Sleep-Related Breathing Disorders in Children with Epilepsy: Prevalence and Risk Factors

Sleep-related breathing disorders (SRBDs) in children with epilepsy (CWE) are often under-recognized despite their potential impact on seizure control and quality of life. This study aimed to determine the prevalence of SRBDs in CWE using the Pediatric Sleep Questionnaire (PSQ) and to identify clinical factors associated with SRBDs. This observational study included 238 CWE attending the pediatric epilepsy clinic of a tertiary care hospital in Mumbai, India, between June 2020 and May 2021. The PSQ was administered to all participants, with a score >8/22 suggesting SRBDs. Categorical variables were compared using the Chi-square test. SRBDs were present in 44.5% of CWE according to the PSQ. Age, gender, age at epilepsy onset, family history of seizures, seizure type, body mass index, and neck-circumference-to-height ratio did not differ significantly between children with and without SRBDs. SRBDs were more frequent in children on multiple anti-seizure medications (ASMs), those with higher seizure burden, and those with drug-resistant epilepsy. It was present in 36.7% of children on <2 ASMs versus 50.7% on ≥2 ASMs ( P = 0.004). SRBDs affected 31.1% of drug-responsive children compared with 58.0% of those with drug-resistant epilepsy ( P = 0.0001). SRBDs are a common comorbidity, affecting nearly half of CWE. Routine screening for SRBDs in CWE is recommended, especially if drug refractory, followed by confirmation with polysomnography. Early detection of SRBDs offers a modifiable target that can enhance seizure control and neurobehavioral outcomes in CWE.