Abstracts

RATIONALE: Higher rates of sleep problems are reported in children with epilepsy compared to healthy children or children with other chronic illnesses. Emotional and behavior problems are also more common in these children. Interestingly, studies suggest that emotional or behavioral disturbances can result from childhood sleep disorders. The purpose of the current study was to examine the relationship between sleep disorders and epilepsy, and to explore the behavioral and emotional consequences that may result in children with these co-morbid diagnoses. At the end of this activity the participants should be able to discuss the relationships between seizure variables, sleep disturbance, and behavioral and emotional problems in children with epilepsy.
METHODS: Study participants consisted of 23 children [12 boys; 11 girls; mean age 10.0, (2.1)] diagnosed with epilepsy, with reports of possible sleep disturbances. The presence of sleep-disordered complaints was first assessed with a parental questionnaire focusing on the child[ssquote]s behavior during sleep and wakefulness (Chervin et al., 2000). Further quantification of sleep problems was obtained from an overnight polysomnograph, and included measures of sleep efficiency, REM latency, a respiratory arousal index, a periodic limb movement arousal index, and the length of apnea events. Evidence of behavioral and emotional disturbances was assessed using parent rating questionnaires and child symptom self-report measures.
RESULTS: Nineteen of the 23 children were found to have abnormal polysomnographs with evidence of obstructive hypopneas or apneas with associated sleep disruption and mild hypoxemia. Regression analyses found that seizure frequency had a significant effect on length of apnea ([beta]= .557; p[lt].007). Analyses also confirmed that children with higher scores on measures of hyperactive-impulsive/inattentive behavior experienced delayed REM onset ([beta] = 0.532; p[lt].017). Children with higher scores on a depression measure displayed an increased length in their apnea events ([beta]= 0.475; p[lt].021). Published normative data for each behavioral/emotional measure was then used to reclassify the entire sample into clinical and non-clinical groups on each measure. Unpaired t-tests found that children who fell into the clinical ranges on the parent report and child symptom report behavioral measures took a significantly longer time to go into REM sleep. Type of seizure disorder (generalized vs. partial) and the presence or absence of current seizures did not affect these findings.
CONCLUSIONS: The present research supports the hypothesis that sleep disruption is associated with increased behaviors such as hyperactive-impulsive/inattentiveness and depression in children with epilepsy. This research is relevant to clinical care because it may aid clinicians in the recognition and treatment of sleep disorders, thus potentially reducing seizure frequency and improving quality of life for children with epilepsy.
[Supported by: University of Florida, Division of Sponsored Research]