P.002 Increased epileptiform activity during N2 and slow wave sleep in Alzheimer’s Disease

Background: Recent evidence shows that epileptiform activity (EA) in sleep can present early in Alzheimer’s Disease (AD) with faster cognitive decline. Existing literature examining sleep, AD and seizures is mostly qualitative. We conducted a systematic review to quantify the sleep stage most associated with EA in AD and amnestic mild cognitive impairment (aMCI)Methods: We searched MEDLINE and Embase using MeSH terms: “Alzheimer’s Disease” AND “Epilepsy” OR “Seizures’’ AND “Sleep” OR “REM” (rapid eye movement sleep). We extracted data to determine the EA distribution across sleep stages. We averaged percentages across studies. If a study had AD and aMCI subgroups, we averaged percentages to represent that study. Results: 4/14 articles had quantitative sleep stage EA data from a total of 111 AD or aMCI patients. Most EA occurred in the non-REM stage (N2; 36.1±17.8%). EA next most frequently occurred in slow-wave sleep (SWS; 34.1±9.9%), N1 (15.5±6.7%), and REM (14.4±11.6%). Conclusions: N2 and slow-wave sleep were most associated with sleep EA in AD or aMCI. This suggests the importance of therapeutic interventions that may decrease N2 and slow-wave sleep and increase REM. Future studies could explore whether it is the quantity or quality of the N2 and slow-wave sleep that is associated with EA.