies were conducted on the basis of the analysis of clinical symptoms and instrumental studies. EEG, EEG-video monitoring and polysomnography were used as screening methods.

 

Results: Data analysis of 300 patients aged 18-55 revealed the presence of epileptiform (25%) and non-epileptiform phenomena (28%), among which there were present parasomnias (somnambulism, nightmares, bruxism) – 5% and dyssomnias (difficulty falling asleep, frequent nocturnal awakenings, hypersomnia) – 23%. 10% of patients had a combination of both non-epileptiform and epileptiform phenomena, which greatly hampered the diagnosis. Fifteen patients (5%) didn’t have any sleep disorders. In the study of 137 patients with epilepsy during an inter-paroxysmal period, EEG showed certain increase in the number of "sleep spindles" and their high synchronization (amplitude, duration) in comparison with 163 patients with wakeful epilepsy. The influence of AEDs on sleep structure cannot be excluded either. In patients receiving carbamazepine (7%), the REM-sleep phase decreased, especially at the beginning of treatment. In patients treated with valproate (5%), the 1^st stage of sleep increased while the clinical course of obstructive sleep apnea worsened as a result of side effects. In patients taking lamotrigine (3%), the slow-wave sleep stage decreased, while in patients treated with levetiracetam (8%), sleep continuity improved and there was some increase in the slow-wave stage.

 

Conclusion: The study revealed that sleep disorders in patients with epilepsy are observed in 53% of cases. AEP affects the structure and quality of sleep. The differential diagnosis of epileptic and non-epileptic sleep disorders has a lot of problems in clinical practice. Adequate assessment of the syndrome is essential for developing optimal treatment strategies.