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Urquhart DS, McLellan AE, Hill LE, Carruthers E, Hill EA, Chin RF, Shetty J. A case-control study to investigate the prevalence of obstructive sleep apnea and the utility of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire in children and young people with epilepsy. J Clin Sleep Med 2024; 20:1039-1047. [PMID: 38318844 PMCID: PMC11217635 DOI: 10.5664/jcsm.11054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
STUDY OBJECTIVES Epilepsy and obstructive sleep apnea syndrome (OSAS) are each relatively common in children. OSAS may affect cognition, such that recognition of OSAS is important for children and young people with epilepsy (CYPWE). Published pilot data reported 55% of CYPWE had symptoms suggestive of OSAS, compared with 7% of typically developing controls. The primary aim of this study was to ascertain OSAS prevalence by polysomnography in CYPWE, with secondary aims being to evaluate the utility of sleep questionnaires in CYPWE. METHODS CYPWE and age- and sex-matched typically developing controls were studied. A single night of level I attended polysomnography was undertaken, along with questionnaires (Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire, Pittsburgh Sleep Quality Index, and the childhood and adolescent Epworth Sleepiness Scale). OSAS was defined as obstructive apnea-hypopnea index of ≥ 1 event/h. RESULTS Polysomnography was performed in 72 children including 48 CYPWE (60% male) and 24 controls (54% male). Mean age (11 years) was similar for CYPWE and controls (P = .42), with slightly higher body mass index z scores (0.7 vs 0.1, P = .03) noted in CYPWE. Mean obstructive apnea-hypopnea index was 0.61 in CYPWE vs 0.42 in controls (P = .62). Despite higher Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire scores in CYPWE (0.38 vs 0.12, P < .001), no difference in OSAS prevalence (10% vs 4%, P = .78) was found. CYPWE had higher childhood and adolescent Epworth Sleepiness Scale (6 vs 3.5, P = .01) and Pittsburgh Sleep Quality Index (5 vs 3.3, P = .02) scores, indicating greater levels of daytime sleepiness and poorer sleep quality. CONCLUSIONS The study found no evidence for increased OSAS prevalence in CYPWE, and the utility of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire in predicting OSAS appears limited for CYPWE. CYPWE are, however, demonstrably sleepier and have poorer sleep quality. The cause for these findings remains unclear. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Investigation of Sleep Quality and Prevalence of Sleep-disordered Breathing in Children and Young People With Epilepsy; URL: https://www.clinicaltrials.gov/study/NCT03103841; Identifier: NCT03103841. CITATION Urquhart DS, McLellan AE, Hill LE, et al. A case-control study to investigate the prevalence of obstructive sleep apnea and the utility of the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire in children and young people with epilepsy. J Clin Sleep Med. 2024;20(7):1039-1047.
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Affiliation(s)
- Donald S. Urquhart
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ailsa E. McLellan
- Department of Paediatric Neurosciences, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Muir Maxwell Epilepsy Center, Center for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Laura E. Hill
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Emma Carruthers
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - Elizabeth A. Hill
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Richard F. Chin
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
- Department of Paediatric Neurosciences, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Muir Maxwell Epilepsy Center, Center for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Jay Shetty
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
- Department of Paediatric Neurosciences, Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Muir Maxwell Epilepsy Center, Center for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
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Tsai SY, Lee WT, Lee CC, Jeng SF, Weng WC. Five-year follow-up of a clinic-based sleep intervention for paediatric epilepsy: A randomized clinical trial. J Sleep Res 2024; 33:e14059. [PMID: 37770048 DOI: 10.1111/jsr.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Sleep disturbances in children with epilepsy are prevalent, and are associated with substantial adverse medical and psychosocial consequences. This study is a 5-year follow-up of a clinic-based sleep intervention study that randomized 100 toddlers and preschool-age children with epilepsy to a usual care group or a sleep intervention group. The intervention group received standard paediatric neurology care plus three education sessions during the child's routine clinic visit. The outcomes measured were: (1) child sleep by actigraphy and parental report; and (2) maternal sleep and depression. We aimed to evaluate the long-term benefits of a clinic-based sleep intervention for paediatric epilepsy. In total, 42 families (42.0%) participated. The average child's age at follow-up was 9.55 years. Thirty-eight (90.5%) children were not obtaining sufficient sleep at baseline, and 40 (95.2%) at the 5-year follow-up. The numbers of children with clinically significant sleep disturbances were 40 (95.2%) at baseline and 36 (85.7%) at the 5-year follow-up. Fourteen mothers (33.3%) had poor sleep quality and high depressive symptoms at both assessment time points. There were no differences (P > 0.05) in the child and maternal outcomes between the two trial arms. Overall, there was no evidence that a clinic-based sleep intervention that effectively improved multiple aspects of sleep in toddlers and preschool-age children with epilepsy had long-lasting beneficial effects. Our findings suggest that sleep interventions for families of children with epilepsy require ongoing reinforcement and monitoring during routine paediatric neurology care to prevent sleep problems from persisting or recurring.
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Affiliation(s)
- Shao-Yu Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
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Yan L, Chen J, Xie L, Li T, Hu Y, Hong S, Jiang L. Mediating effects of sleep quality between clinical characteristics and quality of life in children with epilepsy: A cross-sectional study from Southwest China. Epilepsy Behav 2024; 154:109738. [PMID: 38513572 DOI: 10.1016/j.yebeh.2024.109738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Although sleep quality (SQ) reportedly affects the health-related quality of life (QOL) of patients with epilepsy, little is known about the potential association between SQ and QOL, particularly in children with epilepsy (CWE). Our study aimed to investigate the mediating effect of SQ on the QOL of CWE to obtain more information for the prevention and treatment of epilepsy in children. METHODS We collected general demographic and clinical data of 212 CWE and 79 controls (children who visited the Health Examination Department), and their guardians were instructed to answer the Children's Sleep Habits Questionnaire (CSHQ) and the optimized Quality of Life in Childhood Epilepsy Questionnaire-16 (QOLCE-16). The t-test, analysis of variance, chi-square test, and Fisher's exact test were used for between group comparisons. The Pearson correlation was used to analyze the correlation between variables. The direct, indirect, and total effects of predictors on the QOL of CWE were estimated based on an adjusted mediation model. RESULTS CWE had significantly smaller long-term urban residence rates, less educated guardians, higher total CSHQ score, higher incidence of poor SQ, higher bedtime resistance, more sleep anxiety, worse sleep-disordered breathing, increased parasomnia, more daytime sleepiness, more frequent night waking, and greater sleep onset delay than controls (P < 0.05 for all). The univariable analysis showed significant differences in total CSHQ scores between CWE with different seizure frequency in the last month, whether or not drug-resistant epilepsy (DRE), and with different video electroencephalogram (VEEG) findings (P < 0.05 for all). Differences in QOLCE-16 scores between CWE with different guardian's employment status, age at diagnosis, number of anti-seizure medication (ASM) types, seizure frequency in the last month, DRE status, seizure type, VEEG findings, neuropsychological evaluation findings, magnetic resonance imaging (MRI) findings, and etiology were statistically significant (P < 0.05 for all). The correlation study indicated that the total CSHQ score was negatively correlated with the QOLCE-16 score (P < 0.05). The mediation analysis showed that DRE and VEEG abnormalities had a standardized direct effect on the QOL. Seizure frequency in the last month, DRE, and VEEG abnormalities had an indirect effect on the QOL through SQ, and their mediating effect values of SQ were 31.61 %, 13.45 %, and 14.35 %, respectively. CONCLUSION Our findings uncovered the relationship of some clinical characteristics with SQ and QOL and characterized the nature of factors affecting the QOL of CWE. SQ could be a key factor in the prognosis of CWE experiencing epileptic seizures, and more attention should be paid on the management of SQ in interventions for epilepsy.
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Affiliation(s)
- Lisi Yan
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Jin Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Lingling Xie
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Tianyi Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Siqi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No. 136 Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
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Düken ME, Zengin M. The mediating role of social support in the relationship between psychosocial problems and sleep patterns of adolescents with epilepsy. Epilepsy Behav 2024; 152:109656. [PMID: 38277846 DOI: 10.1016/j.yebeh.2024.109656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
AIM This study was conducted to examine the mediating role of social support in the relationship between psychosocial problems of adolescents with epilepsy and their sleep patterns. METHODS The data were collected with Adolescent Information Form, Strength and Difficulties Questionnaire, Sleep Disturbance Scale for Children and Multidimensional Scale of Perceived Social Support in this descriptive and correlational study. The mediating role of multidimensional social support that children with epilepsy received with the Process Macro program was examined in the relationship between their psychosocial problems and their sleep status. Process model 4 was used and analysis was made based on the Bootstrap method. RESULTS As a result of the analysis, it was found that the participants had been diagnosed with epilepsy for a mean of 6.0 ± 1.61 years and had a mean of 3.1 ± 2.48 seizures per week. It was found that the sleep problems experienced by adolescents with epilepsy affected their psychosocial health and this effect was at the level of 84 % (β = 0.933; p < 0.001). The effect of perceived social support on the dependent variable sleep disturbance in adolescents with epilepsy was found to be statistically significant (β = -0.540; p < 0.001). It was determined that the Psychosocial Health Status score of adolescents diagnosed with epilepsy explained 87 % of the change in sleep disturbance experienced with perceived social support (p < 0.001). The effect of social support perceived by adolescents with epilepsy on sleep disturbance was found to be statistically significant. Perceived social support has no effect on the psychosocial problems they experience. CONCLUSIONS It was found that social support was not a mediator in the relationship between psychosocial problems of adolescents with epilepsy and their sleep status.
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Affiliation(s)
- Mehmet Emin Düken
- Department of Child Health and Diseases Nursing, Harran University, Şanlıurfa 63000, Turkey.
| | - Mürşide Zengin
- Health Sciences of Faculty, Department of Child Health and Diseases Nursing, Adıyaman University, Adıyaman, Turkey.
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Sadek J. Attention Deficit Hyperactivity Disorder Misdiagnosis: Why Medical Evaluation Should Be a Part of ADHD Assessment. Brain Sci 2023; 13:1522. [PMID: 38002482 PMCID: PMC10669410 DOI: 10.3390/brainsci13111522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that interferes with multiple aspects of daily functioning and is associated with impairments in several domains. It may affect academic, educational, vocational, social, emotional, interpersonal, and health domains, and worsen risks to health outcomes. OBJECTIVE To identify and discuss medical conditions that commonly present with symptoms resembling ADHD. METHOD This review is selective and not systematic. It is conducted through a focused literature search through PubMed, Google Scholar, and EMBASE. Search term included "ADHD misdiagnosis", "medical conditions with ADHD like symptoms", "ADHD AND medical problems". EXCLUSION giftedness, high IQ, and any article that does not list medical conditions. The limits applied were the following: the work must have been published in the past 20 years, be on humans, and be in the English language. RESULTS There are several medical conditions that can be misdiagnosed as ADHD and may show a similar presentation to ADHD, particularly with inattentive symptoms. Examples include, but are not limited to, absence seizure disorder, diabetes, thyroid dysfunction, sleep deprivation, post-concussion states, inflammatory bowel disease, iron deficiency states and anemia, and disordered breathing. CONCLUSIONS Our review suggests that a thorough medical evaluation should be conducted prior to the diagnosis of ADHD. Allied health professionals and psychologists who diagnose ADHD should seek medical clearance from a physician prior to making the ADHD diagnosis in order to reduce misdiagnosis rates and improve patient outcomes. ADHD diagnosis should follow guidelines and be carried out under a systematic standardized approach. A full medical evaluation should be conducted to assess for medical conditions that may look like ADHD or be associated with ADHD.
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Affiliation(s)
- Joseph Sadek
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H4K3, Canada
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Winsor AA, Richards C, Seri S, Liew A, Bagshaw AP. The contribution of sleep and co-occurring neurodevelopmental conditions to quality of life in children with epilepsy. Epilepsy Res 2023; 194:107188. [PMID: 37421713 DOI: 10.1016/j.eplepsyres.2023.107188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Health-related quality of life (HRQOL) in children with epilepsy (CWE) is multifactorial and can be affected not only by epilepsy-specific variables but also co-occurring conditions such as sleep disturbances, autism, and attention deficit hyperactivity disorder (ADHD). While highly prevalent in CWE, these conditions are underdiagnosed despite having a significant impact on HRQOL. Sleep problems have a complex relationship with epilepsy and neurodevelopmental characteristics. However, little is known about how these issues interact and contribute to HRQOL. OBJECTIVES The current study aims to explore the relationship between sleep and neurodevelopmental characteristics on HRQOL in CWE. METHODS 36 CWE aged 4-16 years old were recruited from two hospitals and asked to wear an actiwatch for a period of 14 days and caregivers completed a series of questionnaires assessing co-occurrences and epilepsy-specific variables. RESULTS A high proportion of CWE (78.13%) presented significant sleep problems. Informant-reported sleep problems were significantly predictive of HRQOL above seizure severity and the number of antiseizure medications. Interestingly, informant-reported sleep problems were no longer significantly predictive of HRQOL when neurodevelopmental characteristics were considered, indicating a possible mediating effect. Similarly, actigraphy-defined sleep (variability in sleep onset latency) displayed a similar effect but only for ADHD characteristics, whereas autistic characteristics and variability in sleep onset latency continued to exert an individual effect on HRQOL. CONCLUSION These data from our study shed light on the complicated relationship between sleep, neurodevelopmental characteristics and epilepsy. Findings suggest that the impact of sleep on HRQOL in CWE is possibly mediated by neurodevelopmental characteristics. Furthermore, the impact this triangular relationship exerts on HRQOL is dependent on the type of tool used to measure sleep. These findings highlight the importance of a multidisciplinary approach to epilepsy management.
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Affiliation(s)
- Alice A Winsor
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK; Maurice Wohl Clinical Neuroscience Institute, King's College London, UK.
| | | | - Stefano Seri
- Children's Epilepsy Surgery Programme, Birmingham Children's Hospital, UK; Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Ashley Liew
- South London and Maudsley NHS Foundation Trust, University of Warwick, UK; Evelina London Children's Hospital, University of Warwick, UK
| | - Andrew P Bagshaw
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK
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Vatansever Pınar Z, Sager G, Çağ Y, Çakın Memik N, Kutlubay B, Akın Y. The course of sleep habits in newly diagnosed epilepsy in children: A prospective study. Epilepsy Behav 2023; 141:109150. [PMID: 36871321 DOI: 10.1016/j.yebeh.2023.109150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/22/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Epilepsy and sleep have a close, complex, and reciprocal relationship. Sleep may also be adversely affected by epilepsy and anti-seizure medication (ASM). This study sought to determine sleep-related problems before and after six months of treatment with ASMs follow-up in children with epilepsy, to reveal changes in sleep habits, and to determine the effect of ASMs on sleep in different types of epilepsy. METHODS This is a prospective study that included 61 children, aged 4-18 years with newly diagnosed epilepsy, who regularly had follow-up checks and used ASM for six months, and completed the Children's Sleep Habits Questionnaire (CSHQ). Children's Sleep Habits Questionnaire was completed before and after six months of ASM, allowing for assessments based on treatment group and type of epilepsy. RESULTS The mean ages of 61 children were 10.6 ± 3.9 years. The participants' post-treatment total scores on the CSHQ decreased by 2.9 ± 7.8 units on average compared to their pretreatment scores (p = 0.008; p < 0.01). In the levetiracetam group, post-treatment CSHQ subscale scores showed a mean decrease for bedtime resistance (p = 0.001), sleep duration (p = 0.005), sleep anxiety (p = 0.030), and total scores (p = 0.012) (p < 0.05). In the valproic acid group, post-treatment CSHQ subscale scores showed a mean decrease in sleep duration (p = 0.007) and a mean increase in daytime sleepiness (p = 0.03) (p < 0.05). CONCLUSION Our study found that children diagnosed with epilepsy had significantly higher rates of pretreatment sleep problems, which significantly decreased in patients who regularly attended follow-up examinations and received treatment. Except for the daytime sleepiness factor, our study found that sleep-related problems improved with treatment. It was observed that the initiation of epilepsy treatment had a positive effect on the patient's sleep, regardless of the type of treatment or epilepsy.
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Affiliation(s)
- Zeynep Vatansever Pınar
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
| | - Gunes Sager
- Department of Pediatric Neurology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Yakup Çağ
- Department of Pediatrics, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Nursu Çakın Memik
- Department of Child and Adolescent Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Büşra Kutlubay
- Department of Pediatric Neurology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Yasemin Akın
- Department of Pediatrics, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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Johnson EC, Atkinson P, Muggeridge A, Chan S, Helen Cross J, Reilly C. Perceived impact of epilepsy on sleep: Views of children with epilepsy, parents and school staff. Epilepsy Behav 2023; 138:109026. [PMID: 36512932 DOI: 10.1016/j.yebeh.2022.109026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To gain an understanding of the views of school-aged children with epilepsy, their parents, and school staff regarding the impact of epilepsy on sleep. METHODS As part of the What I Need in School (WINS) study, school-aged children (n = 18) with 'active epilepsy' (taking Anti-Seizure Medications, ASMs, for epilepsy), their parents (n = 68) and school staff (n = 56) were interviewed or completed bespoke questionnaires. Questions focussed on the potential impact of epilepsy on the child's sleep or tiredness in school and the potential impact of sleep/tiredness on learning and behavior. RESULTS Fifty-six percent of children believed that epilepsy affects their sleep while 65% of parents believed that their child had more difficulties with sleep than other children of their age. Seventy-eight percent of parents believed that their child's difficulties were due to epilepsy and 95% believed that their child's difficulties impacted their learning and behavior. Fifty-four percent of school staff believed that the child with epilepsy they supported was more tired/fatigued than their peers, and 86% of school staff believed that the child's increased tiredness affected their learning/behavior. Parents of children with intellectual disabilitiy were significantly more likely to indicate that they felt that their child had more sleep difficulties than other children (p = 0.016). Regarding the impact on their sleep, participating children felt that epilepsy contributed to difficulties in falling and staying asleep and daytime tiredness. Their parents reported a range of potential sleep difficulties and potential impacts on the child's learning and behavior. Parental reported difficulties included daytime tiredness, difficulty falling and staying asleep, and the impact of nocturnal seizures. In terms of impact, parents felt that sleep difficulties impacted negatively cognition and emotional-behavioral functioning. Additionally, parents reported that ASMs and medication for ADHD can contribute to sleep difficulties. School staff felt that many of the children appeared tired/fatigued during the day and this could lead to less engagement with classroom activities, impact attention and processing speed negatively, and contribute to behavioral and emotional difficulties. CONCLUSION The majority of children and parents who responded believed that epilepsy affects the child's sleep. Most parents and school staff also believed that the child's sleep difficulties/excess tiredness were due to the child's epilepsy and that the difficulties significantly impacted the child's learning and behavior. There is a need to better understand the role epilepsy plays in sleep difficulties and associated learning and behavioral impairments. There is also a need to develop interventions to reduce the subsequent impact on child learning and behavior.
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Affiliation(s)
- Emma C Johnson
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, West Green Drive, Crawley RH11 7DH, West Sussex, UK
| | - Amy Muggeridge
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Samantha Chan
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH, UK
| | - J Helen Cross
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH, UK
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London WC1N 1EH, UK.
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Kopciuch D, Fliciński J, Steinborn B, Winczewska-Wiktor A, Paczkowska A, Zaprutko T, Ratajczak P, Nowakowska E, Kus K. Pharmacoeconomics Aspects of Antiepileptic Drugs in Pediatric Patients with Epilepsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127517. [PMID: 35742766 PMCID: PMC9223520 DOI: 10.3390/ijerph19127517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023]
Abstract
Objective: This study assessed the differentiation of treatment costs with newer and older antiepileptic drugs (AEDs) through its correlation with treatment effectiveness and an adverse event (AE) in pediatric patients with epilepsy (PPE). Methods: PPE on monotherapy of AEDs for the last 6 months were screened for this study. Seizure frequency during the study was compared with that within 6 months before the study. The following parameters were also assessed: quality of life in epilepsy, Pittsburgh Sleep Quality Index, and Liverpool AEs Profile. An incremental cost-effectiveness ratio (ICER) analysis based on the costs of pharmacotherapy was also performed. Results: Out of 80 PPE, 67 completed the study, and 13 PPE were lost after failing to meet the inclusion criteria. A total of 56.71% of PPE were on newer AEDs, and 43.28% were on older AEDs. Newer and older AEDs did not differ significantly in seizure frequency reduction and quality of life parameters, although these were improved significantly during the study period. As per ICER, newer AEDs need an additional EUR 36.82 per unit reduction in seizure frequency. Conclusion: Newer AEDs have comparatively better efficacy, although not significantly better than older AEDs. However, the additional cost per unit improvement is quite high with newer AEDs, necessitating pharmacoeconomic consideration in pediatric epilepsy treatment.
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Affiliation(s)
- Dorota Kopciuch
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
- Correspondence: ; Tel./Fax: +48-6-1854-6894
| | - Jędrzej Fliciński
- Department of Developmental Neurology, Karol Marcinkowski University of Medical Sciences in Poznań, 60-355 Poznan, Poland; (J.F.); (B.S.); (A.W.-W.)
| | - Barbara Steinborn
- Department of Developmental Neurology, Karol Marcinkowski University of Medical Sciences in Poznań, 60-355 Poznan, Poland; (J.F.); (B.S.); (A.W.-W.)
| | - Anna Winczewska-Wiktor
- Department of Developmental Neurology, Karol Marcinkowski University of Medical Sciences in Poznań, 60-355 Poznan, Poland; (J.F.); (B.S.); (A.W.-W.)
| | - Anna Paczkowska
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
| | - Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
| | - Elżbieta Nowakowska
- Department of Pharmacology and Toxicology Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Góra, Poland;
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Karol Marcinkowski University of Medical Sciences in Poznań, 60-865 Poznan, Poland; (A.P.); (T.Z.); (P.R.); (K.K.)
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10
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Ahmed GK, Darwish AM, Khalifa H, Haridy NA. Relationship between Attention Deficit Hyperactivity Disorder and epilepsy: a literature review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00482-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurological disorder. ADHD has been linked to epilepsy.
Main body
ADHD was found to be present in 30–40% of epileptic children. Researchers have developed numerous theories to explain how and why ADHD and epilepsy coexist. Whether ADHD and epilepsy symptoms are caused by co-occurring psychiatric disorders or by the temporary effects of epileptic discharges or by antiepileptic medicines is critical to consider. Diagnosis and treatment of individuals with ADHD and epilepsy are complicated and challenging from the clinical base.
Conclusions
Comorbidity between ADHD and epilepsy is still challenging to understand. The two diseases have a bidirectional link, so the association may not be coincidental. A disputable point is whether co-occurring ADHD and epilepsy symptoms represent a comorbid psychiatric disorder or are the epileptic discharges’ temporary effects, and are they related to antiepileptic drugs (AEDs). It is recommended to follow up with children with epilepsy or ADHD as they may develop comorbidity after a while.
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11
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Öz B, Şahin AK, Türay S, Sungur MA. Evaluation of sleep habits, sleep chronotype, and quality of life in children with drug-resistant epilepsy in Turkey. Epilepsy Behav 2022; 130:108675. [PMID: 35395515 DOI: 10.1016/j.yebeh.2022.108675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Drug-resistant epilepsy (DRE) is a condition that affects sleep habits and the quality of life of children unfavorably. The aim of our study was to evaluate the relationship of sleep habits and sleep chronotype with the quality of life and behavioral problems in children with DRE. MATERIALS AND METHODS In our study, 2-11-year-old children, who were either healthy or diagnosed with DRE, were evaluated. A sociodemographic data form was filled out to evaluate the general characteristics of children. The Children's Sleep Habits Questionnaire (CSHQ) and the Children's Chronotype Questionnaire (CCTQ) for sleep habits, the Pediatric Quality of Life Inventory (PedsQL) for the quality of life, and the Aberrant Behavior Checklist (ABC) for behavioral problems were filled out through face-to-face interviews with parents. RESULTS Thirty children with DRE and 31 healthy children were included in our study. Statistically significant differences were found in children with DRE compared to the control group in terms of the total and the subscale scores of CSHQ, including sleep onset delay, sleep duration, sleep anxiety, parasomnias, and sleep-disordered breathing (p < 0.001). There were no significant differences between the groups in terms of CCTQ total scores and sleep patterns (p > 0.05). Significant differences were found in PedsQL total and subscale scores, and ABC scores in children with DRE compared to the control group (p < 0.001). Children's Sleep Habits Questionnaire, PedsQL, and ABC scores were significantly correlated with each other in children with DRE. CONCLUSIONS Our results have shown that sleep habits and the quality of life are poor in children with DRE. Our study has shown that sleep disturbances, quality of life, and behavioral problems are strongly associated with each other in DRE. The recognition and appropriate treatment of sleep disturbances are important for improving the quality of life in children with DRE.
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Affiliation(s)
- Büşra Öz
- Department of Child and Adolescent Psychiatry, Duzce University Medical Faculty, Düzce, Turkey.
| | - Ayşenur Kübra Şahin
- Department of Child and Adolescent Psychiatry, Duzce University Medical Faculty, Düzce, Turkey
| | - Sevim Türay
- Department of Pediatric Neurology, Duzce University Medical Faculty, 81820 Duzce, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics and Medical Informatics, Duzce University Medical Faculty, Düzce, Turkey
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12
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Proost R, Lagae L, Van Paesschen W, Jansen K. Sleep in children with refractory epilepsy and epileptic encephalopathies: A systematic review of literature. Eur J Paediatr Neurol 2022; 38:53-61. [PMID: 35395626 DOI: 10.1016/j.ejpn.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
Children with epilepsy have more sleep disorders compared to healthy children. The bidirectional interaction between epilepsy and sleep is not completely understood. However, disruption of sleep architecture during childhood may have consequences for cognitive development. As children with drug-refractory epilepsy often have intellectual disability, sleep disruption could be an important contributing factor in severity of their cognitive impairment. To better understand these interactions, sleep architecture in children with drug-refractory epilepsy and epileptic encephalopathies should be investigated. In this review, we conducted a systematic literature search on this topic. Articles that investigated sleep macro- and/or microstructure by means of electroencephalogram/polysomnography were included, as well as articles that used validated questionnaires. Sixteen articles were reviewed, eight of which used polysomnography. Only 2 articles examined sleep in children with epileptic encephalopathies. Consistent findings on measures of sleep architecture were a reduction in REM percentage and an increase in sleep fragmentation when comparing drug-refractory patients with non-refractory and healthy subjects. The findings on slow wave sleep were less clear. Studies with questionnaires unambiguously confirmed subjectively more sleep problems in children with drug-refractory epilepsy. This is the first review of literature in this patient population. More good quality sleep studies in children with drug-refractory epilepsy are warranted. The use of wearables in the home setting together with automatic sleep staging could provide more insights.
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Affiliation(s)
- R Proost
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium.
| | - L Lagae
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium
| | - W Van Paesschen
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - K Jansen
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium.
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13
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Sleep disorders and ADHD symptoms in children and adolescents with typical absence seizures: An observational study. Epilepsy Behav 2022; 128:108513. [PMID: 35085916 DOI: 10.1016/j.yebeh.2021.108513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the occurrence of sleep disorders (SD) and attention deficit hyperactivity disorder (ADHD) symptoms in children with typical absence seizures (TAS) compared to control children and to evaluate the impact of epilepsy-related factors on sleep and attention in children with TAS. METHODS The Sleep Disturbance Scale for Children (SDSC) and the ADHD rating scale were filled in by parents of a cohort composed by 82 children aged from 5 to 15.6 years, 49% of boys (41 with TAS with a syndromic diagnosis of childhood absence epilepsy and 41 controls). For children with TAS, the Pediatric Epilepsy Side Effects Questionnaire was completed. Statistical analyses were conducted in order to compare sleep and attention scores between groups. In children with TAS, a correlation was computed between these scores. Logistics regression models were conducted to identify predictors of excessive diurnal sleepiness and inattention in children with TAS. RESULTS Compared to controls, children with TAS had higher total scores for subjective sleep (mean 42.9 vs 38.3, p = 0.05) and attention disorders (mean 16.8 vs 11.6, p = 0.01), especially for excessive diurnal sleepiness (mean 3.9 vs 3.2, p = 0.02) and inattention (mean 9.3 vs 5.6, p = 0.003) components. In children with TAS, sleep problems were significantly under-reported by parents. Sleep disorders symptoms as breathing-related sleep disturbance, excessive diurnal sleepiness or naps at or after 7 years of age were reported. Subjective sleep and attention disorders were significantly correlated (r = 0.43, p = 0.01). Subjective excessive diurnal sleepiness may be the result of a polytherapy (p = 0.05) or a side effect of anti-seizure medication (ASM) (p = 0.03) but children without medication side effects also reported subjective SD. In children with TAS, the risk of inattention symptoms was increased in boys (p = 0.02), with a high BMI (p = 0.05), or with ASM side effects (p = 0.03). CONCLUSIONS This study demonstrates that children with TAS are at risk of sleep and attention disorder symptoms. If attention disorders in a context of epilepsy are now widely assessed and identified, sleep disorders are still under-estimated. An accurate identification and management of sleep disorders could improve academic performances, quality of life, and seizure management in children with TAS.
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14
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Winsor AA, Richards C, Bissell S, Seri S, Liew A, Bagshaw AP. Sleep disruption in children and adolescents with epilepsy: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101416. [PMID: 33561679 DOI: 10.1016/j.smrv.2021.101416] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 01/20/2023]
Abstract
This systematic review and meta-analysis aims to assess and quantify putative differences in sleep architecture, sleep efficiency, sleep timing and broadly-defined sleep difficulties between children with and without epilepsy. Databases were searched systematically, and studies identified in PubMed, EMBASE, PsychINFO and Medline. The meta-analysis included 19 studies comparing a total of 901 children with epilepsy to 1470 healthy children. Relative to healthy children, children with epilepsy experienced reduced sleep time, sleeping on average 34 mins less across self-report, actigraphy, 24-h video-EEG and polysomnography measures. They had more sleep difficulties specifically in the domains of night waking, parasomnias and sleep disordered breathing. The analysis also revealed a significantly increased percentage of N2 sleep and decreased sleep efficiency in children with epilepsy compared to healthy children. These results illustrate that children with epilepsy are vulnerable to more sleep difficulties compared to healthy children. This suggests that screening for sleep difficulties should be an integral part in a diagnosis of epilepsy to ensure that clinically relevant sleep difficulties are identified and treated. Such an approach may ultimately aid in the development of treatment strategies which can contribute to improvements in both developmental and diagnostic outcomes for children with epilepsy.
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Affiliation(s)
- Alice A Winsor
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK.
| | | | | | - Stefano Seri
- Birmingham Children's Hospital, Birmingham Women's and Children's Hospital NHS Foundation, UK
| | - Ashley Liew
- Evelina London Children's Hospital, South London and Maudsley NHS Foundation Trust, University of Warwick, University of Birmingham, UK
| | - Andrew P Bagshaw
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK
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15
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Safarpour Lima B, Zokaei A, Assarzadegan F, Hesami O, Zareh Shahamati S. Prevalence of sleep disorders in patients with epilepsy: A questionnaire-based cross-sectional study. Epilepsy Behav 2021; 114:107635. [PMID: 33309236 DOI: 10.1016/j.yebeh.2020.107635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sleep disturbance is a frequent finding in patients with epilepsy. As evaluation of sleep disorders and quality of sleep in patients with epilepsy may provide better management of these patients, we aimed to assess the prevalence of common sleep disorders in patients with epilepsy. METHODS Patients with epilepsy referred to an outpatient epilepsy clinic in Tehran during one year were included. Validated Persian questionnaires were used by an interviewer to assess Excessive daytime sleepiness (EDS), Restless leg syndrome (RLS), and insomnia. Also, patients' demographic features and clinical seizure-related characteristics were recorded. RESULTS Seventy patients (35 males) aged between 18 and 75 were enrolled. Among patients, 61.4, 35.7, and 28.6% suffered from insomnia, EDS, and RLS, respectively (mild to severe). When considering seizure characteristics, there was no significant correlation between either seizure frequency or its type and the prevalence of sleep disturbance (although sleep disturbance was more common among patients with higher seizure frequency and patients with generalized seizure). Interestingly, age had a positive correlation with EDS. CONCLUSION This study showed that sleep disturbance is a common finding in patients with epilepsy, which may become severe in some cases. Taking this into consideration, we suggest that routine evaluation of sleep disorders may help physicians to boost patients' sleep quality.
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Affiliation(s)
- Behnam Safarpour Lima
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Zokaei
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Assarzadegan
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Hesami
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Zareh Shahamati
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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16
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Arhan E, Uçar HK, Aydın K, Hirfanoğlu T, Serdaroglu A. How do children with drug-resistant epilepsy sleep? A clinical and video-PSG study. Epilepsy Behav 2021; 114:107320. [PMID: 32839145 DOI: 10.1016/j.yebeh.2020.107320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
AIM The aim of this study was to assess sleep architecture and sleep problems among three homogenous groups of children including children with drug-resistant focal epilepsy, children with newly diagnosed, drug-naïve focal epilepsy, and healthy children using overnight video-polysomnography (V-PSG) and a sleep questionnaire. METHODS We compared sleep architecture among 44 children with drug-resistant focal epilepsy, 41 children with newly diagnosed, drug naïve focal epilepsy, and 36 healthy children. All children underwent an overnight V-PSG recording, and their parents completed the Children's Sleep Habits Questionnaire (CSHQ). Sleep recordings were scored according to the American Academy of Sleep Medicine criteria. RESULTS Compared with children with newly diagnosed epilepsy and healthy controls, children with drug-resistant epilepsy receiving antiepileptic treatment showed disturbed sleep architecture, a significant reduction in time in bed, total sleep time, sleep efficiency, NREM3%, REM%, and a significant increase in awakenings, wake after sleep onset, and periodic leg movement. Children with drug-naïve, newly diagnosed focal epilepsy showed a statistically significant increase in sleep onset latency, rapid eye movement (REM) latency, N1%, awakenings, and a significant decrease in time in bed when compared with the controls. Children with drug-resistant epilepsy had the highest CSHQ total scores, while children with drug-naïve, newly diagnosed focal epilepsy had higher scores than healthy children. CONCLUSION This is one of the few polysomnographic studies adding to the limited research on the sleep macrostructure of children with drug-resistant epilepsy compared with children with drug-naïve, newly diagnosed focal epilepsy and healthy children by obtaining objective measurements of sleep concurrently with a validated questionnaire. Children with drug-resistant epilepsy had a greater incidence of sleep disturbance on the basis of qualitative aspects and architecture of sleep than children with newly diagnosed epilepsy, suggesting the need for referral of children with drug-resistant epilepsy for overnight sleep evaluation in order to improve the clinical management and optimize therapeutic strategies.
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Affiliation(s)
- Ebru Arhan
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology.
| | | | - Kürsad Aydın
- Medipol University, Faculty of Medicine, Department of Pediatric Neurology
| | - Tugba Hirfanoğlu
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology
| | - Ayse Serdaroglu
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology
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17
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Yang H, Feng Y, Zhu Z, Qiao Z, Xiao B, Feng L. Evaluation of anxiety, depression, and sleep quality among parents of children with epilepsy in Southern China. Epilepsy Behav 2020; 112:107340. [PMID: 32861027 DOI: 10.1016/j.yebeh.2020.107340] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of the study was to evaluate sleep quality in the parents of children with epilepsy (CWE) as well as their symptoms of anxiety and depression in Southern China. METHOD A structured questionnaire, comprised of The State-Trait Anxiety Inventory (STAI), Center for Epidemiologic Studies Depression Scale (CES-D), and the Pittsburgh Sleep Quality Index (PSQI), was administered to parents of CWE (n = 234) in Xiangya Hospital and parents of healthy children (n = 230) during 2019-2020. RESULTS The scores (Mean ± SD) of State Anxiety Inventory (S-AI) and Trait Anxiety Inventory (T-AI) among parents of CWE were 51.850 ± 11.380 and 48.201 ± 9.526, respectively, which were significantly higher than those of control group (37.172 ± 8.047 and 37.478 ± 7.314, respectively) (p < 0.001). Compared with 10.84% in parents of healthy children, 23.51% of parents of CWE had symptoms of depression (p < 0.001). The mean score of total PSQI among parents of CWE (6.944 ± 3.814) was statistically higher than that of parents of healthy children (5.039 ± 3.390) (p < 0.001). Moreover, anxiety and depression subscores among parents of infants with epilepsy were significantly higher than in other groups. The T-AI and CES-D could explain 43.9% of the variance (R2 = 0.444, F = 92.215, p < 0.001) on the PSQI. CONCLUSIONS Our study showed more severe symptoms of anxiety and depression as well as poorer sleep quality among parents of CWE, especially in the infants group. In light of this information, more attention should be paid to early identification and intervention of symptoms of anxiety and depression in susceptible parents who are the main caregivers of their CWE.
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Affiliation(s)
- Haojun Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Yanyan Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Ziqing Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Zhihua Qiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China.
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18
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Course and impact of sleep disturbance in newly diagnosed epilepsy: A prospective registry study. Clin Neurol Neurosurg 2020; 195:105963. [PMID: 32474255 DOI: 10.1016/j.clineuro.2020.105963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/13/2020] [Accepted: 05/23/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the course of sleep distrurbance (insomnia symptoms and short sleep duration) after a diagnosis of epilepsy and their associations with seizure control, mood, disability, and quality of life. PATIENTS AND METHODS One hundred and sixty-nine adults were drawn from the Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC), a prospective, multicenter, community-wide study in Sydney, Australia. Socio-demographic, psychosocial, clinical characteristics, and information on sleep disturbance were obtained early (median 48 [IQR15-113] days) after a diagnosis of epilepsy, and at 12 months. Logistic regression models were used to determine associations between patterns of sleep disturbance with outcomes at 12 months. RESULTS Insomnia symptoms and/or short sleep duration were present in 18-23% of participants at both time points, with over half (54-61%) showing a chronic pattern. There was no association of sleep disturbance pattern with recurrent seizures, medication use or disability. Chronic insomnia symptoms and short sleep duration were strongly associated with worse mental health (aOR 3.76, 95% CI 1.28-11.06; and aOR 5.41, 95% CI 1.86-15.79) and poorer quality of life at 12 months (aOR 3.02, 95% CI 1.03-8.84; and aOR 3.11, 95% CI 1.10-8.82), after adjusting for clinical features of epilepsy and comorbidity. Those whose sleep disturbance remitted had no adverse outcomes. CONCLUSIONS Insomnia symptoms and short sleep duration are less common in people with recently-diagnosed than chronic epilepsy. The temporal association with poor psycholosocial outcomes supports specific interventions addressing sleep disturbance.
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19
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Lin YY, Lee WT, Yang HL, Weng WC, Lee CC, Jeng SF, Tsai SY. Screen Time Exposure and Altered Sleep in Young Children With Epilepsy. J Nurs Scholarsh 2020; 52:352-359. [PMID: 32396281 DOI: 10.1111/jnu.12558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine the association between daily screen time exposure and both sleep patterns (sleep onset, sleep offset, and nighttime, and daily sleep durations) and sleep disturbances among a clinical sample of children with epilepsy. DESIGN A cross-sectional actigraphic sleep study. METHODS A convenience sample of 141 children with epilepsy (1.5-6 years of age) was recruited from an outpatient pediatric neurology clinic of a university-affiliated children's hospital in northern Taiwan. Participating families completed questionnaires and reported children's screen time use, with children wearing an actigraphy monitor for 7 days to assess sleep patterns. Multivariable linear regression analyses were conducted to examine the association of screen time exposure with the child's sleep patterns and sleep disturbance scores. FINDINGS Mean minutes per day of screen time exposure was 89.79 ± 83.94 min, with 62 parents (44.0%) reporting their child having >1 hr of screen time daily. Mean daily sleep duration was 9.26 ± 1.01 hr, with 106 children (93.0%) sleeping <10 hr in a 24-hr period. In multivariate regression models, daily screen time exposure of >1 hour was associated with 23.4-min later sleep onset (b = 0.39, p = .02), 20.4-min later sleep offset (b = 0.34, p = .04), and more severe sleep disturbances (b = 2.42, p = .04). CONCLUSIONS In toddlers and preschool-age children with epilepsy, daily screen time exposure is greater and sleep duration is shorter than the recommended amount, with increased screen time exposure associated with disturbed sleep. CLINICAL RELEVANCE Parents need to be informed about the possible adverse impact of screen time exposure on children's sleep and health as well as the importance of limiting screen time exposure to <1 hr per day for their toddlers and preschool-age children with epilepsy.
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Affiliation(s)
- Ying-Ying Lin
- Graduate in Woman, Child & Mental Health Nursing Program, School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wang-Tso Lee
- Professor, Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Hsiao-Ling Yang
- Assistant Professor, School of Nursing, College of Medicine, National Taiwan University, Adjunct registered nurse, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Assistant Professor, Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chien-Chang Lee
- Associate Professor, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Suh-Fang Jeng
- Professor, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shao-Yu Tsai
- Lambda Beta-at-Large, Professor, School of Nursing, College of Medicine, National Taiwan University, Adjunct Supervisor, National Taiwan University Hospital, Taipei, Taiwan
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20
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Zambrelli E, Turner K, Vignoli A, La Briola F, Dionisio S, Malanchini S, Galli F, Canevini MP. Sleep disturbances in Italian children and adolescents with epilepsy: A questionnaire study. Epilepsy Behav 2020; 106:107014. [PMID: 32229412 DOI: 10.1016/j.yebeh.2020.107014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 11/18/2022]
Abstract
Sleep and epilepsy interact with each other in a complex bidirectional way. The main objective of this study was to characterize and determine the prevalence of sleep and behavioral disorders among Italian children and adolescents with epilepsy. We asked 84 consecutive parents/caregivers of patients with epilepsy aged between 6 and 17 years old to fill out the Sleep Disturbances Scale for Children (SDSC) and Child Behavior Checklist (CBCL). An abnormal total sleep score was found in 20 subjects with epilepsy (23.8%), compared with 4 (4.4%) of control group (P < .001). Forty-eight patients (57.1%) had an abnormal score in at least one SDSC factor: disorders in initiating and maintaining sleep (DIMS; 13.1%), sleep breathing disorders (SBD; 13.1%), disorders of arousal (DA; 5.9%), sleep-wake transition disorders (SWTD; 15.5%), disorders of excessive somnolence (DOES; 20.2%), and sleep hyperhidrosis (SHY; 5.9%). Patients with epilepsy showed higher prevalence of behavioral/emotional disturbances in all CBCL domains but one compared with patients without epilepsy. The SDSC and CBCL total scores showed a significant correlation (R-square = 0.256; P < .001). Sleep and behavioral/emotional disorders are common in epilepsy during childhood and adolescence. The SDSC could be a valid tool to screen sleep disturbances in this group of patients.
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Affiliation(s)
- Elena Zambrelli
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy.
| | - Katherine Turner
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Aglaia Vignoli
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy; Department of Health Sciences, University of Milan, Italy
| | - Francesca La Briola
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Silvia Dionisio
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Sara Malanchini
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Federica Galli
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Maria Paola Canevini
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy; Department of Health Sciences, University of Milan, Italy
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Physically active children with epilepsy have good objective sleep duration and efficiency despite subjective reports of fatigue and sleep problems. Epilepsy Behav 2020; 104:106853. [PMID: 31958642 DOI: 10.1016/j.yebeh.2019.106853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to longitudinally characterize in children with epilepsy the objective and subjective sleep quality and the relationship between increased physical activity and sleep as well as measures of psychosocial well-being. METHODS Baseline physical activity and sleep were established in children with epilepsy over four weeks, prior to a 12-week exercise intervention (weekly meeting with exercise counselor). Participants continuously wore a wrist pedometer (Fitbit Flex®) to capture daily number of steps, sleep efficiency, and total sleep time. The Early Childhood Epilepsy Severity Scale (E-Chess) assessed baseline epilepsy severity. Subjective sleep quality (Children's Sleep Habits Questionnaire, CSHQ), quality of life (KIDSCREEN-27; Pediatric Quality of Life Inventory, PedsQL™, 4.0 Core), fatigue (PedsQL™ Multidimensional Fatigue Scale), depression (Children's Depression Inventory-Short), and anxiety (Multidimensional Anxiety Scale for Children) were assessed pre- and post-interventions. RESULTS Our cohort of 22 children with epilepsy aged 8-14 years was similarly active to peers (11,271 ± 3189 mean steps per day) and displayed normal sleeping patterns (mean sleep efficiency: 87.4% ± 3.08 and mean total sleep time: 521 ± 30.4). Epilepsy severity assessed by E-Chess was low to moderate (median baseline E-Chess score of 6, interquartile range: 5-7). Study outcomes did not change with the intervention. Older children and those with lower baseline activity were more likely to increase their activity during the intervention. Changes in physical activity were not associated with changes in sleep outcomes when accounting for age, sex, and baseline E-Chess score. Subjective sleep quality marginally improved with the intervention (CSHQ total score: 44.5 ± 5.8 at baseline and 41.6 ± 7.2 at the end of study, p = 0.05). Quality of life, fatigue, depression, and anxiety did not change with the intervention (p = 0.55, 0.60, 0.12, and 0.69, respectively). SIGNIFICANCE Children with epilepsy who are as active as peers without epilepsy have good objective measures of sleep despite self-reported fatigue and parent-reported sleep problems. The physical activity of initially less active and older children with epilepsy may benefit from an exercise counseling intervention.
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Tsai S, Lee W, Lee C, Jeng S, Weng W. Sleep in mothers of children with epilepsy and its relation to their children's sleep. Res Nurs Health 2020; 43:168-175. [DOI: 10.1002/nur.22008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Shao‐Yu Tsai
- School of NursingNational Taiwan University Taipei Taiwan
| | - Wang‐Tso Lee
- Department of Pediatric NeurologyNational Taiwan University Children's Hospital Taipei Taiwan
| | - Chien‐Chang Lee
- Department of Emergency MedicineNational Taiwan University Hospital Taipei Taiwan
| | - Suh‐Fang Jeng
- School and Graduate Institute of Physical Therapy, College of MedicineNational Taiwan University Taipei Taiwan
| | - Wen‐Chin Weng
- Department of Pediatric NeurologyNational Taiwan University Children's Hospital Taipei Taiwan
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Tsai SY, Lee WT, Lee CC, Jeng SF, Weng WC. Behavioral-educational sleep interventions for pediatric epilepsy: a randomized controlled trial. Sleep 2019; 43:5573595. [DOI: 10.1093/sleep/zsz211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/22/2019] [Indexed: 01/02/2023] Open
Abstract
AbstractStudy ObjectivesTo evaluate the effect of a clinic-based, behavioral-educational sleep intervention on sleep of children with epilepsy, maternal knowledge about childhood sleep, and maternal sleep quality.MethodsA total of 100 toddlers and preschool-age children with epilepsy (1.5–6 years, 55% boys) and their parents were randomized to receive sleep intervention (n = 50) or usual care with attention (n = 50). Outcomes were assessed at baseline, 3, 6, and 12 months after intervention with the use of objective actigraphy, Children’s Sleep Habits Questionnaire, Parents’ Sleep Knowledge Inventory, and Pittsburgh Sleep Quality Index. Intervention effects were examined using general linear models for repeated measurements to compare the mean change in outcomes from baseline to 12 months post-intervention between the two groups.ResultsSleep intervention resulted in children having greater sleep efficiency by 2.03% compared with the usual care group (95% CI = 0.20% to 3.86%; p = .03). Children in the intervention group also had significantly longer total nighttime sleep as objectively assessed by actigraphy than did those in the usual care group, with an adjusted mean difference of 16.13 minutes (95% CI = 0.24% to 32.03%; p = .04). No intervention effects were observed for maternal knowledge about childhood sleep, and maternal sleep quality.ConclusionSleep intervention provided during routine neurologic visits results in significant, measurable, and sustained benefits in sleep quality and quantity in children with epilepsy. Future trials are warranted to evaluate whether improvements in sleep could impact health-related quality of life or other aspects of functioning in children with epilepsy.Clinical TrialThis trial has been registered at www.clinicaltrials.gov (trial name: Sleep Intervention for Pediatric Epilepsy; registration number: NCT02514291).
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Affiliation(s)
- Shao-Yu Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatric Neurology, National Taiwan University Children’s Hospital, Taipei, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatric Neurology, National Taiwan University Children’s Hospital, Taipei, Taiwan
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Tsai SY, Lee WT, Jeng SF, Lee CC, Weng WC. Sleep and Behavior Problems in Children With Epilepsy. J Pediatr Health Care 2019; 33:138-145. [PMID: 30149961 DOI: 10.1016/j.pedhc.2018.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/20/2018] [Accepted: 07/15/2018] [Indexed: 01/14/2023]
Abstract
We designed a cross-sectional study to examine the association between sleep and behavior problems in toddlers and preschool-age children with epilepsy. We found that 71 (78.9%) children slept less than 10 hours in a 24-hour period according to the actigraphy, with 75 (83.3%) children waking for more than an hour during nocturnal sleep. Twenty-five (27.8%) children usually or sometimes had an inconsistent bedtime, and 24 (26.7%) did not sleep the same amount each day. Twenty-nine (32.2%) and 18 (20.0%) children had an internalizing and externalizing problem in clinical range, respectively. Sleep anxiety was significantly (p < .01) associated with increased internalizing and externalizing problems, even after the relevant epilepsy variables were controlled for. Findings from our study suggest that screening of sleep and behavior problems should be part of routine epilepsy care to identify children with problematic sleep and unrecognized sleep disorders and those at risk of behavioral dysfunction.
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Reilly C, Atkinson P, Memon A, Jones C, Dabydeen L, Cross JH, Das KB, Gillberg C, Neville BG, Scott RC. Child and parental sleep in young children with epilepsy: A population-based case-control study. Epilepsia Open 2018; 3:383-391. [PMID: 30187009 PMCID: PMC6119759 DOI: 10.1002/epi4.12241] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the prevalence of parent-reported sleep problems in young children with epilepsy and their parents, and to compare findings with those in a non-epilepsy-related neurodisability (neurodevelopmental/neurological difficulties) group. METHOD Parents of young children (1-7 years) with epilepsy (n = 48 [91% ascertainment]) completed the Child Sleep Habits Questionnaire (CSHQ). Parents (mothers and fathers) also completed the Pittsburgh Sleep Quality Index (PSQI) and the Iowa Fatigue Scale (IFS) in relation to their own functioning. The responses of parents of children with epilepsy were compared with parents of developmental-, age-, and gender-matched children with nonepilepsy-related neurodisability (n = 48). RESULTS There was not a significant difference in the proportion of children with epilepsy and the children with neurodisability scoring in the at-risk range on the CSHQ (81% vs. 71% respectively) (p = 0.232). 62% of mothers and 44% of fathers of children with epilepsy had 'poor quality sleep' on the PSQI; there was not a significant difference between mothers of children with epilepsy and those of children with neurodisability (p = 0.526) or IFS (p = 0.245) total scores. However, mothers of children with epilepsy had significantly more difficulties on the productivity subscale of the IFS (p = 0.004). There were no significant differences between fathers' scores on either measure. In the epilepsy group, child behavioral problems (p = 0.001) were independently associated with child sleep difficulties and maternal mental health problems were associated with parental sleep difficulties (p = 0.04) and fatigue (p = 0.018). SIGNIFICANCE Young children with epilepsy and their parents have a high rate of sleep difficulties. There is a need to develop effective interventions for this population, taking into consideration of the role of child behavioral problems and parental mental health difficulties.
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Affiliation(s)
- Colin Reilly
- Research DepartmentYoung EpilepsySurreyUnited Kingdom
- UCL Great Ormond Street Institute of Child Health (ICH)LondonUnited Kingdom
| | | | - Ayesha Memon
- Child Development CentreCrawley HospitalCrawleyUnited Kingdom
| | - Chloe Jones
- Research DepartmentYoung EpilepsySurreyUnited Kingdom
| | | | - J. Helen Cross
- Research DepartmentYoung EpilepsySurreyUnited Kingdom
- UCL Great Ormond Street Institute of Child Health (ICH)LondonUnited Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondonUnited Kingdom
| | - Krishna B. Das
- UCL Great Ormond Street Institute of Child Health (ICH)LondonUnited Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondonUnited Kingdom
| | - Christopher Gillberg
- Research DepartmentYoung EpilepsySurreyUnited Kingdom
- UCL Great Ormond Street Institute of Child Health (ICH)LondonUnited Kingdom
- Gillberg Neuropsychiatry CentreUniversity of GothenburgGothenburgSweden
| | - Brian G.R. Neville
- Research DepartmentYoung EpilepsySurreyUnited Kingdom
- UCL Great Ormond Street Institute of Child Health (ICH)LondonUnited Kingdom
| | - Rod C. Scott
- UCL Great Ormond Street Institute of Child Health (ICH)LondonUnited Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondonUnited Kingdom
- Department of Neurological SciencesUniversity of Vermont College of MedicineBurlingtonVermontU.S.A
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26
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Sleep in children with epilepsy: the role of maternal knowledge of childhood sleep. Sleep 2018; 41:5077591. [DOI: 10.1093/sleep/zsy157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Indexed: 12/27/2022] Open
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Plevin D, Jureidini J, Howell S, Smith N. Paediatric antiepileptic polytherapy: systematic review of efficacy and neurobehavioural effects and a tertiary centre experience. Acta Paediatr 2018; 107:1587-1593. [PMID: 29603802 DOI: 10.1111/apa.14343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/09/2018] [Accepted: 03/23/2018] [Indexed: 11/28/2022]
Abstract
AIM This paper presents the prevalence of antiepileptic polytherapy at a single tertiary institution and systematically reviews the evidence base for its efficacy and neurobehavioural safety in children. METHOD Prevalence of antiepileptic polypharmacy was determined from pharmacy dispensing records at a paediatric tertiary hospital and neurobehavioural comorbidities quantified through casenote review; comparison is made with studies evaluating the neurobehavioural safety of antiepileptic polytherapy, identified via systematic literature review. RESULTS Amongst 262 patients at the hospital, 117 (44.7%) were prescribed polytherapy; with patients having an intellectual disability statistically more likely to be prescribed polytherapy than those without (70.5% vs 40.6%; p < 0.0001). Systematic review identified no trials addressing the efficacy or neurobehavioural outcomes of polytherapy as a primary outcome. Several observational studies identified associations between polytherapy and neurobehavioural adverse outcomes such as anxiety and behavioural disturbance. Observational studies also suggest that a reduction in polytherapy load is generally not associated with worsening seizure control. CONCLUSION Whilst antiepileptic polytherapy is common practice within paediatric epilepsy cohorts attending tertiary care institutions, evidence is lacking to support its efficacy. There are significant practical difficulties to undertaking randomised controlled trials within this population. Nonetheless, clinicians must consider that adverse neurobehavioural consequences of polytherapy might outweigh benefits to seizure control.
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Affiliation(s)
- D Plevin
- Flinders Medical Centre, Bedford Park, SA, Australia
| | - J Jureidini
- Department of Psychological Medicine, Women's and Children's Hospital, Adelaide, SA, Australia
- University Department of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - S Howell
- Data Design and Statistics Service, Adelaide Health Technology Assessment (AHTA), School of Public Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - N Smith
- University Department of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
- Department of Neurology, Women's and Children's Hospital, Adelaide, SA, Australia
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Trickett J, Heald M, Oliver C, Richards C. A cross-syndrome cohort comparison of sleep disturbance in children with Smith-Magenis syndrome, Angelman syndrome, autism spectrum disorder and tuberous sclerosis complex. J Neurodev Disord 2018; 10:9. [PMID: 29490614 PMCID: PMC5831859 DOI: 10.1186/s11689-018-9226-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background Sleep disturbance is common in children with neurodevelopmental disorders, with high rates identified in children with Smith-Magenis syndrome (SMS), Angelman syndrome (AS), autism spectrum disorder (ASD) and tuberous sclerosis complex (TSC). Phenotypic sleep profiles for these groups may implicate different pathways to sleep disturbance. At present, cross-group comparisons that might elucidate putative phenotypic sleep characteristics are limited by measurement differences between studies. In this study, a standardised questionnaire was administered across groups affording comparison of the prevalence and profile of sleep disturbance between groups and contrast to chronologically age-matched typically developing (TD) peers. Methods The modified version of Simonds and Parraga’s sleep questionnaire, adapted for use in children with intellectual disabilities, was employed to assess sleep disturbance profiles in children aged 2–15 years with SMS (n = 26), AS (n = 70), ASD (n = 30), TSC (n = 20) and a TD contrast group (n = 47). Associations between sleep disturbance and age, obesity, health conditions and overactivity/impulsivity were explored for each neurodevelopmental disorder group. Results Children with SMS displayed severe night waking (81%) and early morning waking (73%). In contrast, children with ASD experienced difficulties with sleep onset (30%) and sleep maintenance (43%). Fewer children with ASD (43%) and AS (46%) experienced severe night waking compared to children with SMS (both p < .01). Higher sleep-disordered breathing scores were identified for children with SMS (p < .001) and AS (p < .001) compared to the TD group. Sleep disturbance in children with AS and TSC was associated with poorer health. Children experiencing symptoms indicative of gastro-oesophageal reflux had significantly higher sleep-disordered breathing scores in the AS, SMS and ASD groups (all p < .01). A number of associations between overactivity, impulsivity, gastro-oesophageal reflux, age and sleep disturbance were found for certain groups. Conclusions These data reveal syndrome-specific profiles of sleep disturbance. The divergent associations between sleep parameters and person characteristics, specifically symptoms of gastro-oesophageal reflux, overactivity and impulsivity and age, implicate aetiology-specific mechanisms underpinning sleep disturbance. The differences in prevalence, severity and mechanisms implicated in sleep disturbance between groups support a syndrome-sensitive approach to assessment and treatment of sleep disturbance in children with neurodevelopmental disorders. Electronic supplementary material The online version of this article (10.1186/s11689-018-9226-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Trickett
- Department of Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, Leicester, LE1 7RH, UK. .,Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
| | - M Heald
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - C Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - C Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
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Paprocka J, Kijonka M, Wojcieszek P, Pęcka M, Emich-Widera E, Sokół M. Melatonin and Angelman Syndrome: Implications and Mathematical Model of Diurnal Secretion. Int J Endocrinol 2017; 2017:5853167. [PMID: 29379523 PMCID: PMC5742894 DOI: 10.1155/2017/5853167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/17/2017] [Indexed: 02/01/2023] Open
Abstract
The main aim of the study was to compare the melatonin rhythms in subjects with Angelman syndrome (n = 9) and in children with (n = 80) and without (n = 40) epilepsy (nonepileptic patients diagnosed with peripheral nerve palsies, myopathy, and back pain) using our mathematical model of melatonin circadian secretion. The characteristics describing the diurnal hormone secretion such as minimum melatonin concentration, release amplitude, phase shift of melatonin release, and sleep duration as well as the dim light melatonin onset (DLMO) of melatonin secretion and the γ shape parameter allow analyzing the fit and deducing about how much the measured melatonin profile differs from a physiological bell-shaped secretion. The estimated sleep duration and phase shift of melatonin release as well as the DMLO offsets at 25% and 50% relative thresholds are the key characteristic of Angelman syndrome children. As revealed from the γ shape parameter, the melatonin secretion profiles are disturbed in majority of the AG subjects revealing rather a triangular course instead of the bell-like one.
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Affiliation(s)
- Justyna Paprocka
- Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marek Kijonka
- Department of Medical Physics, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Piotr Wojcieszek
- Brachytherapy Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Marcin Pęcka
- Faculty of Automatic Control, Electronics and Computer Science Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Ewa Emich-Widera
- Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maria Sokół
- Department of Medical Physics, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
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Macêdo PJOM, Oliveira PSD, Foldvary-Schaefer N, Gomes MDM. Insomnia in people with epilepsy: A review of insomnia prevalence, risk factors and associations with epilepsy-related factors. Epilepsy Res 2017; 135:158-167. [DOI: 10.1016/j.eplepsyres.2017.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/18/2017] [Accepted: 05/27/2017] [Indexed: 11/16/2022]
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Sleep problems in pediatric epilepsy and ADHD: The impact of comorbidity. Epilepsy Behav 2017; 71:7-12. [PMID: 28437682 DOI: 10.1016/j.yebeh.2017.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/03/2017] [Accepted: 03/18/2017] [Indexed: 01/01/2023]
Abstract
AIMS Attention-deficit hyperactivity disorder (ADHD) is a frequent comorbidity in pediatric epilepsy. Although sleep problems are commonly reported in both children with primary ADHD and epilepsy, those with epilepsy-ADHD comorbidity have not been well studied. This study aimed to compare sleep problems among three groups of children: 1) children with epilepsy, 2) children with epilepsy and ADHD (epilepsy-ADHD), and 3) children with primary ADHD. METHODS 53 children with epilepsy, 35 children with epilepsy-ADHD, and 52 children with primary ADHD completed the Children's Sleep Habits Questionnaire (CSHQ). Neurology clinic charts were reviewed for the epilepsy-related variables. ADHD subtypes were diagnosed according to the DSM-IV. RESULTS Children with epilepsy-ADHD had the highest CSHQ total scores, while children with primary ADHD had higher scores than those with epilepsy. Besides the total score, epilepsy-ADHD group differed from the primary ADHD and epilepsy groups with higher CSHQ subscores on sleep onset delay and sleep anxiety. The frequency of moderate-severe sleep problems (CSHQ>56) was 62.9% in children with epilepsy-ADHD, while it was 40.4% and 26.4% in children with primary ADHD and epilepsy, respectively. CSHQ total scores were not different between ADHD subtypes in both children with epilepsy-ADHD and those with primary ADHD. None of the epilepsy-related variables were found to be associated with CSHQ scores. DISCUSSION Epilepsy-ADHD is associated with a significantly poor sleep quality which is beyond that of primary ADHD and epilepsy.
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Staniszewska A, Mąka A, Religioni U, Olejniczak D. Sleep disturbances among patients with epilepsy. Neuropsychiatr Dis Treat 2017; 13:1797-1803. [PMID: 28744129 PMCID: PMC5513823 DOI: 10.2147/ndt.s136868] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The aim of this study was to analyze the prevalence of sleep disorders among patients with epilepsy and to compare the incidence of sleep disorders between the clinical and demographics factors. MATERIALS AND METHODS The study was conducted among 302 patients with epilepsy. Sleep disturbances were measured with the Polish version of the Pittsburgh Sleep Quality Questionnaire (PSQI). The questionnaire prepared and applied by the authors contained questions relating to sociodemographic characteristics, clinical status, and sleep. RESULTS AND CONCLUSION Mean PSQI score in the study group was 9±2 points, with the range of 4-16 points. PSQI test results were analyzed with regard to clinical and demographic characteristics of those suffering from epilepsy: gender, age, profession, body mass index, illness duration, number of medicines taken, type of seizures, frequency of seizures, time which elapsed since last seizure, provocative factor of seizure attacks, occurrence of adverse effects of antiepileptic drugs (AEDs). Furthermore, the existence of a relationship between PSQI test result and particular sleep-related factors or particular sleep conditions was examined. However, the examination of a relationship between certain independent variables and the final PSQI test result did not prove the existence of a statistically relevant influence (in all cases P>0.05).
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Affiliation(s)
- Anna Staniszewska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Mąka
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Urszula Religioni
- Collegium of Socio-Economics, Warsaw School of Economics, Warsaw, Poland
| | - Dominik Olejniczak
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
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Neto FK, Noschang R, Nunes ML. The relationship between epilepsy, sleep disorders, and attention deficit hyperactivity disorder (ADHD) in children: A review of the literature. ACTA ACUST UNITED AC 2016; 9:158-163. [PMID: 28123654 PMCID: PMC5241617 DOI: 10.1016/j.slsci.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/04/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Abstract
Objective To analyze the relationship between epilepsy, sleep disorders, and attention deficit hyperactivity disorder (ADHD). Bibliographic search A literature search of the PubMed database was performed using the following key words: epilepsy, sleep, and ADHD. In total, 91 articles were located in PubMed, 34 were selected for abstract reading and twelve articles were reviewed, in which the main objectives were examine the relationship between epilepsy, sleep and ADHD from several perspectives, including epidemiology, effect of comorbidities on academic performance and the factors leading to diagnostic difficulties among these three disorders Results Among the main findings, there were difficulties to start and maintain sleep in patients with epilepsy and ADHD, reduction in sleep efficiency, decreased seizure threshold, as well as behavioral and cognitive deficits in both groups. Conclusions It is important to know which symptom is the predominant one. For this reason, children and adolescents with epilepsy, ADHD and sleep disorders need to be assessed carefully before initiating treatment. Our review concluded that there is an important link in this pathological triad.
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Affiliation(s)
- Felipe Kalil Neto
- Division of Neurology, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renan Noschang
- Pontifícia Universidade Católica do Rio Grande do Sul, School of Medicine, Brazil
| | - Magda Lahorgue Nunes
- Division of Neurology, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, School of Medicine, Brazil; Brain Institute (InsCer) PUCRS, Brazil
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Urquhart DS, Kehinde OO, Mclellan AE. Observational pilot study of reported symptoms of obstructive sleep apnoea in children with epilepsy. Dev Med Child Neurol 2016; 58:1063-8. [PMID: 27316368 DOI: 10.1111/dmcn.13173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 12/20/2022]
Abstract
AIM To estimate symptoms of obstructive sleep apnoea (OSA) and excessive daytime sleepiness (EDS) in children with epilepsy (CWE) compared with those in a typically developing comparison group. CWE are known to have poor sleep, with increased rates of OSA suggested. METHOD The Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD) was used to estimate OSA symptoms, with scores ≤0.33 known to be highly sensitive and specific for OSA. The Epworth Sleepiness Scale (ESS) was used to assess EDS, with scores of 10 or above considered abnormal. RESULTS Thirty-three CWE (21 males, 12 females) were studied (median age [interquartile range {IQR}] 9y [5-12]), along with 42 comparison children (20 males, 22 females; median age [IQR] 6y [4-8.5]). Fifty-five per cent of CWE scored 0.33 or higher on the PSQ-SRBD compared with 7% in the comparison group (p<0.001), and 30% of CWE had an abnormal ESS compared with 5% controls (p=0.003). Within the CWE cohort, PSQ-SRDB and ESS appeared higher in those taking antiepileptic drugs (AEDs); although PSQ-SRBD score for CWE not on AEDs was higher than in the comparison group. INTERPRETATION This study suggests higher rates of symptoms of OSA and EDS in CWE compared with typically developing children. AEDs may be a confounding factor, but do not alone account for the associations seen. Further studies including polysomnography to verify the presence (rather than suggestion by questionnaire) of OSA are warranted.
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Affiliation(s)
- Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK.,Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Olaniyi O Kehinde
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Ailsa E Mclellan
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.,Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, UK
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Ekinci O, Isik U, Gunes S, Ekinci N. Understanding sleep problems in children with epilepsy: Associations with quality of life, Attention-Deficit Hyperactivity Disorder and maternal emotional symptoms. Seizure 2016; 40:108-13. [DOI: 10.1016/j.seizure.2016.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 11/26/2022] Open
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Beattie JF, Koch SA, Bolden LB, Thompson MD. Neuropsychological consequences of sleep disturbance in children with epilepsy. Epilepsy Behav 2016; 57:118-123. [PMID: 26949152 DOI: 10.1016/j.yebeh.2016.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/26/2016] [Accepted: 01/30/2016] [Indexed: 10/22/2022]
Abstract
A growing body of research reveals strong relationships between sleep disturbance, sleep architecture, and neuropsychological functioning in children. Children with epilepsy experience numerous neuropsychological comorbidities, including cognitive deficiencies and emotional/behavioral difficulties; thus, it is reasonable to consider the moderating role of sleep in this population. This review summarizes findings involving the prevalence and characteristics of sleep problems often experienced by children with epilepsy. The complex and bidirectional relationship between sleep and seizure frequency is discussed. Research pertaining to the relationship between sleep disturbance and daytime cognition as well as behavior reveals a substantial association between these variables. Clinically relevant practices related to the assessment and treatment of sleep-related complications are reviewed, and directions for further research involving intervention and assessment are also reviewed.
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Affiliation(s)
- Julia F Beattie
- Department of Psychology, University of Alabama at Birmingham, Campbell Hall 201, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
| | - Sarah A Koch
- Department of Psychology, University of Alabama at Birmingham, Campbell Hall 201, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
| | - Lauren B Bolden
- Department of Psychology, University of Alabama at Birmingham, Campbell Hall 201, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
| | - Matthew D Thompson
- Children's Behavioral Health, Children's of Alabama, 1600 7th Avenue South, Birmingham, AL 35233, USA.
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Abstract
BACKGROUND Epilepsy is a common neurological disorder among children and adolescents that is associated with increased mortality for numerous reasons. Sudden unexpected death in epilepsy is a critically important entity for physicians who treat patients with epilepsy. Many pediatric neurologists are hesitant to discuss this condition with patients and families because of the lower risk in the pediatric age group. METHODS We searched for studies published between January 2000 and June 2015 by means of a PubMed search and a cumulative review of reference lists of all relevant publications, using the keywords "sudden unexpected death in epilepsy patients," "pediatric SUDEP," "sudden unexpected death in epilepsy patients and children," "sudden unexpected death in children" and "sudden infant death syndrome." RESULTS SUDEP is a rare condition in children. Its mechanism is poorly understood and may have a distinct pathogenesis from adult sudden unexpected death in epilepsy. Limited comfort, experience, and knowledge to provide appropriate education about sudden unexpected death in epilepsy leads to fewer physicians discussing this subject leading to less informed and less prepared patients and families. CONCLUSION We provide a detailed review of the literature on pediatric SUDEP, including the definition, classification, and proposed mechanisms of sudden unexpected death in epilepsy in children, as well as discuss the incidence in the pediatric population and risk factors in children, concluding with possible prevention strategies.
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Diet, exercise, sleep, sexual activity, and perceived stress in people with epilepsy in NE Thailand. Epilepsy Behav 2015; 45:39-43. [PMID: 25801753 DOI: 10.1016/j.yebeh.2015.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 11/21/2022]
Abstract
The aim of this study was to find out how people with epilepsy in NE Thailand feel about their levels of stress, sleep, diet, exercise habits, and sex lives using a cross-sectional design. Two hundred and three people with epilepsy (PWE) were randomly recruited from a university epilepsy clinic in Khon Kaen and then completed an interview and a questionnaire. A total of 27.6% of the patients believed that diet had an influence on their epilepsy (of those who reported changes, 41.1% stopped consuming alcohol, while 32.1% stopped drinking caffeinated beverages). A total of 47.2% of the patients exercised at least three times per week, while 52.8% exercised two times or less a week. Daytime sleeping was prevalent, with 43.3% saying that they slept during the day frequently or every day. There were 44.3% of the patients who believed that their sex lives changed after the onset of epilepsy, with decreased sexual arousal being most commonly mentioned. A total of 76.4% of the patients said that they had medium or high levels of stress, and epilepsy was listed as the most common reason for their stress (50.2%). Focusing on the problem was the most common method to reduce stress (80.3%). The findings illuminate the need to increase attention towards improving and promoting self-management of epilepsy. As a whole, diet, exercise, sleep, stress reduction, and sex therapy can be valuable tools to improve the quality of life of people with epilepsy.
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Jain SV, Horn PS, Simakajornboon N, Beebe DW, Holland K, Byars AW, Glauser TA. Melatonin improves sleep in children with epilepsy: a randomized, double-blind, crossover study. Sleep Med 2015; 16:637-44. [PMID: 25862116 DOI: 10.1016/j.sleep.2015.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/05/2015] [Accepted: 01/10/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Insomnia, especially maintenance insomnia, is widely prevalent in epilepsy. Although melatonin is commonly used, limited data address its efficacy. We performed a randomized, double-blind, placebo-controlled, crossover study to identify the effects of melatonin on sleep and seizure control in children with epilepsy. METHODS Eleven prepubertal, developmentally normal children aged 6-11 years with epilepsy were randomized by a software algorithm to receive placebo or a 9-mg sustained release (SR) melatonin formulation for four weeks, followed by a one-week washout and a four-week crossover condition. The pharmacy performed blinding; patients, parents, and study staff other than a statistician were blinded. The primary outcomes were sleep onset latency and wakefulness after sleep onset (WASO) measured on polysomnography. The secondary outcomes included seizure frequency, epileptiform spike density per hour of sleep on electroencephalogram (EEG), and reaction time (RT) measures on psychomotor vigilance task (PVT). Statistical tests appropriate for crossover designs were used for the analysis. RESULTS Data were analyzed from 10 subjects who completed the study. Melatonin decreased sleep latency (mean difference, MD, of 11.4 min and p = 0.02) and WASO (MD of 22 min and p = 0.04) as compared to placebo. No worsening of spike density or seizure frequency was seen. Additionally, slow-wave sleep duration and rapid eye movement (REM) latency were increased with melatonin and REM sleep duration was decreased. These changes were statistically significant. Worsening of headache was noted in one subject with migraine on melatonin. CONCLUSION SR melatonin resulted in statistically significant decreases in sleep latency and WASO. No clear effects on seizures were observed, but the study was too small to allow any conclusions to be drawn in this regard.
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Affiliation(s)
- Sejal V Jain
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Narong Simakajornboon
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Pulmonology and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dean W Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine Holland
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anna W Byars
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tracy A Glauser
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Grigg-Damberger MM, Foldvary-Schaefer N. Primary sleep disorders in people with epilepsy: clinical questions and answers. Child Adolesc Psychiatr Clin N Am 2015; 24:145-76. [PMID: 25455580 DOI: 10.1016/j.chc.2014.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The questions facing clinicians with patients with sleep disorder and epilepsy are addressed in this article. Both adult and child epilepsy are discussed in the context of the most typical questions a clinician would have, such as "Are parasomnias more common in people with epilepsy?", "Is sleep architecture abnormal in children with epilepsy", along with outcomes of numerous questionnaire-based, case-based, and double-blind placebo studies on such aspects as sleep duration, daytime sleepiness, anxiety and fears, limb movement, nocturnal seizures, agitation, behavioral disorders, and learning disorders.
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Affiliation(s)
- Madeleine M Grigg-Damberger
- Department of Neurology, University of New Mexico School of Medicine, MSC10 5620, One University of New Mexico, Albuquerque, NM 87131-0001, USA.
| | - Nancy Foldvary-Schaefer
- Section of Sleep Medicine, Department of Neurology, Cleveland Clinic, S51, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Excessive daytime sleepiness and epilepsy: a systematic review. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:629469. [PMID: 24288600 PMCID: PMC3833197 DOI: 10.1155/2013/629469] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 09/10/2013] [Indexed: 11/23/2022]
Abstract
Background. Sleep complaints are common in patients with epilepsy (PWE). Excessive daytime sleepiness (EDS) is one of the most reported complaints and its impact is still a matter of debate. Objective. Evaluate the relationship between EDS and epilepsy, with emphasis on prevalence, assessment, and causes. Methods. A systematic review on PubMed database in the last 10 years (2002 to 2012). The search returned 53 articles and 34 were considered relevant. After citation analysis, 3 more articles were included. Results. Most studies were cross-sectional and questionnaire based. 14 papers addressed EDS as the primary endpoint. 14 adult and 3 children studies used subjective and objective analysis as methodology. The number of studies increased throughout the decade, with 21 in the last 5 years. Adult studies represent almost three times the number of children studies. EDS prevalence in PWE varies from 10 to 47.5%. Prevalence was higher in developing countries. Conclusion. EDS seems to be related more frequently to undiagnosed sleep disorders than to epilepsy-related factors, and although it affects the quality of life of PWE, it can be improved by treating comorbid primary sleep disorders.
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Gutter T, Brouwer OF, de Weerd AW. Subjective sleep disturbances in children with partial epilepsy and their effects on quality of life. Epilepsy Behav 2013; 28:481-8. [PMID: 23892578 DOI: 10.1016/j.yebeh.2013.06.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/13/2013] [Accepted: 06/18/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE The purposes of this study were to explore the prevalence of sleep disturbances in a large cohort of school-aged children with partial epilepsy, to compare the findings with those in children without epilepsy of the same age and gender, and to evaluate the relationship between sleep disturbances and health-related quality of life (HRQoL). METHODS One hundred thirty children with partial epilepsy aged 4 to 10years, who were treated in the outpatient setting of a Dutch epilepsy clinic, and 161 age- and sex-matched controls participated in this study. In addition to providing information about their child's demography and health, parents of both groups of children completed three questionnaires to measure their child's sleep [Sleep Disturbance Scale for Children (SDSC), Medical Outcomes Study-Sleep Scale (MOSS-S), and Groningen Sleep Quality Scale (GSQS)] and one questionnaire to measure quality of life (Kidscreen-27). Parents of children with epilepsy also completed the Hague Scales to measure the severity of epilepsy. The prevalence of sleep disturbances and scores on HRQoL in children with and without epilepsy were compared. Additionally, the HRQoL scores were compared between children with and without sleep disturbances in children both with and without epilepsy. RESULTS The answers for all three questionnaires suggested worse sleep in children with epilepsy than in children of the same age and gender without epilepsy. Pathological scores (T-value>70) for total SDSC were seen twelve times more frequently in children with epilepsy (36.92% vs. 3.01%, p<0.001). Children with epilepsy also scored significantly lower for all dimensions of HRQoL. Between subgroups of children with and without disturbed sleep, insignificant differences in quality of life were found, with the lowest scores in children with sleep disturbances in both groups. CONCLUSION This study confirms the high prevalence of disturbed sleep, as well as its effect on quality of life, in a large group of children with partial epilepsy. The abnormalities are both more prevalent and more severe than in children without epilepsy.
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Affiliation(s)
- Th Gutter
- Department of Clinical Neurophysiology and Sleep Centre SEIN, Zwolle, The Netherlands.
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Chausson P, Leresche N, Lambert RC. Dynamics of intrinsic dendritic calcium signaling during tonic firing of thalamic reticular neurons. PLoS One 2013; 8:e72275. [PMID: 23991078 PMCID: PMC3749121 DOI: 10.1371/journal.pone.0072275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/16/2013] [Indexed: 11/30/2022] Open
Abstract
The GABAergic neurons of the nucleus reticularis thalami that control the communication between thalamus and cortex are interconnected not only through axo-dendritic synapses but also through gap junctions and dendro-dendritic synapses. It is still unknown whether these dendritic communication processes may be triggered both by the tonic and the T-type Ca2+ channel-dependent high frequency burst firing of action potentials displayed by nucleus reticularis neurons during wakefulness and sleep, respectively. Indeed, while it is known that activation of T-type Ca2+ channels actively propagates throughout the dendritic tree, it is still unclear whether tonic action potential firing can also invade the dendritic arborization. Here, using two-photon microscopy, we demonstrated that dendritic Ca2+ responses following somatically evoked action potentials that mimic wake-related tonic firing are detected throughout the dendritic arborization. Calcium influx temporally summates to produce dendritic Ca2+ accumulations that are linearly related to the duration of the action potential trains. Increasing the firing frequency facilitates Ca2+ influx in the proximal but not in the distal dendritic compartments suggesting that the dendritic arborization acts as a low-pass filter in respect to the back-propagating action potentials. In the more distal compartment of the dendritic tree, T-type Ca2+ channels play a crucial role in the action potential triggered Ca2+ influx suggesting that this Ca2+ influx may be controlled by slight changes in the local dendritic membrane potential that determine the T-type channels’ availability. We conclude that by mediating Ca2+ dynamic in the whole dendritic arborization, both tonic and burst firing of the nucleus reticularis thalami neurons might control their dendro-dendritic and electrical communications.
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Affiliation(s)
- Patrick Chausson
- UMR 7102 CNRS, Paris, France
- UPMC, Université Paris 6, Paris, France
| | | | - Régis C. Lambert
- UMR 7102 CNRS, Paris, France
- UPMC, Université Paris 6, Paris, France
- * E-mail:
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Jain SV, Simakajornboon N, Glauser TA. Provider practices impact adequate diagnosis of sleep disorders in children with epilepsy. J Child Neurol 2013; 28:589-95. [PMID: 22791548 DOI: 10.1177/0883073812449692] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sleep disorders significantly affect the lives of children with epilepsy. Limited data exist about provider practices concerning detection and correct diagnosis of sleep problems in epilepsy. The authors conducted this study to identify and correlate sleep screening methods, referral practices, referral reasons and final sleep diagnoses. They identified that 94% of the providers who had referred patients to the sleep center of a major children's hospital used routine screening and 70% of them used 2 to 3 screening questions. This method, however, underidentified the patients at risk for sleep disorders. Moreover, in 40% of the children, sleep disorder was incorrectly anticipated, based on the initial symptoms. Of these children, 10% had no sleep disorder and 30% had unexpected sleep disorder. The authors conclude that better screening methods should be used for sleep disorders. Once identified, these patients should have formal sleep evaluation and management. Further studies are needed to develop screening questionnaires.
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Affiliation(s)
- Sejal V Jain
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Kotagal S, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, D'Andrea LA, Hoban TF. Non-respiratory indications for polysomnography and related procedures in children: an evidence-based review. Sleep 2012; 35:1451-66. [PMID: 23115394 DOI: 10.5665/sleep.2188] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This evidence-based review provides a systematic and comprehensive review of the literature regarding the utility of polysomnography for the evaluation of non-respiratory sleep disorders in children including hypersomnias, parasomnias, sleep-related movement disorders, and sleep in other special populations. METHODS A task force of pediatric sleep medicine experts performed a systematic review of the literature regarding the use of polysomnography for non-respiratory sleep disorders in children. They identified and graded 76 papers as evidence. RESULTS The main results include (1) polysomnography combined with the multiple sleep latency test is useful for evaluating disorders of excessive somnolence to objectively quantify sleepiness. The results have to be interpreted with consideration of the pubertal stage and regularity of the sleep patterns of the child; (2) polysomnography is indicated in children with parasomnias or sleep related movement disorders who have a high likelihood of having obstructive sleep apnea (OSA); (3) polysomnography is not routinely indicated in children with enuresis unless there is a high likelihood of OSA; (4) polysomnography can be helpful in evaluating children with restless legs syndrome (RLS) and when periodic limb movement disorder (PLMD) is suspected. CONCLUSIONS These findings suggest that, in children with non-respiratory sleep disorders, polysomnography should be a part of a comprehensive sleep evaluation in selected circumstances to determine the nature of the events in more detail or when the suspicion of OSA is relatively high.
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Larson AM, Ryther RCC, Jennesson M, Geffrey AL, Bruno PL, Anagnos CJ, Shoeb AH, Thibert RL, Thiele EA. Impact of pediatric epilepsy on sleep patterns and behaviors in children and parents. Epilepsia 2012; 53:1162-9. [PMID: 22594377 DOI: 10.1111/j.1528-1167.2012.03515.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Disrupted sleep patterns in children with epilepsy and their parents are commonly described clinically. A number of studies have shown increased frequency of sleep disorders among pediatric epilepsy patients; however, few have characterized the association between epilepsy and parental sleep quality and household sleeping arrangements. The purpose of this study was to explore the effect of pediatric epilepsy on child sleep, parental sleep and fatigue, and parent-child sleeping arrangements, including room sharing and cosleeping. METHODS Parents of children 2 to 10 years of age with and without epilepsy completed written questionnaires assessing seizure history, child and parent sleep, and household sleeping arrangements. Children's Sleep Habits Questionnaire (CSHQ) scores were used to evaluate sleep disturbances for the child. The Pittsburgh Sleep Quality Index (PSQI) and the Iowa Fatigue Scale (IFS) were used to evaluate parental sleep and fatigue, respectively. The Early Childhood Epilepsy Severity Scale (E-Chess) was used to assess epilepsy severity. KEY FINDINGS One hundred five households with a child with epilepsy and 79 controls participated in this study. Households with a child with epilepsy reported increased rates of both parent-child room sharing (p < 0.001) and cosleeping (p = 0.005) compared to controls. Children with epilepsy were found to have greater sleep disturbance by total CSHQ score (p < 0.001) and the following subscores: parasomnias (p < 0.001), night wakings (p < 0.001), sleep duration (p < 0.001), daytime sleepiness (<0.001), sleep onset delay (p = 0.009), and bedtime resistance (p = 0.023). Parents of children with epilepsy had increased sleep dysfunction (p = 0.005) and were more fatigued (p < 0.001). Severity of epilepsy correlated positively with degree of child sleep dysfunction (0.192, p = 0.049), parental sleep dysfunction (0.273, p = 0.005), and parental fatigue (0.324, p = 0.001). Antiepileptic drug polytherapy was predictive of greater childhood sleep disturbances. Nocturnal seizures were associated with parental sleep problems, whereas room sharing and cosleeping behavior were associated with child sleep problems. Within the epilepsy cohort, 69% of parents felt concerned about night seizures and 44% reported feeling rested rarely or never. Finally, 62% of parents described decreased sleep quality and/or quantity with cosleeping. SIGNIFICANCE Pediatric epilepsy can significantly affect sleep patterns for both the affected child and his or her parents. Parents frequently room share or cosleep with their child, adaptations which may have detrimental effects for many households. Clinicians must not only be attentive to the sleep issues occurring in pediatric patients with epilepsy, but also for the household as a whole. These data provide evidence of a profound clinical need for improved epilepsy therapeutics and the development of nocturnal seizure monitoring technologies.
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Affiliation(s)
- Anna M Larson
- Pediatric Epilepsy Program, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Pereira AM, Bruni O, Ferri R, Nunes ML. Sleep instability and cognitive status in drug-resistant epilepsies. Sleep Med 2012; 13:536-41. [DOI: 10.1016/j.sleep.2011.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/27/2011] [Accepted: 12/10/2011] [Indexed: 11/24/2022]
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Grigg-Damberger MM, Foldvary-Schaefer N. Primary Sleep Disorders in People with Epilepsy: What We Know, Don’t Know, and Need to Know. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2011.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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