Napping characteristics and seizure frequency in toddlers and preschool-age children with epilepsy

This study examined the associations between napping characteristics and seizure frequency in toddlers and preschool-aged children with epilepsy. A secondary analysis was conducted using data from 139 children with epilepsy aged 1.5-6 years recruited from pediatric neurology clinics at a medical center in northern Taiwan. Sleep was objectively measured by 7-day actigraphy, with daily seizure frequency recorded in caregiver diaries. Children were categorized as habitual nappers (≥6 days per week) or non-habitual nappers. Habitual nappers were further categorized as early or late nappers according to whether their naps ended before or after 5:00 p.m. Habitual nappers had longer daily sleep than non-habitual nappers (561 vs. 533 min, p = 0.03). Among habitual nappers, early nappers experienced fewer daily seizures (0.03 vs. 0.10, p = 0.04) and fewer daytime seizures (0.02 vs. 0.07, p = 0.02) compared with late nappers. Multiple linear regression analyses showed that later nap end times significantly predicted more daytime seizures (β = 0.24, p = 0.04), independent of age, nocturnal sleep and antiseizure medication use. These findings suggest that earlier nap timing, rather than nap presence alone, was associated with reduced daytime seizures. Our findings highlight the potential clinical importance of promoting earlier and more consistent napping schedules as part of behavioral strategies for seizure management. Future research with larger and more diverse pediatric epilepsy populations is needed to confirm these associations and to elucidate the underlying mechanisms linking circadian rhythms, sleep regulation, and seizure susceptibility.