High prevalence of epilepsy in pediatric patients with obstructive sleep apnea-a large-scale cross-sectional study

The purpose of the study is to evaluate the prevalence of epilepsy in children with surgically treated obstructive sleep apnea (OSA) and examine the associated healthcare utilization. This cross-sectional study included children aged 1-18 years diagnosed with moderate to severe OSA who were treated with adenoidectomy or adenotonsillectomy. A matched control group (1:3 ratio) without OSA was used for comparison. Data were obtained from Clalit Health Services, Israel's largest healthcare provider. The study analyzed the prevalence of epilepsy, hospital admissions for seizures, use of anti-seizure medications (ASMs), and outpatient visits to pediatric neurologists. Among 55,164 children (13,791 in the OSA group and 41,373 in the control group), the prevalence of epilepsy was higher in the OSA group (0.9% vs. 0.4%; odds ratio (OR) = 2.22, p < 0.001). The OSA group also exhibited higher rates of ASM use (1.1% vs. 0.5%; OR = 2.24, p < 0.001), emergency department visits (OR = 15.66, p < 0.001), hospital admissions (OR = 3.18, p < 0.001), and visits to pediatric neurologists (14% vs. 8.1%; OR = 1.85, p < 0.001). The usage of ASMs was significantly higher in the OSA group, particularly for levetiracetam (OR = 3.73, p < 0.001).

Children with surgically treated OSA had higher rates of epilepsy and greater healthcare utilization compared to their peers. These findings underscore the necessity for integrated care, including neurological assessments, for children with OSA. Further research is needed to examine the impact of OSA treatment on epilepsy outcomes.

• Obstructive sleep apnea (OSA) and epilepsy are prevalent neurological conditions in children, with evidence suggesting a bidirectional relationship between sleep disorders and epilepsy in adults. • OSA prevalence is notably higher in children with refractory epilepsy or those prescribed multiple anti-seizure medications (ASMs).

• This study demonstrates a twofold increase in epilepsy prevalence among children with surgically treated moderate-to-severe OSA compared to matched controls. • Pediatric patients with OSA exhibit significantly higher rates of epilepsy-related healthcare utilization, including hospital admissions, emergency visits, and consultations with pediatric neurologists.