Sleep disturbances are common in late‐onset epilepsy of unknown origin

Objective: The bidirectional relationship between epilepsy and sleep is well established. People with epilepsy frequently experience sleep and wake disturbances, which may be more frequent in older adults. With 15%–20% of epilepsy cases presenting as late-onset epilepsy of unknown etiology (LOEU), this study aimed to assess subjective sleep quality and daytime sleepiness in LOEU patients compared to older adults without neurological and psychiatric diseases. Methods: This observational study included 78 LOEU patients (55.1% males, mean age 68.29 ± 8.01 y.o.) diagnosed at Epilepsy Centers in Rome Tor Vergata, Perugia, and Chieti, and 55 older controls (38.2% males, mean age 69.76 ± 14.99 y.o.). Patients and controls completed the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI), and a subgroup of patients also answered the Quality of Life in Epilepsy Inventory (QOLIE-31) and the Beck Depression Inventory-II (BDI-II). Results: Following the adjustment for age and epilepsy centers, LOEU patients showed significantly poorer global sleep quality (p =.046) and lower sleep quality and efficiency (p <.001) compared to controls. ESS scores were similar between groups. Patients with generalized seizures reported lower sleep quality than patients with other types of seizures. BDI-II scores correlated positively with poor sleep quality and negatively with quality of life. Significance: LOEU patients reported lower subjective sleep quality than older controls. Sleep disturbances correlated with depressive symptoms, which in turn were associated with a more impaired quality of life. These findings highlight the importance of addressing sleep issues in this population to prevent seizure recurrence and to improve well-being and quality of life.