2026 American Academy of Neurology Abstract Website

Objective:

To examine associations between obstructive sleep apnea (OSA) severity and seizure frequency/severity in adults with epilepsy (AWE).

Background:

OSA is among the most common comorbidities in AWE. Studies exploring the relationship between OSA measured by in-lab polysomnography (PSG) and seizure outcomes are conflicting and based on small samples.

Design/Methods:

A total of 1048 AWE with completed PSG and the Liverpool Seizure Severity Scale (LSSS) were included. Seizure frequency was defined as the number of seizures excluding auras in the preceding 4 weeks. OSA was defined as having an apneas-hypopnea index (AHI) ≥5. AHI was categorized as no-OSA (<5), mild (5- <15), moderate: (15- <30), and severe (≥30) OSA. Categorical variables were compared using chi-square tests; continuous or ordinal variables with Wilcoxon or Kruskal-Wallis tests. Spearman correlations measured the association between AHI and LSSS severity.

Results:

Of 1,048 participants, 553 (52.8%) had OSA. Patients with OSA were older (50.1 ± 15.1 vs 42.9 ± 16.5 years, p<0.001), had higher BMI (33.9 ± 9.3 vs. 30.8 ± 8.1 kg/m2, p<0.001), and more likely to be male (40.9% vs. 28.5%, p<0.001) than those without OSA. Monthly seizure frequency in patients with OSA was 0.00 [0.00, 1.00] vs no-OSA 0.00 [0.00, 2.00] (p<0.64). LSSS score was 47.5 [35.0, 6.00] vs 51.3 [35.0, 67.5] in patients with OSA and no-OSA, respectively (p<0.47). Seizure frequency and LSSS scores did not differ by AHI category (p=0.41/0.53, respectively). No correlation between AHI and LSSS was found [ρ = -0.10 (-0.24, 0.05), p=0.20].

Conclusions:

In this largest, single-center cohort of AWE with PSG, OSA was associated with age, BMI and gender as seen in the general population, but not with seizure frequency or severity. Given the known adverse health outcomes of untreated OSA, screening should be considered in all AWE regardless of seizure control.