CPAP therapy improved sleep and reduced seizures in a young, obese epileptic woman with OSA

Introduction: Sleep disorders and epilepsy are both common diseases in the general population. Comorbidity between obstructive sleep apnea syndrome (OSAS) and epilepsy varies from 8% to 76%, with a recent meta-analysis reporting a 33.4% prevalence of mild-to-severe OSAS in epileptic patients. Case report: We describe the case of a 39 year old woman, non-smoker, suffering from temporal lobe epilepsy; she was diagnosed in 2018 upon experiencing her first nocturnal tonic-clonic seizure. She also suffers from hyperinsulinism and obesity (BMI: 36.3). In 2020, she came to our Sleep Clinic because of excessive daytime sleepiness (EDS). At that time, she was on Lacosamide (LAC) 150 mg twice daily with partial control of her seizures. Her EEG showed bi-temporal interictal epileptiform discharges (IEDs) during wake and sleep, more evident over the right hemisphere. Cardiorespiratory monitoring revealed an apneic/hypopneic index (AHI) of 28.9, indicative of moderate to severe OSAS. She was subsequently titrated on CPAP and is currently on CPAP at 9 cmH2O with complete resolution of EDS and apneic episodes. Disappearance of IEDs during sleep was observed at her check-up in 2022, and LAC was reduced to 50 mg twice a day. Her CPAP compliance is still excellent. Conclusion: We report a case of a young, obese epileptic woman with persistent seizures despite antiseizure medication. Interestingly, CPAP treatment alone led to EEG normalization with no further seizure recurrence, suggesting a potentially beneficial role of CPAP on both sleep and epilepsy.