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Rapid eye movement sleep reduction in pediatric epilepsy: A propensity score-matched study
Alen Juginović1, Laura Rodman2
1Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, USA.
Objective:
This study was undertaken to characterize sleep architecture assessed by polysomnography (PSG) in children with epilepsy versus matched nonepilepsy clinical comparators and disentangle disease from antiseizure medication (ASM) effects.
Methods:
In this cross-sectional analysis of the Nationwide Children's Hospital Sleep DataBank (3647 PSG studies from 3392 patients aged ≤18 years), a clinical cohort referred for PSG, we compared 560 PSG studies in children with epilepsy to 3087 studies in nonepilepsy clinical comparators. Propensity score matching (1:1) on age, sex, and body mass index percentile yielded 560 pairs. Fifteen PSG outcomes were compared using Wilcoxon signed-rank tests with Hedges g and false discovery rate (FDR) correction. A secondary analysis compared 208 matched pairs of on- versus off-ASM epilepsy patients. Seven sensitivity analyses addressed age subgroups, medication exclusions, and comorbidity matching.
Results:
Children with epilepsy had reduced rapid eye movement (REM) sleep (median 18.2% vs. 20.9%, g = -.32 [95% confidence interval = -.41 to -.24], FDR p < .001), lower sleep efficiency (g = -.14, p = .007), shorter total sleep time (g = -.12, p = .015), prolonged REM latency (g = .14, p = .029), and lower arousal index (g = -.12, p = .013). ASM use amplified the REM deficit (15.8% vs. 19.8%, g = -.48, p < .001). The effect followed a developmental gradient: strongest at age < 6 years (g = -.38, p < .001), intermediate at 6-12 years (g = -.31, p = .002), and not detected at >12 years (g = -.07, p = .953). Excluding benzodiazepine users attenuated the signal (g = -.24), whereas excluding melatonin users preserved it (g = -.29).
Significance:
In the largest pediatric epilepsy PSG study to date, epilepsy is associated with an REM-predominant sleep disruption concentrated in children younger than 6 years and amplified by ASMs, although the independent contribution of epilepsy itself remains uncertain. These cross-sectional findings identify early childhood as a period of heightened vulnerability that warrants prospective study.
