Decrease in wearable-based nocturnal sleep efficiency precedes epileptic seizures

Laura Gagliano; Tian Yue Ding; Denahin H Toffa; Laurence Beauregard; Manon Robert; Frédéric Lesage; Mohamad Sawan; Dang K Nguyen; Elie Bou Assi

doi:10.3389/fneur.2022.1089094

Decrease in wearable-based nocturnal sleep efficiency precedes epileptic seizures

Front Neurol. 2023 Jan 11:13:1089094. doi: 10.3389/fneur.2022.1089094. eCollection 2022.

Authors

Laura Gagliano^{1

2}, Tian Yue Ding², Denahin H Toffa², Laurence Beauregard², Manon Robert², Frédéric Lesage¹, Mohamad Sawan^{1

3}, Dang K Nguyen^{2

4}, Elie Bou Assi^{2

4}

Affiliations

¹ Institute of Biomedical Engineering and the Department of Electrical Engineering, Polytechnique Montréal, Montreal, QC, Canada.
² Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CRCHUM), Montreal, QC, Canada.
³ CenBRAIN, Westlake University, Hangzhou, China.
⁴ Department of Neuroscience, Université de Montréal, Montreal, QC, Canada.

Abstract

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.

Keywords: Hexoskin; epilepsy; seizure forecasting; seizure risk; sleep quality (SQ); wearable.

Grants and funding

This work was supported by the Canada Research Chair T2 in Epilepsy and Functional anatomy of the human brain (grant #: 232075), the Canadian Institute of Health Research (CIHR) (grant #: 453544), the Natural Sciences and Engineering Research Council of Canada (NSERC) (grant #: 415079), the Fonds de Recherche du Québec – Nature et Technologies (FRQNT) (grant #: 260530), and the Institute for Data Valorization (IVADO) (grant #: 51628, 3949094496). The funding sources had no involvement in this study.