Insomnia symptoms and obesity are associated with aggression independent of depression in patients with epilepsy

Purpose: There has been little research conducted into aggression in persons with epilepsy (PWE). We determine whether sleep disturbances and obesity are associated with aggression in PWE independent of psychological distress.

Methods: This was a cross-sectional study. The Aggression Questionnaire (AQ-K), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were utilized in the study. A stepwise linear regression analysis was used.

Results: A total of 104 participants (49% men) were included. Mean AQ-K score was 51.4 (SD 12.6). PHQ-9 scores ≥10 and GAD-7 scores ≥7 were noted in 26.9% and 24.0% of participants, respectively. In a stepwise linear regression model, AQ-K scores were positively associated with PHQ-9 scores ≥10 (p = 0.002), ISI scores (p = 0.007), body mass index (BMI) (p = 0.001), and composite scores of epilepsy severity (p = 0.013). This model explained 46.6% of the variance in the AQ-K. In the subscale analyses, different variables were identified as independent factors associated with different subscales of the AQ-K. For example, physical aggression was related to a PHQ-9 score ≥10, men, and perampanel usage, whereas hostility was related to a GAD-7 score ≥7, polytherapy, and BMI.

Conclusions: Insomnia symptoms and obesity were related to overall aggressive behavior in PWE independent of depressive symptoms. The individual subscales of the AQ were correlated differently with the various factors including male sex, obesity, depressive symptoms, anxiety, insomnia symptoms, epilepsy severity, polytherapy, and the use of perampanel.