Abstracts

Rationale: Children with epilepsy have a higher rate of impaired sleep than normal children, including altered sleep architecture and reporting symptoms of disordered sleep. The aim of this study was to compare the prevalence of sleep disorder symptoms in children with epilepsy versus controls and another chronic condition, type 1 diabetes (DM), to ascertain specificity to epilepsy. Methods: After obtaining IRB permission from Rush Medical Center and Stroger Hospital, the Pediatric Sleep Questionnaire was administered to parents of children 2-18 years old with epilepsy (n=71), normal children (n=52) and children with DM (n=25). Subjects were recruited from child neurology, pediatrics and endocrinology clinics. Between-group analyses were completed using chi-square tests to compare the frequency of symptoms on the questionnaire. Using the Bonferroni correction, significance was established if p<0.001. Results: Patients with Epilepsy vs. Controls: The mean age of patients with epilepsy was 9.7 years (SD=4.3) and was 7.1 years (SD=4.1) in controls. Children with epilepsy were significantly more likely to have difficulty with sleep (p<0.001). Symptoms of sleep-disordered breathing were more likely in children with epilepsy, including apnea (20% vs. 0%), shaking the child to get him to breathe and awakening with a snort (all p<0.001). Restless sleep, leg restlessness, brief kicks of the legs and repeated kicks of the legs (26% vs. 10%) were more likely in children with epilepsy (all p<0.001). Teeth grinding, but not other parasomnias, was seen more in the epilepsy group (50% vs. 27%; p<0.001). Bedtime rituals and routines were seen more frequently in children with epilepsy, as were awakening more than twice per night and trouble falling asleep after awakening (all p<0.001). Symptoms of daytime hypersomnolence were also more likely, including waking up unrefreshed (53% vs. 27%), feeling sleepy, an irresistible urge to nap (38% vs. 12%) and having a teacher say the child appears sleepy (45% vs. 6%) (all p<0.001). Parents of children with epilepsy were more likely to have trouble awakening their children (42% vs. 21%; p<0.001). Patients with Epilepsy vs. Patients With DM: The mean age of DM patients was 13.3 years (SD=4.0). All of the significant differences between patients with epilepsy and controls were maintained in comparing patients with epilepsy and DM (all p<0.001), with the exception of awakening unrefreshed and being hard to awaken in the morning. Additionally, patients with epilepsy were more likely than patients with DM to snore, breathe loudly and nap (all p<0.001). Conclusions: This study suggests that patients with epilepsy are at an increased risk for daytime hypersomnolence and sleep disorders, including sleep-disordered breathing and periodic limb movements of sleep, compared to controls. It also suggests that these risks are not due to the burden of having a chronic condition alone. This is an important finding, as impaired sleep may decrease seizure threshold, perpetuating further seizures in children with epilepsy and prompting further workup and treatment of specific sleep disorders.