Characteristics of refractory vs. medically controlled epilepsy patients with obstructive sleep apnea and their response to CPAP treatment

Obstructive sleep apnea (USA) commonly coexists with epilepsy, and treatment of USA may decrease seizure frequency. However, it is unclear whether patients with medically refractory epilepsy have a higher incidence of USA compared with well-controlled epilepsy patients and whether the two groups carry different risk factors. Purpose: This study aimed to investigate the presence of USA in patients with refractory vs. well-controlled epilepsy and their associated risk factors. We also assessed the benefits of treatment of USA with continuous positive airway pressure (CRAP) in refractory epilepsy patients. Methods: We retrospectively reviewed data from patients who presented to the Jacobs Neurological Institute Comprehensive Epilepsy Center of University at Buffalo from 2007 to 2010. Results: There is a tendency for much higher incidence of USA in our epilepsy population compared with the general population (15.2% vs. 4.41%). For patients with well-controlled epilepsy, older age, male gender, and higher seizure frequency were predictors of a diagnosis of USA. However, in medically refractory epilepsy patients, diabetes and snoring predicted a diagnosis of USA. Treatment of USA with CPAP in refractory epilepsy patients improved their seizure control (p < 0.02). Conclusion: This study confirms that USA is common in epilepsy patients and treatment of USA can improve seizure control in medically refractory cases. Patients with refractory epilepsy who have diabetes are more likely to have USA. (c) 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.