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Published on: December 6, 2016
Observational pilot study of reported symptoms of obstructive sleep apnoea in children with epilepsy
Don S Urquhart1,2, Olaniyi O Kehinde3, Ailsa E Mclellan2,3
1Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK.
Insights
Children with epilepsy (CWE) show higher symptoms of obstructive sleep apnoea (OSA) and excessive daytime sleepiness (EDS) than typically developing children. Antiepileptic drugs may influence these findings, but do not fully explain them.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Clinical Research
Background:
- Children with epilepsy (CWE) often experience sleep disturbances.
- Previous research suggests a potential link between epilepsy and increased rates of obstructive sleep apnoea (OSA).
Purpose of the Study:
- To compare symptoms of obstructive sleep apnoea (OSA) and excessive daytime sleepiness (EDS) in children with epilepsy (CWE) versus typically developing children.
- To investigate potential contributing factors, such as antiepileptic drug (AED) use.
Main Methods:
- Utilized the Pediatric Sleep Questionnaire's Sleep-Related Breathing Disorder scale (PSQ-SRBD) to assess OSA symptoms (score ≤0.33 indicates high likelihood).
- Employed the Epworth Sleepiness Scale (ESS) to evaluate EDS (score ≥10 is abnormal).
- Compared results between 33 CWE and 42 typically developing children.
Main Results:
- 55% of CWE exhibited symptoms suggestive of OSA (PSQ-SRBD score ≥0.33) compared to 7% of controls (p<0.001).
- 30% of CWE reported abnormal daytime sleepiness (ESS score ≥10) versus 5% of controls (p=0.003).
- Higher PSQ-SRBD and ESS scores were observed in CWE taking antiepileptic drugs (AEDs), though elevated scores were also present in CWE not on AEDs compared to controls.
Conclusions:
- Children with epilepsy demonstrate significantly higher rates of symptoms indicative of OSA and EDS compared to their typically developing peers.
- While AEDs may be a confounding factor, they do not solely account for the observed associations.
- Further research, including polysomnography, is recommended to confirm OSA diagnosis in this population.
Aim:
To estimate symptoms of obstructive sleep apnoea (OSA) and excessive daytime sleepiness (EDS) in children with epilepsy (CWE) compared with those in a typically developing comparison group. CWE are known to have poor sleep, with increased rates of OSA suggested.
Method:
The Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD) was used to estimate OSA symptoms, with scores ≤0.33 known to be highly sensitive and specific for OSA. The Epworth Sleepiness Scale (ESS) was used to assess EDS, with scores of 10 or above considered abnormal.
Results:
Thirty-three CWE (21 males, 12 females) were studied (median age [interquartile range {IQR}] 9y [5-12]), along with 42 comparison children (20 males, 22 females; median age [IQR] 6y [4-8.5]). Fifty-five per cent of CWE scored 0.33 or higher on the PSQ-SRBD compared with 7% in the comparison group (p<0.001), and 30% of CWE had an abnormal ESS compared with 5% controls (p=0.003). Within the CWE cohort, PSQ-SRDB and ESS appeared higher in those taking antiepileptic drugs (AEDs); although PSQ-SRBD score for CWE not on AEDs was higher than in the comparison group.
Interpretation:
This study suggests higher rates of symptoms of OSA and EDS in CWE compared with typically developing children. AEDs may be a confounding factor, but do not alone account for the associations seen. Further studies including polysomnography to verify the presence (rather than suggestion by questionnaire) of OSA are warranted.
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