New arguments for patients with apnea and epilepsy

The impetus for writing this article was the recent publication in The Lancet (October 2025) of the results of a multicenter, randomized, double-blind, placebo-controlled trial of sultiame, a well-known antiepileptic drug, in patients with obstructive sleep apnea without epilepsy. This article analyzes the role of apnea in epilepsy, issues of diagnostics and therapy are considered. Key findings: apnea is a common, underestimated comorbidity of epilepsy, worsening the course of the underlying disease, and is a trigger for sudden unexpected death in epilepsy. Patients with epilepsy should be assessed for the risk of developing ictal apnea and screened for obstructive sleep apnea to ensure timely detection and treatment. A number of antiepileptic drugs (benzodiazepines, valproates) can cause or exacerbate apnea. Based on the high-quality evidence obtained, sultiame should be considered as a first-line antiepileptic drug in patients with epilepsy and apnea.