To determine the prevalence of sleep central apnea in individuals with intractable epilepsy and psychogenic nonepileptic seizures (PNES) and to assess its relationship with generalized convulsive seizures (GCS) peri-ictal breathing dysfunction.

Intractable epilepsy is associated with a risk for sudden unexpected death in epilepsy (SUDEP). The clear pathologic mechanisms of SUDEP is unknown, although it is thought to be a heterogeneous phenomenon. Studies have shown that breathing dysfunction may be a comorbidity in epilepsy and is associated with an increased risk of SUDEP. 

We conducted a prospective analysis of video-EEG evaluations of patients ≥ 18 years old. We only included patients with thoracic and abdominal belts during admission. Among patients with epilepsy, we only included patients with recorded GCS. Patients with diagnoses of both epilepsy and PNES were excluded. We collected central apnea index during sleep, as well as maximal apnea duration. In patients with GCS, presence of ictal central apnea and post-ictal central apnea were evaluated. The presence of respiratory and cardiac comorbidities as well as use of serotonin and noradrenaline reuptakes inhibitors and benzodiazepines were also collected.

We enrolled 49 intractable epilepsy patients with monitored GCS and 31 patients with PNES. The mean age of the 80 patients in the study was 39.78±14.31. Difference in central apnea index between epilepsy and PNES groups was not statistically significant (p = 0.427). In the GCS group, there is no association between inter-ictal central apnea and pre-ictal or post-ictal apnea (p =0.908, p=0.234).

Sleep central apnea in epileptic patient is as common as in psychogenic nonepileptic seizure patients. There is no difference regarding prevalence of sleep central apnea among epileptic and non-epileptic patients. Larger prospective studies are needed to validate this finding.