British Society for Clinical Neurophysiology

...to promote and encourage for the public benefit the science and practice of clinical neurophysiology and related sciences

Abstract Details

GETTING LESS SLEEP DURING THE PANDEMIC: Subtitle : Auditing the Kings Sleep EEG Service 2019-2020

Introduction: A routine EEG in wakefulness detects epileptiform abnormalities in 40% of patients with epilepsy. The chance of finding epileptiform discharges increases to 80%-90% with EEG recordings during sleep. King's College Hospital in London is one of the few centres in the United Kingdom performing medication induced sleep EEG with approximately 1600-1800 sleep EEG attendees annually. Prior to the Covid-19 pandemic, we typically administered Seconal (Quinalbarbitone) to adult patients undergoing sleep EEG necessitating a recovery period afterwards. To avoid departmental overcrowding and help adherence to social distancing, we replaced Seconal with Melatonin, which we previously used only in our paediatric population.


Aim and objective: To assess efficacy of Melatonin-induced sleep in adults by comparing a 2019 cohort (who received Seconal) with the 2020 cohort (who received Melatonin).

Method: We retrospectively reviewed the reports of all adult sleep EEG patients (over 16 years) for the same three month period (May-July) in 2019 and 2020. Successful sleep was defined as reaching sleep stage N2.

Results: In the 2019 study period, 246 patients attended for sleep EEG. 161/181 who received Seconal reached stage II sleep (89%). In the 2020 cohort, among 159 sleep attendees, 75/135 patients who received Melatonin reached stage II sleep (53%). The difference in proportion of patients attaining sleep is statistically significant (2=45.6; p<0.001).

Conclusion: The audit demonstrates that 36% fewer adults reached stage 2 sleep when melatonin was administered. This is a fourfold increase of our failure rate to induce sleep (11% in 2019 vs 47% in 2020). This has resource implications, as many patients will need a repeat test. We will discuss possible approaches to improve the yield in the current situation. It is also noted that there were fewer contraindications to Melatonin (135/159 [85%] were given the drug vs 181/246 [73%] for Seconal).

TitleForenamesSurnameInstitutionLead AuthorPresenter
DrMay Chaw Thazin Win Kings college hospital,London
DrJoelWinstonKing’s College London/King’s College Hospital
DrFranzBrunnhuberDepartment of Clinical Neurophysiology
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