1161 Sleep Matters: Effect of Habitual Sleep Duration on Epilepsy Outcomes

Abstract Introduction Sleep deprivation is a common seizure trigger in adults with epilepsy (AWE), but studies measuring the effects of total sleep duration on seizures are limited. We examined associations between habitual sleep duration (SD)/sleep disturbance and seizure frequency/severity. Methods We retrospectively analyzed seizure and sleep-related patient-reported outcomes in AWE who reported average nightly Sleep Duration (SD) over the past 4 weeks and completed the Liverpool Seizure Severity Scale (LSSS) during the same period. Seizure outcomes were derived from the LSSS 4-week seizure count and the LSSS total score. SD was modeled continuously and categorically (< 7h, 7-9h, >9h). Mixed-effects Poisson regression modeled seizure counts and log-linear mixed models with continuous scales, with adjustments for age, sex, and race. Results We analyzed 453 observations from 370 AWE (mean age 44.5±15.1 yr; 55.1% female; 80.3% Caucasian). Median SD was 6.0 (IQR 5-8), median LSSS 4-week seizure count was 2.0 (IQR 1-6), and median LSSS total severity score was 47.5 (IQR 30-62.5). SD groups were < 7h (n=269, 59.4%), 7-9h (n=147, 32.5%, and >9h (n=37, 8.2%); those sleeping >9h were younger than < 7h and 7-9h sleepers (38.8±13.7 vs 45.1±13.6 and 45.9±16.3; p=0.027). In the adjusted continuous model, SD was not associated with seizure frequency (RR 1.00, 95% CI 0.97-1.04; p=0.96). When analyzing seizure frequency categorically, adjusted mean seizure counts were 8.39 (4.04-17.46) for < 7h, 9.42 (95% CI 4.50-19.70) for 7-9h, and 13.30 (6.14-28.79) for >9h. Compared with < 7h, seizure frequency was similar in 7–9h (RR 1.12, 95% CI 0.91–1.38; p=0.27), but >9h sleepers had higher seizure frequency than < 7h (RR 1.58, 95% CI 1.14–2.20; p=0.006) and 7–9h (RR 1.41, 95% CI 1.03–1.93; p=0.031). LSSS total scores were not significantly associated with SD. Conclusion Relative to normal habitual SD, long sleep was associated with higher seizure frequency, while short sleepers had similar seizure counts. Seizure severity did not differ between SD groups. This is the largest investigation of SD and seizure outcomes in AWE. These results support expanding sleep education from avoiding sleep deprivation to also avoiding over-sleep as a modifiable strategy to improve seizure control. Support (if any) None