Abstracts

Rationale: Sleep disorders in epilepsy are increasingly becoming recognized as important in cognition, behavior, and quality of life. Sleep related problems in typical adolescents continue to be studied, and there is growing evidence of a link between sleep disorders and executive dysfunction, manifesting as attention-deficit like symptoms. We were interested in defining the types of sleep problems in adolescents with epilepsy and their relationship with executive functioning. Our hypothesis is that epilepsy patients would report greater degrees of sleep disruption, disordered sleep/wake cycles, and increased daytime fatigue compared to controls. We also predicted that these problems would be in conjunction with increased executive dysfunction and attention deficit symptoms. Methods: As part of an ongoing study of pediatric epilepsy and executive function, 45 adolescents ages 10-17 were asked about sleep habits using the Adolescent Sleep Habits Survey (Owens 2002). Executive functioning and attention symptoms were assessed using the BRIEF (Gioia et al., 1996) and by a diagnostic psychiatric interview. The group consisted of 20 epilepsy patients (mean age 13.2, SD 1.76; 11 males; group mean FSIQ 94. SD 7.8) defined by clinical semiology and medical history, 13 with localization-related, and 7 with primary generalized epilepsy. 16 patients were on antiepilepsy medication. The mean duration of disease for the group was 3.7 years (SD=3.2). Patient responses were compared to 25 controls with no neurological or psychiatric history (mean age 13.9, SD 1.76; 14 males; group mean FSIQ 106, SD 11). Results: The overall number of patients reporting sleep problems (70%) was higher compared to the control group (32%). The most common sleep problem reported by the patients was difficulty falling asleep (N=15 patients, N=11 controls), daytime sleepiness and fatigue (N=14 patients, N=8 controls), and awakening during the night (N=15 patients, N=9 controls). Only 3 patients in the group have tried using medication or seeking medical help specifically for a sleep problem. Executive functioning was compromised in the epilepsy group. Patients reported increased impairment in overall functioning (t(43)=4.32, p<0.001), behavioral regulation (t (43)=3.7, p<0.001), and cognitively manage performance (t(43)=3.75, p<0.001). Total behavior problems measured by the CBCL were higher in the patient group (t(41)=6.29, p<0.001). 9 of the patients had the diagnosis of ADD, primarily inattentive type. Conclusions: Qualitative sleep problems in adolescent epilepsy patients appear to be increased compared to similarly aged peers. Sleep initiation difficulties, fatigue, and sleep interruption appear to be common problems which arise in the context of increased executive dysfunction independent of antiepilepsy medication treatment. These sleep problems were not previously brought to medical attention and therefore underscore the importance of screening epilepsy patients for sleep problems during routine care. Minimizing or resolving these sleep disturbances may potentially lead to improvements in seizure control, cognitive, and behavioral outcomes.