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Sleep disturbances in children and adolescents with epilepsy: Clinical, polysomnographic and management aspects
Camila Dos Santos El Halal1, Magda Lahorgue Nunes2
1Paediatric Neurologist, Brazil.
Insights
Sleep disturbances are common in children with epilepsy, impacting cognition and behavior. Addressing these sleep issues may improve seizure control and overall well-being for affected children and their families.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Epileptology
Background:
- Sleep and epilepsy share bidirectional neurobiological links.
- Sleep disturbances are prevalent in pediatric epilepsy, worsening seizures and affecting cognition, behavior, and quality of life.
Purpose of the Study:
- Synthesize evidence on sleep disturbances in pediatric epilepsy.
- Integrate subjective and objective sleep measures across epilepsy severity, syndromes, and comorbidities.
- Discuss implications for clinical management.
Main Methods:
- Narrative review of studies on sleep in children and adolescents with epilepsy.
- Utilized validated questionnaires and objective tools (polysomnography, actigraphy, cyclic alternating pattern analysis).
- Summarized evidence by epilepsy severity, syndrome, comorbidities (ADHD/ASD), caregiver outcomes, and management.
Main Results:
- Subjective reports show high rates of sleep problems linked to behavioral and cognitive difficulties.
- Objective data reveal reduced sleep time, efficiency, increased fragmentation, and altered sleep stages.
- Drug-resistant epilepsy exhibits significant sleep disruption, especially with cognitive impairment; sleep alterations are syndrome-specific and influenced by seizure burden and treatment.
Conclusions:
- Sleep impairment in childhood epilepsy is common, significant, and treatable.
- Systematic screening and objective assessment can guide interventions.
- Improving sleep may enhance seizure outcomes, daytime function, and family well-being.
Background:
Sleep and epilepsy interact through bidirectional neurobiological mechanisms. In children, sleep disturbances are highly prevalent and may exacerbate seizures while adversely affecting cognition, behaviour, and quality of life.
Objective:
To synthesise current evidence on sleep disturbances in paediatric epilepsy by integrating subjective reports and objective sleep measures across epilepsy severity, syndromes, and common neurodevelopmental comorbidities, and to discuss implications for clinical management.
Methods:
Narrative review of studies assessing sleep in children and adolescents with epilepsy using validated questionnaires and objective tools, including polysomnography/video-EEG-polysomnography, actigraphy, and cyclic alternating pattern analysis. Evidence was summarised according to epilepsy severity, epilepsy syndrome, comorbid ADHD/ASD, caregiver outcomes, and management strategies.
Results:
Questionnaire-based studies consistently report high rates of sleep problems and associations with behavioural difficulties and poorer cognitive performance. Objective evidence, including meta-analytic data, demonstrates reduced total sleep time, decreased sleep efficiency, increased sleep fragmentation, and altered sleep-stage distribution compared with healthy controls. Drug-resistant epilepsy shows a severity gradient characterised by marked macrostructural disruption (reduced N3 and REM sleep, increased wake after sleep onset) and microstructural NREM instability, particularly in children with cognitive impairment. Reported sleep alterations appear syndrome-specific and influenced by seizure burden, nocturnal epileptiform activity, and treatment-related factors. Sleep disruption is also prominent in epilepsy with neurodevelopmental comorbidities and is closely associated with caregiver sleep disturbance and mental health burden.
Conclusions:
Sleep impairment in childhood epilepsy is common, clinically meaningful, and potentially modifiable. Systematic screening with validated tools and targeted objective assessment may support interventions that improve sleep quality, seizure-related outcomes, daytime functioning, and family well-being.
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