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Sleep deprivation and melatonin for inducing sleep in paediatric electroencephalography: a prospective multicentre
James J P Alix1,2, Rosalind H Kandler2, Catherine Pang3
1Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.
Insights
Combining sleep deprivation with melatonin is the most effective method for inducing sleep in children for EEG recordings. This approach improves sleep achievement without increasing the risk of epileptiform abnormalities.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
- Sleep Medicine
Background:
- Electroencephalography (EEG) is crucial for diagnosing pediatric neurological conditions.
- Achieving adequate sleep during EEG recordings is essential for accurate diagnosis, particularly for identifying sleep-related abnormalities.
- Current methods for inducing sleep in children for EEG have varying degrees of efficacy.
Purpose of the Study:
- To compare the effectiveness of different sleep induction methods in pediatric EEG.
- To evaluate the yield of electroencephalography (EEG) abnormalities with various sleep induction techniques.
- To provide recommendations for best practices in pediatric EEG sleep studies.
Main Methods:
- A prospective study involving 51 UK centers.
- Comparison of sleep deprivation, melatonin, and combined sleep deprivation/melatonin for sleep induction.
- Collection of data on patient demographics, achievement of stage II sleep, and EEG recording characteristics.
Main Results:
- Stage II sleep was achieved in 90% of combined intervention studies, compared to 77% for melatonin and 69% for sleep deprivation alone (p<0.001).
- No significant difference in epileptiform abnormalities was observed when children achieved sleep across the three methods.
- Epileptiform abnormalities were more frequent in children who did not sleep following combined or melatonin interventions compared to sleep deprivation alone (p=0.02).
Conclusions:
- The combined use of sleep deprivation and melatonin is superior for inducing sleep in pediatric EEG.
- The chosen sleep induction method does not significantly impact the detection of epileptiform activity once sleep is achieved.
- Combined sleep deprivation/melatonin is recommended for optimizing sleep induction in pediatric EEG studies.
Aim:
To compare the efficacy of the main methodologies in attaining sleep and electroencephalography (EEG) abnormalities in children with a view to producing recommendations on best practice.
Method:
Fifty-one UK centres participated. Methods for sleep induction (sleep deprivation, melatonin, and combined sleep deprivation/melatonin) were compared. Data pertaining to demographics, achievement of stage II sleep, and recording characteristics (duration of study, presence of epileptiform activity in awake/sleep states) were prospectively collected for consecutive patients in November and December 2013.
Results:
Five hundred and sixty-five patients were included. Age range was 1 years to 17 years (mean 7y 10mo), 27.7 per cent had an underlying neurobehavioural condition. Stage II sleep was achieved in 69 per cent of sleep deprived studies, 77 per cent of melatonin studies, and 90 per cent of combined intervention studies (p<0.001, χ2 ). In children who slept, there was no difference between the three interventions in eliciting epileptiform discharges. In children who did not sleep, epileptiform abnormalities were seen more often than after sleep deprivation alone (p=0.02, χ2 ). Seizures were rare.
Interpretation:
Combined sleep deprivation/melatonin is more effective than either method alone in achieving sleep. The occurrence of epileptiform activity during sleep is broadly similar across the three groups. We recommend the combined intervention to induce sleep for paediatric EEG.
What This Paper Adds:
Combined sleep deprivation/melatonin is more effective in achieving sleep than either sleep deprivation or melatonin alone. Sleep latency is shorter with combined sleep deprivation/melatonin. When children do sleep, there is no difference in the occurrence of epileptiform abnormalities between different induction methods. Seizures are rare in sleep electroencephalography recordings.
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