Sleep quality and associated factors among adult patients with epilepsy attending follow-up care at referral hospitals in Amhara region, Ethiopia

Background
Globally, epilepsy is the commonest neurological disorder in adults. It has significant health and economic consequences to the affected individuals and the family. There is ample evidence that epileptic patients are at increased risk of poor sleep quality than the general population. However, there is limited evidence on sleep quality among epileptic patients and associated factors in Ethiopia. Therefore, this study investigated the prevalence of poor sleep quality and associated factors among adult patients with epilepsy.

Method
Institutional based cross-sectional study was conducted among adult epileptic patients attending follow-up care at referral hospitals in the Amhara region. A total of 575 epileptic patients were recruited using a stratified systematic random sampling technique. An interviewer-administered semi-structured questionnaire and record review were used for data collection. To assess sleep quality the pretested Pittsburgh Sleep Quality Index (PSQI) tool was used. A binary logistic regression model was used to assess factors associated with poor sleep quality. Variables with a p-value less than 0.2 in the bivariable binary logistic regression analysis were considered for the multivariable binary logistic regression analysis. In the multivariable binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported to declare the statistical significance and strength of association. Model fitness was assessed using the Hosmer-Lemeshow test and was adequate (p>0.05). Multicollinearity of the independent variables was assessed using the Variance Inflation Factor (VIF) and the mean VIF was less than 10.

Results
A total of 565 participants were enrolled in the study with a response rate of 98.3%. The prevalence of poor sleep quality among adult epileptic patients was 68.8% [95% CI: 64.8%, 72.5%]. In the multivariable binary logistic regression, being unable to read and write [AOR = 3.16, 95%CI: 1.53, 6.51], taking polytherapy treatment [AOR = 2.10, 95% CI: 1.37, 3.21], poor medication adherence [AOR = 2.53, 95%CI: 1.02, 6.23] and having poor support [AOR = 2.72, 95%CI: 1.53, 4.82] and moderate social support [AOR = 1.89, 95%CI: 1.05, 3.41] were significantly associated with higher odds of poor sleep quality.

Conclusion and recommendation
Poor sleep quality is a major public health concern in Ethiopia. The patient’s level of education, number of medication use, medication adherence, and social support were found significant predictors of poor sleep quality. These findings highlight improving medication adherence and social support are effective strategies to improve the sleep quality of epileptic patients. Besides, it is better to give special emphasis to those epileptic patients with a low level of education and taking polytherapy to enhance sleep quality.