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Seventy-six percent of nocturnal seizures and 28 % of diurnal seizures were preceded by sleep. Therefore, the nocturnal time window from 0000-0559 had a sensitivity of 0.65 (95 % confidence interval 0.48-0.78), a specificity of 0.06 (0.02-0.15), a positive predictive value of 0.28 (0.20-0.39), and a negative predictive value of 0.24 (0.10-0.39) in association with sleep-onset seizures. The time of day is an inaccurate surrogate for preictal sleep-wake state in the epilepsy monitoring unit despite a correlation between nocturnal period