Sleep Disturbances in Patients with Nonepileptic Seizures

Figures & data

Figure 1 Summary of the selection process.

Table 1 Summary of Original Research Studies

Study	Sample Size	Study Design	Methodology	Results
Bazil et al^Citation25	8 females with PNES; 10 females with ES	Comparative prospective study	Objective sleep measures: polysomnography over one night, PNES and ES verified by vEEG	Percentage of REM sleep was significantly higher for women with PNES (23±1%) than those with ES (18±1%).
Latreille et al^Citation51 *	17 with PNES; 10 with ES	Comparative pilot prospective study	Objective sleep measures: vEEG monitoring and actigraphy; Questionnaires: PSQI, ISI, ESS, MEQ, daily sleep diary	Patients with PNES more frequently reported moderate-severe changes in sleep patterns, notably sleeping less than usual, waking up 1–2 h earlier, and having trouble returning to sleep.
Latreille et al^Citation50 *	17 with PNES; 10 with ES	Comparative pilot prospective study	Objective sleep measures: vEEG monitoring and actigraphy; Questionnaires: PSQI, ISI, ESS, MEQ, daily sleep diary	PNES subjects showed greater sleep onset latency (48.7 ± 47.5 min vs 14.0 ± 13.4 min; p = 0.02). PNES subjects reported worse sleep quality (10.8 ± 5.1 vs 5.8 ± 2.9; p = 0.01) and were more likely to meet clinical criteria for insomnia relative to epilepsy subjects (50% vs 10%, p = 0.05)
Thacker et al^Citation52	12 with PNES	Case series study	Objective sleep measures: continuous vEEG monitoring in sleeping patients with PNES	All patients had a well‐organized posterior α rhythm immediately before the onset of clinical changes despite the appearance of sleep.
Bazil & Walczak.^Citation55	1116 seizures (280 PNES) in 188 patients	Retrospectively examined vEEG monitoring	Retrospectively examined video-EEG monitoring	PNES were rare between midnight and 6 a. m. and never occurred during sleep.
Duncan et al^Citation56	142 with PNES; 100 with ES	Comparative prospective study	Semi-structured interview verified by vEEG	84/142 patients with PNES (59%) and 47/100 with epilepsy (47%) gave a history of events during sleep (p = 0.062). In patients with PNES, significant associations were found between a history of sleep events and: convulsive clinical semiology, antiepileptic drug treatment, fatigue, suicide attempts, mood disorder, and physical abuse. A particularly strong association with social security benefit was also found (odds ratio 4.0, p<0.001).
Orbach et al^Citation59	27 subjects	Retrospective study	Objective sleep measures: vEEG; Two epileptologists blindly reviewed cases with suspect PNES together with control cases	In a minority of patients (<1%), PNES began either while the patient was sleeping, or within several awakening seconds.
Graham & Kyle^Citation62	225 patients with PNES; sample recruited online via patient charities (N=205) and a consecutive clinical sample (N=20)	Preliminary cross-sectional analysis;	Questionnaires: SCI, PSQI, Sleep item from the CORE-10, WSAS, GADS, PHQ	Poor sleep was common in both samples (89% in the clinical range) and was characterised by low sleep efficiency (M=65.40%) and low total sleep time (M=6.05h). In regression analysis, sleep quality was negatively associated with FND-related functional impairment, accounting for 16% of the variance and remaining significant after introducing mood variables.
Popkirov et al^Citation67	22 with PNES; 44 with ES	Comparative prospective study	Objective sleep measures: 5-day video EEG recording, polysomnography performed on the third night of monitoring.	9% of patients with ES and 9% of patients with PNES had mild sleep-disordered breathing. 7% of patients with ES and 14% of patients with PNES had mild or moderate OSAS. Time awake after sleep onset was high in both groups. There were no significant differences in sleep architecture between the groups except for a difference in average N3 sleep stage proportion. PLMs were common in both groups, and 27% of patients with PNES had high PLM rates and high arousal indices.

Notes: *The team of Latreille et al published their data in two separate studies (2018, 2019) focused on different outcomes. In the first part, they assessed subjective aspects of the sleep via questionnaires, in the second part objective assessment of sleep architecture was conducted via vEEG.

Abbreviations: vEEG, video electroencephalography; REM, rapid eye movement; PNES, psychogenic nonepileptic paroxysms; ES, epileptic seizures; OSAS, obstructive sleep apneas; PSQI, Pittsburgh Sleep Quality Index; ISI, Insomnia Severity Index, ESS, Epworth Sleepiness Scale, MEQ, Morningness-Eveningness Questionnaire; SCI, Sleep Condition Indicator, WSAS, Work and Social Adjustment Scale; GADS, Generalised Anxiety Disorder Scale, PHQ, Patient Health Questionnaire; PLMs, periodic limb movements.

Bazil CW, Legros B, Kenny E. Sleep structure in patients with psychogenic nonepileptic seizures. Epilepsy Behav. 2003;4(4):395–398. doi:10.1016/S1525-5050(03)00120-3

 Web of Science ®Google Scholar

Latreille V, Baslet G, Sarkis R, Pavlova M, Dworetzky BA. Sleep in psychogenic nonepileptic seizures: time to raise a red flag. Epilepsy Behav. 2018;86:6–8. doi:10.1016/j.yebeh.2018.07.001

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Latreille V, Dworetzky BA, Baslet G, Pavlova M. Sleep disturbances in patients with psychogenic nonepileptic seizures: is it all subjective? A prospective pilot study of sleep-wake patterns. Seizure. 2019;65:124–128. doi:10.1016/j.seizure.2019.01.016

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Thacker K, Devinsky O, Perrine K, Alper K, Luciano D. Nonepileptic seizures during apparent sleep. Ann Neurol. 1993;33:414–418. doi:10.1002/ana.410330417

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Bazil CW, Walczak TS. Effects of sleep and sleep stage on epileptic and nonepileptic seizures. Epilepsia. 1997;38:56–62. doi:10.1111/j.1528-1157.1997.tb01077.x

 PubMed Web of Science ®Google Scholar

Duncan R, Oto M, Russell AJ, Conway P. Pseudosleep events in patients with psychogenic nonepileptic seizures: prevalence and associations. J Neurol Neurosurg Psychiatry. 2004;75(7):1009–1012. doi:10.1136/jnnp.2003.022632

 Web of Science ®Google Scholar

Orbach D, Ritaccio A, Devinsky O. Psychogenic, nonepileptic seizures associated with video-EEG–verified sleep. Epilepsia. 2003;44(1):64–68. doi:10.1046/j.1528-1157.2003.29302.x

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Graham CD, Kyle SD. A preliminary investigation of sleep quality in functional neurological disorders: poor sleep appears common, and is associated with functional impairment. J Neurol Sci. 2017;378:163–166. doi:10.1016/j.jns.2017.05.021

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Popkirov S, Stone J, Derry CP. Abnormal sleep in patients with epileptic or dissociative (nonepileptic) seizures: a polysomnography study. Eur J Neurol. 2019;26(2):255–260. doi:10.1111/ene.13798

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