1162 The Interaction between Refractory Temporal Lobe Epilepsy and Obstructive Sleep Apnea: Beyond the Obvious

Abstract Introduction Sleep-disordered breathing (SDB) is recognized as a relevant comorbidity in epilepsy. Individuals with partial epilepsy may reduce antiepileptic drug (AED) by decreasing seizure susceptibility through improved respiratory stability and reduced sleep fragmentation. Certain AEDs may worsen SDB, and the high prevalence of obstructive sleep apnea (OSA) reported in refractory epilepsy raises important questions regarding causality. Despite growing interest, the mechanisms linking Temporal Lobe Epilepsy (TLE) and SDB remain insufficiently defined. Sudden Unexpected Death in Epilepsy (SUDEP), a major cause of mortality in refractory epilepsy, may also have pathways with sleep-related respiratory dysfunction. We aim to examine the expression of SDB in patients with refractory TLE compared with a matched control group. Methods A cross-sectional study was conducted involving adult patients with refractory TLE and a control group matched by sex and age. Participants were selected through a blinded clinical trial, including individuals who had been seizure-free for at least six months and all patients with confirmed refractory TLE. All subjects underwent neuroimaging and baseline polysomnography. Sleep disorder definitions and PSG scoring followed international standards. Results Twenty-four patients (11 women; mean age 33.8 ± 8.5 years) and 21 controls (9 women; mean age 26.1 ± 9.2 years) were included. Sleep disorders were identified in 41.7% of patients. Among them, SDB occurred in 29.2%, sleep-related movement disorders in 8.3%, and insomnia (sleep efficiency < 80%) in 8.3%. In the control group, SDB was observed in 14.3% and reduced sleep efficiency in 4.8%. Patients with refractory TLE had approximately 2.5 times higher odds of SDB compared with controls; however, the wide confidence interval crossing 1 indicates lack of statistical significance with the current sample size (Fisher’s exact test, p = 0.30; OR 2.47; 95% CI 0.55–11.14). Conclusion These findings underscore the relevance of assessing and treating SDB in epilepsy care. Patients with refractory TLE demonstrated a greater burden of sleep disturbances, including highe but not statistically significant prevalence of SDB. Respiratory instability during sleep may influence the clinical trajectory of TLE through reciprocal interactions with epileptic activity. Early management of sleep disorders may assist in seizure control, improve quality of life, and potentially mitigate SUDEP risk. Support (if any)