Risk of Sudden Cardiac Arrest in Children With Epilepsy and Sleep Apnea

Pediatric patients with epilepsy are at risk for sudden cardiac arrest (SCA), and sleep apnea (SA) may exacerbate this risk. This study investigates the incidence and risk of SCA and cardiac dysrhythmia in pediatric patients with epilepsy and SA.

Using the TriNetX global research network, we identified pediatric patients (aged younger than 18 years) who were diagnosed with epilepsy between January 2000 and March 2025. SA was identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and polysomnography records. Two cohorts, ie, patients with epilepsy with and without SA, were matched using propensity scores. SCA and cardiac dysrhythmia were assessed over 5- and 10-year follow-up periods.

The incidence of SCA was highest in patients with both epilepsy and SA (50.5 per 10 000 person-years) compared with those with epilepsy alone (20.0 per 10 000) or SA alone (9.0 per 10 000). Patients with epilepsy and SA had an increased risk of SCA (5-year hazard ratio [HR]: 1.99; 10-year HR: 1.74; both P < .001) and cardiac dysrhythmia (10-year HR: 2.06; P < .001). Refractory epilepsy increased the risk of SCA (odds ratio [OR]: 1.74; 95% CI: 1.25-2.42). Additionally, long-term continuous positive airway pressure (CPAP) therapy was associated with increased SCA risk (OR: 3.41; 95% CI: 2.27-5.11), whereas adenotonsillectomy reduced it (OR: 0.40; 95% CI: 0.27-0.60).

Pediatric patients with epilepsy and SA are at significantly increased risk for SCA and cardiac dysrhythmia. Adenotonsillectomy may mitigate this risk, whereas long-term CPAP use may increase it. These findings highlight the importance of individualized treatment strategies in pediatric patients with epilepsy and comorbid SA to reduce the risk of SCA.