|Year : 2018 | Volume
| Issue : 1 | Page : 28-30
Quality of Sleep in Children with Epilepsy
Fahad A Bashiri1, Shahid Bashir2
1 Department of Pediatrics, Division of Neurology, Faculty of Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
2 Department of Neurophysiology, Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
|Date of Web Publication||7-Mar-2018|
Department of Pediatrics, Division of Neurology, Faculty of Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh
Source of Support: None, Conflict of Interest: None
Background: Sleep disorders are a common concern among pediatric epilepsy patients. This study aimed to assess the sleep quality in children with epilepsy. Subjects and Methods: The present study examined parent-reported sleep problems in 34 children (20 boys and 14 girls; age 4–14 years) with epilepsy. Children's Sleep Habits Questionnaire (CSHQ) assesses sleep patterns with 33 sleep disturbance items, and each item is rated on a 3-point scale (99 total score) that describes the frequency of the behaviors. A score of 41 was used as a cutoff for identification of poor and good sleeper. Results: Epilepsy poor sleepers (based on CSHQ score) have more sleep impairment than epilepsy good sleepers (CSHQ score) (P < 0.04), and the CSHQ subscores are as follows: night awakenings (P < 0.03), sleep duration (P < 0.04), daytime sleepiness (P < 0.04), sleep-onset delay (P = 0.02), and bedtime resistance (P = 0.02). Conclusions: Although sleep problems are known to be common among young children with epilepsy, the results of this work may provide the basis for focused studies to gain deeper understanding of sleep disturbances in this population.
Keywords: Assessment, childhood, development, epilepsy, sleep
|How to cite this article:|
Bashiri FA, Bashir S. Quality of Sleep in Children with Epilepsy. J Nat Sci Med 2018;1:28-30
| Introduction|| |
Epilepsy is a neurological disorder affecting approximately 1% of children. Approximately 25%–50% children with epilepsy have prominent behavioral features with sleep problems., As many as 80% of children with epilepsy manifest these difficulties,,,,, regardless of whether they are measured via parental report  or polysomnography.
Despite the fact that the clinical association between pediatric epilepsy and sleep has been explored in a few earlier studies,,,,,,, our clinical comprehension of this association corresponds to a model in which sleep patterns influence seizure profiles and vice versa. Sleep impairment and circadian rhythms can predict seizure pattern. For example, obstructive sleep apnea and restless legs syndrome have been reported to interfere with the effective seizure control. Moreover, epileptic episodes appear to disrupt sleep–wake cycles, and some antiepileptic medications can adversely affect sleep structure and quality. Poor rest, for example, can similarly influence the execution of intellectual tasks.
Therefore, we conducted this study to assess the effect of sleep patterns in children with epilepsy.
| Subjects And Methods|| |
The study included 34 children between 4 and 14 years of age, with a diagnosis of epilepsy and who were followed up in the clinic from October 2015 to March 2016. Participants were diagnosed with epilepsy through clinical assessment by a qualified pediatric neurologist and were classified according to the International League Against Epilepsy classification. The present study was conducted at the Pediatric Neurology Outpatient Clinic, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia. Informed consent was obtained from all participants' parents or guardians before enrollment in the study. The study was approved by the ethics committee in our institute.
The study participants were required to have stable medical and behavioral conditions, with no change in medication in the previous 6 months. Participants were excluded from the study if they had comorbid psychiatric disorders, such as autism spectrum disorder or attention-deficit hyperactivity disorder, significant vision or hearing loss, or a complex neurological disorder (e.g., cerebral palsy, neurometabolic disorders, neurodegenerative diseases, tuberous sclerosis, neurofibromatosis, and Rett syndrome).
Children's Sleep Habits Questionnaire
Parents were interviewed by trained medical students to recall sleep behaviors occurring over a recent “typical” week.
Child sleep habits were measured using Children' Sleep Habits Questionnaire (CSHQ) scores., The CSHQ is an approved instrument for both behaviorally and medically based pediatric sleep difficulty. The CSHQ is a 33-item-based psychometric assessment for eight domains: bedtime resistance, sleep-onset delay, sleep duration, sleep anxiety, night awakenings, parasomnias, disordered breathing, and daytime sleepiness. A total score can be ranged from 33 to 99 based on calculation from all of the abovementioned domains.
Higher scores are indicative of more disturbed sleep (epilepsy poor sleepers (EP-PS)). A score of 41 has been reported to be a sensitive cutoff for identification of probable sleep problems in children with epilepsy.
Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 23 (SPSS Inc., IBM, Chicago, Illinois, USA) on all variables (sleep variables, subjective sleep measures, and behavioral scales). P < 0.05 was considered statistically significant. Mann–Whitney U-tests were used for pairwise, between-group comparisons. Spearman's rank correlations (r) were used to evaluate the associations between all variables. Results were presented as mean ± standard deviation.
| Results|| |
The study comprised 34 children (20 boys and 14 girls), who were 4–14 years of age [Table 1]. Total sleep disturbance scores ranged from 32 to 48 (M = 40.00, SD = 3.63), with 44% of the sample (n = 15) meeting the diagnostic cutoff score of 41 for a sleep disorder and 56.7% (n = 19) falling below this cutoff score for CSHQ.
|Table 1: Participant characteristics and comparison of Children's Sleep Habits Questionnaire subscales among epilepsy poor sleepers and epilepsy good sleepers|
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Nineteen children with epilepsy were classified as epilepsy good sleeper (EP-GS) and 15 were classified as epilepsy poor sleepers (EP-PS), based on the CSHQ score by their parents.
The sleep histories of all participants were reviewed. In the EP-PS group, 15 of 34 children had moderate-to-severe sleep problems expressed by parents. Night awakenings were a major concern in 23 of 34 children (67%). In the EP-GS group, eight parents rated their children as having no sleep problems (23%) and seven as having mild sleep problems (20%). Several children in the EP-GS group requested to go to bed at a scheduled time each night.
All CSHQ domain scores differed significantly between the two groups [Figure 1] and were lower in the EP-GS group than that in the EP-PS group. Children in the EP-PS group were found to experience greater sleep disturbances compared to good sleepers according to total CSHQ score (P< 0.04) and the following CSHQ subscores: night awakenings (P< 0.03), sleep duration (P< 0.04), daytime sleepiness (P< 0.04), sleep-onset delay (P = 0.02), and bedtime resistance (P = 0.02) [Table 1].
|Figure 1: Participants' characteristics and comparison of Children's Sleep Habits Questionnaire subscales among epilepsy poor sleepers and epilepsy good sleepers for bedtime resistance, sleep duration, sleep anxiety, and night waking|
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| Discussion|| |
Epilepsy can significantly affect the sleep patterns in the children. This finding is consistent with the relationship between sleep and epilepsy observed in older school-aged children  and adolescents.
In this study, we found that waking up in the middle of the night (night awakenings), sleep duration, daytime sleepiness, sleep-onset delay, and bedtime resistance were the most common problems among pediatric population with epilepsy according to CSHQ. Although parasomnias are common in childhood – being present in >80% of preschool-aged children , – a marked association with epilepsy has been described by several ,,, but not all  previous studies. Mechanistically, hypotheses have suggested that epileptic seizures lead to sleep fragmentation, facilitating the subsequent occurrence of parasomnias.,,, Data on the association between epilepsy therapeutics and sleep problems are contradictory; while some studies support an association,, other studies have found no such association., To date, the clinical understanding of the effect of childhood epilepsy on parent and/or caregiver sleep is relatively limited.
One limitation of the present study was its small sample size, which may have resulted in specific effects of CSHQ measurements between the good (EP-GS) and poor sleeper (EP-PS) groups being missed due to inadequate statistical power to detect significant changes. However, data from the present study may provide a basis for a larger, more focused study examining its promising elements. An additional limitation is lack of objective assessment of sleep in children.
| Conclusions|| |
Our results suggest that sleep problems are known to be common among young children with epilepsy; the results of this work may provide the basis for focused studies to gain deeper understanding of sleep disturbances in this population. Sleep habits should be comprehensively reviewed when a sleep problem is identified in children with epilepsy.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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