Sleep Traits and Epilepsy Risk
INSOMNIA appears to causally increase generalized epilepsy risk, underscoring sleep traits as modifiable targets in epilepsy care. In this Mendelian randomization study, investigators examined shared genetic foundations between multiple sleep traits and epilepsy outcomes. Genetic instruments from large genome wide association studies were used to test both directions of effect and to account for potential confounding by related sleep characteristics.
Univariable analyses suggested that insomnia and chronotype were positively associated with generalized epilepsy. Insomnia was linked with more than a three-fold higher odds of generalized epilepsy, and chronotype also showed an increased risk. Focal epilepsy showed a modest positive association with daytime napping. These findings initially supported broad connections between several sleep traits and epilepsy risk.
Insomnia As a Causal Sleep Trait
When the researchers applied multivariable Mendelian randomization models that adjusted for other sleep traits and potential confounders, insomnia emerged as the only sleep trait with a clear causal relationship. Insomnia was causally and positively related to generalized epilepsy, with more than a five-fold increase in risk in fully adjusted models. After adjustment, chronotype no longer showed a causal effect on generalized epilepsy. Similarly, the apparent association between focal epilepsy and daytime napping disappeared once other traits and confounders were taken into account.
These results indicate that although several sleep traits may correlate with epilepsy, insomnia has a distinct and robust causal role in generalized epilepsy risk. The findings also support the presence of a shared genetic architecture linking sleep regulation and seizure susceptibility.
Clinical Perspectives for Epilepsy Management
For clinicians caring for people with epilepsy, these data reinforce the importance of systematically assessing sleep traits, particularly insomnia, during routine visits. Insomnia may represent not only a comorbidity but also a potentially modifiable driver of generalized epilepsy risk. Integrating targeted sleep interventions, such as evidence-based insomnia treatments and careful optimization of sleep schedules, could help support seizure management and overall quality of life in affected patients. Further work is needed to translate genetic risk estimates into practical strategies for individual patients in clinical settings.
Reference: Zhu Y et al. Sleep Traits and Risk of Epilepsy: A Bidirectional and Multivariable Two Sample Mendelian Randomization Study. Yonsei Med J. 2025;66(12):841-850.
