A non-epileptic attack disorder is associated with poor quality sleep

Patient-reported sleep disorders should be carefully considered clinically in patients with non-epileptic seizure disorder (NEAD), as these patients were found to have poor sleep during a 6-night sleep study according to the study results published in Epilepsy and Behavior.

Study researchers recruited participants (n = 17) with NEAD and control group participants (n = 20) from the National Health Service in the UK for this 6-night study of objective sleep variables, next-day functioning and seizures. The research team objectively assessed participants using the Actiwatch, a wrist-worn device used to monitor activity, wakefulness, and sleep, and also assessed them using validated instruments. The participants kept a sleep and mood journal with subjective findings.

Participants with NEAD had a median of 8 (interquartile range) [IQR], 18.75) attacks per month.

Participants with NEAD and participants in the control group differed significantly with regard to the Pittsburgh sleep quality index (PSQI; d, 0.80; P = 0.000), the dissociative experience scale II (DES-II; d, 0.72; P = 0.000) and the generalized anxiety disorder 7 (GAD7; d, 0.76; P = 0.000) and patient health questionnaire 9 (PHQ9; d, 0.84; P = 0.000).

During the experiment, participants with NEAD had poorer sleep quality (d, 0.57; P = 0.000), greater sleep latency (d, 0.52; P = 0.023), and decreased sleep efficiency (d, 0.41; P = 0.027 ), increased wakefulness after the onset of sleep (d, 0.43; P = 0.030) and more awakening (d, 0.43; P = 0.042) than control group participants.

During the week, participants in the control group had significantly higher reports of positive effects (t[31]-2.9; P £ .01) and the participants with NEAD had more reports of dissociations (t[18.8]6.9; P £ 0.001).

Daily seizures occurred in patients with NEAD during the study period (mean 1.1; standard deviation) [SD]1.7). Attacks were associated with increased sleep hours (odds ratio) [OR]2.78; 95% Cl, 1.2-10.6; P <0.05) and decreased awakening (per event: OR 0.8; 95% CI 0.6-0.9; P <0.05).

This study was limited due to its small sample size and insufficient statistical analysis.

These results suggest that participants with NEAD had poorer sleep and mood compared to members of the control group. Significant associations between total sleep time and awakening and the likelihood of seizures indicated an important clinical relationship between NEAD and sleep.

Additional higher-performance studies are needed to better assess the clinical impact of sleep quality in patients with NEAD.


Mousa S., Latchford G., Weighall A. et al. Evidence for an objective sleep disorder in non-epileptic seizure disorders: a naturalistic prospectively controlled study using actigraphy and daily sleep diaries for six nights. Epilepsy Behavior Published online March 5, 2021. doi: 10.1016 / j.yebeh.2021.107867

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