Decrease in wearable-based nocturnal sleep efficiency precedes epileptic seizures.

Introduction: While it is known that poor sleep is a seizure precipitant, this association remains poorly quantified. This study investigated whether seizures are preceded by significant changes in sleep efficiency as measured by a wearable equipped with an electrocardiogram, respiratory bands, and an accelerometer.
Methods: Nocturnal recordings from 47 people with epilepsy hospitalized at our epilepsy monitoring unit were analyzed (304 nights). Sleep metrics during nights followed by epileptic seizures (24 h post-awakening) were compared to those of nights which were not.
Results: Lower sleep efficiency (percentage of sleep during the night) was found in the nights preceding seizure days ( p < 0.05). Each standard deviation decrease in sleep efficiency and increase in wake after sleep onset was respectively associated with a 1.25-fold (95 % CI: 1.05 to 1.42, p < 0.05) and 1.49-fold (95 % CI: 1.17 to 1.92, p < 0.01) increased odds of seizure occurrence the following day. Furthermore, nocturnal seizures were associated with significantly lower sleep efficiency and higher wake after sleep onset ( p < 0.05), as well as increased odds of seizure occurrence following wake (OR: 5.86, 95 % CI: 2.99 to 11.77, p < 0.001).
Discussion: Findings indicate lower sleep efficiency during nights preceding seizures, suggesting that wearable sensors could be promising tools for sleep-based seizure-day forecasting in people with epilepsy.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2023 Gagliano, Ding, Toffa, Beauregard, Robert, Lesage, Sawan, Nguyen and Bou Assi.)