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Factors associated with poor sleep in children with drug-resistant epilepsy
Renee Proost1, Evy Cleeren2, Bastiaan Jansen3
1Paediatric Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Insights
Children with drug-resistant epilepsy (DRE) experience significantly worse sleep quality, including reduced sleep efficiency and REM sleep. Factors like epilepsy severity and specific EEG findings correlate with these sleep disturbances, highlighting potential targets for intervention.
Area of Science:
- Neurology
- Sleep Medicine
- Pediatric Epilepsy
Background:
- Epilepsy significantly impacts children's quality of life and neurodevelopment.
- Sleep disturbances are common in epilepsy but understudied in pediatric populations, particularly in drug-resistant epilepsy (DRE).
- Understanding sleep in DRE is crucial for identifying potential therapeutic targets.
Purpose of the Study:
- To investigate sleep macrostructure and microstructure in children with DRE, including developmental and epileptic encephalopathies (DEEs).
- To compare sleep characteristics between children with DRE and well-controlled epilepsy (WCE).
- To identify factors associated with poor sleep outcomes in children with DRE.
Main Methods:
- Cross-sectional study involving children aged 4-18 without epilepsy, with WCE, and with DRE.
- Overnight polysomnography (EEG, EMG, EOG) for objective sleep staging and analysis.
- Parent-completed sleep questionnaires for subjective sleep assessment.
Main Results:
- Children with DRE exhibited significantly lower sleep efficiency, reduced REM sleep, fewer sleep spindles, and diminished slow wave activity (SWA) decline compared to WCE.
- Caregivers reported more severe sleep problems and children with DRE experienced increased daytime sleepiness.
- Multifocal epileptiform discharges, benzodiazepine treatment, and epilepsy duration were linked to lower sleep efficiency and REM sleep.
Conclusions:
- Sleep macrostructure and microstructure are profoundly affected in children with DRE and DEEs.
- Epilepsy-related parameters distinctly influence REM sleep, spindle counts, and SWA decline.
- Addressing sleep disturbances in DRE may offer a pathway to improve both epilepsy and neurodevelopmental outcomes.
Objective:
We aimed to investigate sleep in children with drug-resistant epilepsy (DRE), including developmental and epileptic encephalopathies (DEEs). Next, we examined differences in sleep macrostructure and microstructure and questionnaire outcomes between children with well-controlled epilepsy (WCE) and children with DRE. Furthermore, we wanted to identify factors associated with poor sleep outcome in these children, as some factors might be targets to improve epilepsy and neurodevelopmental outcomes.
Methods:
A cross-sectional study was conducted in children 4 to 18-years-old. Children without epilepsy, with WCE, and with DRE were included. Overnight electroencephalography (EEG), including chin electromyography and electrooculography, to allow sleep staging, was performed. Parents were asked to fill out a sleep questionnaire. Classical five-stage sleep scoring was performed manually, spindles were automatically counted, and slow wave activity (SWA) in the first and last hour of slow wave sleep was calculated.
Results:
One hundred eighty-two patients were included: 48 without epilepsy, 75 with WCE, and 59 with DRE. We found that children with DRE have significantly lower sleep efficiency (SE%), less time spent in rapid eye movement (REM) sleep, fewer sleep spindles, and a lower SWA decline over the night compared to children with WCE. Subjectively more severe sleep problems were reported by the caregivers and more daytime sleepiness was present in children with DRE. Least absolute shrinkage and selection operator (LASSO) regression showed that multifocal interictal epileptiform discharges (IEDs), benzodiazepine treatment, and longer duration of epilepsy were associated with lower SE% and lower REM sleep time. The presence of multifocal discharges and cerebral palsy was associated with fewer spindles. Benzodiazepine treatment, drug resistance, seizures during sleep, intellectual disability, and older age were associated with lower SWA decline.
Significance:
Both sleep macrostructure and microstructure are severely impacted in children with DRE, including those with DEEs. Epilepsy parameters play a distinct role in the disruption REM sleep, spindle count, and SWA decline.
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