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Meta-Analysis
. 2025 Apr;46(4):1573-1580.
doi: 10.1007/s10072-024-07931-9. Epub 2024 Dec 30.

Sleep disorders in functional neurological disorder - a systematic review and meta-analysis

Siddarth Kannan  1 , Anirban Dutta  2 , Abhijit Das  3   4
Affiliations
Meta-Analysis

Sleep disorders in functional neurological disorder - a systematic review and meta-analysis

Siddarth Kannan et al. Neurol Sci. 2025 Apr.

Abstract

Introduction: Functional neurological disorders (FND) are conditions marked by disruptions in brain network function without structural abnormalities. Sleep disturbances, though under-researched, are commonly observed in FND patients and may worsen symptoms and overall health.

Methods: This systematic review had been registered prospectively in PROSPERO with the registration number: CRD42023446306. Search of PubMed, MEDLINE, Embase, and Cochrane databases identified 218 articles. After removing duplicates and applying exclusion criteria, 9 studies were included in the final analysis.

Results: The analysis showed a significant prevalence of sleep disorders among FND patients, with 58% reporting sleep disturbances, similar to other neuropsychiatric conditions. Studies on psychogenic non-epileptic seizures (PNES) indicated poorer subjective sleep quality and higher insomnia rates compared to epilepsy controls. Limited data on specific measures such as wake after sleep onset (WASO) and Epworth Sleepiness Scale (ESS) scores prevented definitive conclusions.

Discussion: This review is the first systematic examination of sleep disorders in FND. The findings reveal a high prevalence of sleep disturbances, especially among PNES patients, correlating with lower quality of life and increased symptom severity. However, the heterogeneity of studies and limited reporting of specific sleep metrics weaken these conclusions. Further research is needed to investigate the direct impact of sleep quality on FND pathogenesis and management.

Conclusion: Sleep disturbances are prevalent in FND patients and can significantly affect their quality of life. Increased awareness and routine evaluation of sleep in FND patients are recommended. Future studies should explore the relationship between sleep deprivation and FND to develop targeted therapeutic interventions.

Keywords: ESS; Functional neurological disorder; Non-epileptic attack disorder (NEAD); Sleep; Sleep disorder; WASO.

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Conflict of interest statement

Declarations. Ethical approval: This systematic review was conducted following PRISMA guidelines. As it involves the synthesis of previously published data, no new primary data were collected, and no ethical approval was required. No human participants were directly involved, and all data used were publicly available. The authors declare no conflicts of interest, and the review was conducted with transparency, integrity, and objectivity. Competing interests: None.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analysis (PRISMA)
Fig. 2
Fig. 2
Forest plot depicting incidence of reported sleep disorders among patients FND
Fig. 3
Fig. 3
Funnel plot depicting outcome of Egger’s test
Fig. 4
Fig. 4
Forest plot depicting mean duration of WASO in patients with FND
Fig. 5
Fig. 5
Forest plot depicting mean duration of WASO in non-FND patients
Fig. 6
Fig. 6
Forest plot depicting mean ESS score in patients with FND
Fig. 7
Fig. 7
Forest plot depicting mean ESS score in non-FND patients
Fig. 8
Fig. 8
Bar graph depicting Risk of Bias among all included studies
See this image and copyright information in PMC

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