Abstract
<jats:p>Background: Sleep and epilepsy are linked through a complex, bidirectional relationship in which physiological sleep processes influence cortical excitability and seizure susceptibility, while epileptic activity and its treatments profoundly affect sleep architecture and quality. Sleep disturbances (including insomnia, obstructive sleep apnea, circadian rhythm disorders, excessive daytime sleepiness, and fragmented sleep) are highly prevalent among people with epilepsy and contribute to impaired seizure control, cognitive dysfunction, psychiatric comorbidities, reduced quality of life, and increased healthcare utilization. Although substantial research has examined individual aspects of this relationship, the evidence remains fragmented across multiple disciplines, limiting its translation into comprehensive clinical practice.Objective: This scoping review aimed to systematically map the contemporary evidence regarding the role of sleep across the epilepsy care continuum, encompassing pathophysiological mechanisms, clinical assessment, diagnostic strategies, therapeutic interventions, digital health technologies, and emerging research priorities, while identifying critical knowledge gaps to guide future investigation and precision medicine approaches. Methods: This scoping review was conducted according to the methodological framework proposed by Arksey and O'Malley, refined by Levac and colleagues, and further finalized by the Joanna Briggs Institute, and was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Comprehensive searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library identified English-language studies published from January 2020 onward. Eligible publications included adults and children with epilepsy or seizure disorders addressing at least one sleep-related domain. Evidence was descriptively synthesized across predefined domains, including sleep physiology and epileptogenesis; sleep disorders and epilepsy; effects of antiseizure medications on sleep; sleep deprivation and seizure risk; diagnostic modalities, including polysomnography, electroencephalography, actigraphy, and wearable technologies; digital health and artificial intelligence; therapeutic interventions; perioperative and long-term follow-up; implementation challenges; and health equity. Conclusions: By providing the first comprehensive mapping of sleep throughout the epilepsy care continuum, this review establishes an integrated conceptual framework linking mechanistic, diagnostic, therapeutic, and technological advances. The findings highlight priorities for multidisciplinary research, support the implementation of precision sleep medicine in epilepsy, and inform future evidence-based clinical strategies designed to optimize seizure control, neurological outcomes, and patient-centered care.</jats:p>