LAUSR

This study provides helpful data on the risk of further sleep and awake seizures after an initial sleep seizure.1 However, one of the possible major risk factors influencing this occurrence was not discussed. Sleep apnea is frequently undiagnosed and increasingly common, with rising rates of obesity. I have seen several patients with new onset severe sleep apnea (apnea hypopnea index >30 and severe hypoxemia <80%) and nocturnal seizures who become seizure free when treated with a continuous positive airway pressure and no antiseizure medication. Manni et al.2 found older age at seizure onset was the only risk factor found to be significantly associated with obstructive sleep apnea (OSA). Treating OSA has been shown to reduce seizures in people with epilepsy despite antiseizure medication.3