More variable circadian rhythms in epilepsy captured by long-term heart rate recordings from wearable sensors

Abstract: Objective: The circadian rhythm synchronizes physiological and behavioural patterns with the 24-hour light-dark cycle. Disruption to the circadian rhythm is linked to various health conditions, though optimal methods to describe these disruptions remain unclear. An emerging approach is to examine the intra-individual variability in measurable properties of the circadian rhythm over extended periods. Epileptic seizures are modulated by circadian rhythms, but the relevance of circadian rhythm disruption in epilepsy remains unexplored. Our study investigates intra-individual circadian variability in epilepsy and its relationship with seizures. Methods: We retrospectively analyzed over 70,000 hours of wearable smartwatch data (Fitbit) from 143 people with epilepsy (PWE) and 31 healthy controls. Circadian oscillations in heart rate time series were extracted, daily estimates of circadian period, acrophase, and amplitude properties were produced, and estimates of the intra-individual variability of these properties over an entire recording were calculated. Results: PWE exhibited greater intra-individual variability in period (76 min vs. 57 min, d=0.66, p<0.001) and acrophase (64 min vs. 48 min, d=0.49, p=0.004) compared to controls, but not in amplitude (2 bpm, d=-0.15, p=0.49). Variability in circadian properties showed no correlation with seizure frequency, nor any differences between weeks with and without seizures. Significance: For the first time, we show that heart rate circadian rhythms are more variable in PWE, detectable via consumer wearable devices. However, no association with seizure frequency or occurrence was found, suggesting that this variability might be underpinned by the epilepsy aetiology rather than being a seizure-driven effect.