![]() ![]() Patients 3, 4, 5, 7, and 14 from the original trial were excluded from analyses as we did not have sleep information for these patients. The patient details and recording durations are provided in Table 1. The patient cohort showed a range of demographic and clinical features that is typical of the wider refractory epilepsy population, with a range of aetiologies, and including patients on multiple anti-seizure drugs, as well as patients on minimal therapy. Periods where the external device was not in range of the transmitter or periods where the device was not charged caused dropouts in the data. Fifteen patients with focal epilepsy were implanted with an intracranial EEG device recording at 400 Hz. All patients gave written informed consent before participation in the clinical trial. Patient selection prioritised suitable seizure frequencies (between 2 and 12 per month) and adults with sufficient independence to make the implanted seizure advisory device useful for managing daily activities. The occurrence of a seizure is followed by longer sleep durations and, if a seizure occurs during sleep, sleep quality is reduced with a lower proportion of REM sleep and a greater proportion of time spent in brief arousal. Variability in sleep stage proportions produced variable effects across patients, with no significant change in the odds of a seizure in the following 48 h. Our results demonstrate that an increase in sleep duration is correlated with reduced seizure odds in the following 48 h, which may imply that increased sleep duration offers protective effects. Our objective was to explore and define the bidirectional relationship between seizures and sleep duration and composition. ![]() Recordings were classified into sleep stages and analysed to describe sleep-wake patterns in our patient group. Here, we present the first study using long-term ambulatory intracranial EEG data (spanning several months to years for each patient) to investigate the relationship between sleep and seizures. Existing investigations have either relied on sleep and seizure diaries, which are known to be inaccurate, or on EEG collected within a hospital environment, which is unlikely to be representative of the true relationship between sleep and seizures and whose short-term (<14 days) nature lacks the statistical power for the analyses conducted here. We did not find any longitudinal studies addressing the effects of sleep quality on seizure probability. While many authors accept that sleep has an important impact on seizure propensity, only 4 longitudinal studies have specifically addressed the effects of regular sleep duration variability on seizure likelihood. The bibliographies of relevant reviews and included journal articles were also inspected for additional relevant studies. We used comprehensive search strategies combining terms “epilepsy”, “seizures”, “precipitants”, “sleep”, “deprivation”, “quality”, “composition”, “architecture”, “rapid eye movement”, and “non-rapid eye movement”. We searched the literature for studies on sleep and seizures published in MEDLINE (from 1946 to June, 2020) and Embase (from 1974 to June, 2020).
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