Identification and treatment of obstructive sleep apnea in adults and children with epilepsy: a prospective pilot study.

Abstract Objective To determine the effect of treating obstructive sleep apnea (OSA) on seizure frequency in adults and children with epilepsy in a prospective study. Several case series documented an improvement in seizure control with treatment of coexisting OSA, but published series did not sample a clinic population, were not prospective in design, and did not account for concurrent changes in antiepileptic drug (AED) doses or levels. Patients and methods Adult patients and the parents of pediatric patients seen in the University of Michigan Epilepsy and Pediatric Neurology Clinics were given validated questionnaires. Thirteen adults (aged 20–56) and 5 children (aged 14–17) were selected for polysomnography (PSG) based on frequency of seizures and risk for OSA. Seizure frequency was compared during 8-week baseline and treatment phases and AED levels were done to document stability in medication levels. Results Six of 13 adults and 3 of 5 children met PSG criteria for OSA. Three adults and 1 child were treated with continuous positive airway pressure (CPAP), were tolerant of the device, and had no change in AED doses; all four had at least a 45% reduction in seizure frequency during CPAP treatment. One adult was treated with an oral appliance with a reduction in nocturnal seizures only, and 2 adults and 2 children were intolerant of CPAP. Conclusions Treatment of OSA in patients with epilepsy may improve seizure control and a large randomized placebo-controlled trial appear warranted.