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TOPLINE:

Optimal sleep duration, defined as 6-8 hours, was associated with better executive function in adults with focal epilepsy, whereas poor sleep duration was linked to a fivefold greater risk for dementia than healthy individuals with optimal sleep, new research showed.

METHODOLOGY:

• Researchers analyzed data from the UK Biobank cohort study for more than 482,000 individuals aged 38-72 years (mean age, 58 years; 54% women) without dementia at baseline who underwent cognitive and physiologic assessment between 2006 and 2010, with follow-up until 2021. A subsample of more than 42,300 individuals also underwent brain MRI between 2014 and 2020.
• Participants were classified as those with focal epilepsy (n = 3788), those with stroke (n = 6372), and healthy control individuals. Epilepsy was classified as less severe (on a single antiseizure medication) or more severe (on two or more antiseizure medications).
• Computer-based cognitive testing was performed at baseline and repeated at imaging visits. All participants were assessed for the sleep characteristics of duration, obstructive sleep apnea, insomnia, napping, and dozing. A sleep duration of 6-8 hours was considered “optimal,” whereas other durations were considered “poor.”
• Outcomes included risk for all-cause dementia and Alzheimer’s disease, comparison of executive function measures, and total hippocampal and gray matter volumes.

TAKEAWAY:

• Patients with focal epilepsy and poor sleep duration had a higher risk for dementia (hazard ratio [HR], 5.15; P < .001) than healthy control individuals with optimal sleep, whereas those with focal epilepsy and optimal sleep duration had a lower dementia risk (HR, 2.6; P < .001).
• The stroke group also had greater dementia risk for those with suboptimal vs optimal sleep (HR, 3.5; P < .001), as did the healthy control group (HR, 1.4; P < .001).
• Optimal sleep duration showed stronger protective effects on executive function in patients with focal epilepsy than in healthy control individuals (P < .009), but this was not so for the stroke group vs control group.
• More severe epilepsy was associated with worse executive function (P < .03), with optimal sleep modifying this association. Focal epilepsy and poor sleep duration were both linked to reduced hippocampal and total gray matter volume.

IN PRACTICE:

“In the absence of treatment to mitigate cognitive impairment and dementia risk in epilepsy, targeting sleep as a modifiable risk factor could offer an effective and affordable management strategy,” the investigators wrote.

SOURCE:

The study was led by Xin You Tai, University of Oxford, Oxford, England. It was published online on April 22 in Neurology.

LIMITATIONS:

The study relied on hospital records, death certificates, or self-reports, and the database lacked details on the characteristics of epilepsy. Sleep measures were self‑reported rather than recorded using polysomnography or overnight EEG, making them suboptimal proxies for sleep quality. Additionally, the UK Biobank cohort was healthier and less deprived than the general population.

DISCLOSURES:

The study was funded by the Wellcome Trust, the Medical Research Council, and the National Institute for Health Research. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.