Jacoby Ann, Snape Dee, Lane Steven, Baker Gus A
Department of Public Health and Policy, University of Liverpool, UK.
Department of Public Health and Policy, University of Liverpool, UK.
Epilepsy Behav. 2015 Feb;43:149-58. doi: 10.1016/j.yebeh.2014.09.071. Epub 2015 Jan 16.
Comorbidities are common in epilepsy, and their role in quality of life (QOL) is receiving increasing scrutiny. Considerable attention has been focused on the role of depression, the most common comorbidity, with rather less attention paid to its frequent concomitant, anxiety, and other conditions known to be at increased prevalence among people with epilepsy (PWE) when compared to the general population. In this paper, we report findings from a UK-based survey in which we examined self-reporting of two common comorbidities, anxiety and sleep problems, factors associated with them, and their role in QOL in people with and without epilepsy. Data were obtained via mailed questionnaires, supplemented by an internet survey, from PWE and age- and gender-matched controls. Based on self-reported symptoms, PWE were at higher risk of anxiety and sleep problems. Contributory factors for anxiety included poorer general health, worry about seizures, and self-reported antiepileptic drug (AED) side effects. Good social support emerged as protective for anxiety in PWE. Nighttime sleep problems were very common even in controls but were further elevated in PWE. Antiepileptic drug adverse events emerged as an important contributory factor for sleep problems. Trait anxiety emerged as significant for defining overall QOL, and its importance over state anxiety supports the notion of anxiety in PWE as a primarily premorbid condition. In contrast, sleep quality was not consistently predictive of QOL. Our study has important implications for clinical management, emphasizing the need for a holistic approach to address wider patient-reported problems as well as any epilepsy-specific ones.
共病在癫痫中很常见，其在生活质量（QOL）中的作用正受到越来越多的审视。相当多的注意力集中在最常见的共病——抑郁症的作用上，而对其常见的伴随症状——焦虑，以及与普通人群相比在癫痫患者（PWE）中患病率增加的其他疾病的关注则较少。在本文中，我们报告了一项基于英国的调查结果，在该调查中，我们研究了两种常见共病——焦虑和睡眠问题的自我报告情况、与之相关的因素，以及它们在有癫痫和无癫痫人群生活质量中的作用。数据通过邮寄问卷获得，并辅以网络调查，来自癫痫患者以及年龄和性别匹配的对照组。根据自我报告的症状，癫痫患者出现焦虑和睡眠问题的风险更高。焦虑的促成因素包括总体健康状况较差、对癫痫发作的担忧以及自我报告的抗癫痫药物（AED）副作用。良好的社会支持对癫痫患者的焦虑起到保护作用。夜间睡眠问题即使在对照组中也很常见，但在癫痫患者中更为严重。抗癫痫药物不良事件是睡眠问题的一个重要促成因素。特质焦虑对总体生活质量的定义具有显著意义，其比状态焦虑更重要，这支持了癫痫患者的焦虑主要是病前状况的观点。相比之下，睡眠质量并不能始终如一地预测生活质量。我们的研究对临床管理具有重要意义，强调需要采取整体方法来解决患者报告的更广泛问题以及任何特定于癫痫的问题。
