BACKGROUND: While the effects of prolonged sleep deprivation (≥24 h) on seizure occurrence has been thoroughly explored, little is known about the effects of day-to-day variations in the duration and quality of sleep on seizure probability. A better understanding of the interaction between sleep and seizures may help to improve seizure management. METHODS: To explore how sleep and epileptic seizures are associated, we analysed continuous intracranial electroencephalography (EEG) recordings collected from 10 patients with refractory focal epilepsy undergoing ordinary life activities between 2010 and 2012 from three clinical centres (Austin Health, The Royal Melbourne Hospital, and St Vincent's Hospital of the Melbourne University Epilepsy Group). A total of 4340 days of sleep-wake data were analysed (average 434 days per patient). EEG data were sleep scored using a semi-automated machine learning approach into wake, stages one, two, and three non-rapid eye movement sleep, and rapid eye movement sleep categories. FINDINGS: Seizure probability changes with day-to-day variations in sleep duration. Logistic regression models revealed that an increase in sleep duration, by 1·66 ± 0·52 h, lowered the odds of seizure by 27% in the following 48 h. Following a seizure, patients slept for longer durations and if a seizure occurred during sleep, then sleep quality was also reduced with increased time spent aroused from sleep and reduced rapid eye movement sleep. INTERPRETATION: Our results suggest that day-to-day deviations from regular sleep duration correlates with changes in seizure probability. Sleeping longer, by 1·66 ± 0·52 h, may offer protective effects for patients with refractory focal epilepsy, reducing seizure risk. Furthermore, the occurrence of a seizure may disrupt sleep patterns by elongating sleep and, if the seizure occurs during sleep, reducing its quality.

Czech Institute of Informatics Robotics and Cybernetics Czech Technical University Prague Prague Czech Republic

Department of Biomedical Engineering University of Melbourne Melbourne Victoria Australia

Department of Clinical Studies NBC University of Pennsylvania School of Veterinary Medicine Kennett Square PA United States

Department of Data Science and AI Faculty of Information and Technology Monash University Clayton Victoria Australia

Department of Medicine St Vincent's Hospital University of Melbourne Level 4 29 Regent Street Fitzroy Victoria 3065 Australia

Department of Neurology Mayo Clinic Rochester United States

Seer Medical Melbourne Victoria Australia

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Jain S.V., Kothare S.V. Sleep and epilepsy. Semin Pediatr Neurol. 2015;22(2):86–92. [Review] PubMed

Razavi B., Fisher R.S. Sleep and neurologic disease. Academic Press; 2017. Sleep and epilepsy; pp. 129–140.

Voges B.R., Schmitt F.C., Hamel W. Deep brain stimulation of anterior nucleus thalami disrupts sleep in epilepsy patients. Epilepsia. 2015;56:e99–e103. PubMed

Placidi F., Scalise A., Marciani M., Romigi A., Diomedi M., Gigli G. Effect of antiepileptic drugs on sleep. Clin Neurophysiol. 2000;111(2):S115–S1S9. PubMed

Bazil C.W., Castro L.H.M., Walczak T.S. Reduction of rapid eye movement sleep by diurnal and nocturnal seizures in temporal lobe epilepsy. Arch Neurol. 2000;57:363. PubMed

Ellingson R., Wilken K., Bennett D. Efficacy of sleep deprivation as an activation procedure in epilepsy patients. J Clin Neurophysiol Off Publ Am Electroencephalogr Soc. 1984;1:83–101. PubMed

Foldvary-Schaefer N., Grigg-Damberger M. Sleep and epilepsy: what we know, don't know, and need to know. J Clin Neurophysiol. 2006;23:4–20. [Review] PubMed

Cobabe M.M., Sessler D.I., Nowacki A.S., O'Rourke C., Andrews N., Foldvary-Schaefer N. Impact of sleep duration on seizure frequency in adults with epilepsy: a sleep diary study. Epilepsy Behav. 2014;43:143–148. PubMed

Samsonsen C., Sand T., Bråthen G., Helde G., Brodtkorb E. The impact of sleep loss on the facilitation of seizures: a prospective case-crossover study. Epilepsy Res. 2016;127:260–266. PubMed

Haut S.R., Hall C.B., Masur J., Lipton R.B. Seizure occurrence: precipitants and prediction. Neurology. 2007;69:1905–1910. PubMed

Rajna P., Veres J. Correlations between night sleep duration and seizure frequency in temporal lobe epilepsy. Epilepsia. 1993;34:574–579. PubMed

Redline S., Kirchner L., Quan S., Gottlieb D., Kapur V., Newman A. The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture. Arch Intern Med. 2004;164:406–418. PubMed

Guilleminault C., Partinen M., Quera-Salva M., Hayes B., Dement W., Nino-Murcia G. Determinants of daytime sleepiness in obstructive sleep apnea. Chest. 1988;94:32–37. PubMed

Kumar P., Raju T.R. Seizure susceptibility decreases with enhancement of rapid eye movement sleep. Brain Res. 2001;922:299–304. PubMed

Placidi F., Zannino S., Albanese M. Increased cortical excitability after selective REM sleep deprivation in healthy humans: a transcranial magnetic stimulation study. Sleep Med. 2013;14:288–292. PubMed

Bazil C.W., Anderson C.T. Sleep structure following status epilepticus. Sleep Med. 2001;2:447–449. PubMed

Cook M.J., O'Brien T.J., Berkovic S.F. Prediction of seizure likelihood with a long-term, implanted seizure advisory system in patients with drug-resistant epilepsy: a first-in-man study. Lancet Neurol. 2013;12(6):563–571. PubMed

Fisher R., Blum D., DiVentura B. Seizure diaries for clinical research and practice: limitations and future prospects. Epilepsy Behav. 2012;24(3):304–310. PubMed

Ferlisi M., Shorvon S. Seizure precipitants (triggering factors) in patients with epilepsy. Epilepsy Behav. 2014;33:101–105. PubMed

Karoly P.J., Freestone D.R., Boston R. Interictal spikes and epileptic seizures: their relationship and underlying rhythmicity. Brain. 2016;139:1066–1078. PubMed

Nejedly P., Kremen V., Sladky V. Exploiting graphoelements and convolutional neural networks with long short term memory for classification of the human electroencephalogram. Sci Rep. 2019;9:1–9. PubMed PMC

Kremen V., Brinkmann B.J., Van Gompel J., Stead M., St Louis E.K., Worrell G. Automated unsupervised behavioral state classification using intracranial electrophysiology. J Neural Eng. 2019;16:1–8. PubMed

Nejedly P., Kremen V., Sladky V., Cimbalnik J., Klimes P., Plesinger F., Mivalt F., Travnicek V., Viscor I., Pail M., Halamek J., Brinkmann B.H., Brazdil M., Jurak P., Worrell G. Multicenter intracranial EEG dataset for classification of graphoelements and artifactual signals. Sci Data. 2020;7(1):1–7. PubMed PMC

Gerla V., Kremen V., Macas M. Iterative expert-in-the-loop classification of sleep PSG recordings using a hierarchical clustering. J Neurosci Methods. 2019;317:61–70. PubMed

Karoly P.J., Goldenholz D.M., Freestone D.R. Circadian and circaseptan rhythms in human epilepsy: a retrospective cohort study. Lancet Neurol. 2018;17(11):977–985. PubMed

Adams R., Appleton S., Taylor A. Sleep health of Australian adults in 2016: results of the 2016 Sleep Health Foundation national surey. Sleep Health. 2017;3:35–42. PubMed

Merica H., Gaillard J. Internal structure of sleep cycles in a healthy population. Sleep. 1986;9(4):502–513. PubMed

Rossi K., Joe J., Makhika M., Goldenholz D. Insufficient sleep, electroencephalogram activation, and seizure risk: re-evaluating the evidence. Ann Neurol. 2020;87(6):798–806. PubMed

Baud M., Kleen J.K., Mirro E.A. Multi-day rhythms modulate seizure risk in epilespy. Nat Commun. 2018;9(88):1–10. PubMed PMC

Baldy-Moulinier M. Sleep and epilepsy. Academic Press Inc; Orlando: 1982. Temporal lobe epilepsy and sleep organization; pp. 347–359.

Besset A. Sleep and epilepsy. Academic Press Inc; Orlando: 1982. Influence of generalised seizures on sleep organization; pp. 339–346.

Buxton O., Ellenbogen J., Wang W. Sleep disruption due to hospital noises. Ann Intern Med. 2012;157(3):170–179. PubMed

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