|
1
|
Langfus JA, Chen YL, Janos JA, Youngstrom JK, Findling RL, Youngstrom EA. Psychometric Properties and Clinical Utility of CBCL and P-GBI Sleep Items in Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2025; 54:328-345. [PMID: 37972333 PMCID: PMC11096265 DOI: 10.1080/15374416.2023.2272965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Sleep is crucial to overall health, playing a complex role in a wide range of mental health concerns in children and adults. Nevertheless, clinicians may not routinely assess sleep problems due to lack of awareness or limitations such as cost or time. Scoring sleep-related items embedded on broader scales may help clinicians get more out of tools they are already using. The current study explores evidence of reliability, validity, and clinical utility of sleep-related items embedded on two caregiver-report tools: the Child Behavior Checklist (CBCL) and Parent General Behavior Inventory (P-GBI). METHOD Youth aged 5-18 years and their parents were recruited from both an academic medical center (N = 759) and an urban community health center (N = 618). Caregivers completed the CBCL and P-GBI as part of a more comprehensive outpatient evaluation. Exploratory factor analyses, multi-group confirmatory factor analyses, and graded response models evaluated dimensionality, reliability, and invariance across samples. Correlations and receiver operating characteristic curve analyses probed associations with diagnostic and demographic variables. RESULTS Two subscales emerged for each itemset. Across both samples, P-GBI sleep subscales were more reliable and consistent than CBCL sleep subscales, showed greater coverage of sleepiness and insomnia constructs, were better at discriminating individuals within a wider range of sleep complaints, and showed significant correlation with mood disorder diagnoses. CONCLUSIONS The P-GBI sleep items provide a brief, reliable measure for assessing distinct dimensions of sleep complaints and detecting mood symptoms or diagnoses related to the youth's sleep functioning, making them a useful addition to clinical practice.
Collapse
Affiliation(s)
- Joshua A. Langfus
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yen-Ling Chen
- Department of Psychology, University of Nevada, Las Vegas, NV
| | - Jessica A. Janos
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer K. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert L. Findling
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| | - Eric A. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Helping Give Away Psychological Science, 501c3
| |
Collapse
|
|
2
|
Morales K, De Los Santos T, Harvey D, Dunn D, Jones J, Byars A, Austin J, Hermann B, Oyegbile-Chidi T. Stratifying cognitive and behavioral comorbidities in children with new-onset seizures - The influence of sociodemographic disadvantage. Epilepsy Behav 2025; 165:110267. [PMID: 39983585 PMCID: PMC12045015 DOI: 10.1016/j.yebeh.2025.110267] [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: 11/06/2024] [Revised: 12/30/2024] [Accepted: 01/08/2025] [Indexed: 02/23/2025]
Abstract
RATIONALE Children with new-onset epilepsy often experience co-morbid cognitive and behavioral challenges, which can be influenced by Social Determinants Of Health (SDOH) such as household income and parental education level. Although unsupervised machine learning has identified distinct cognitive and behavioral phenotypes at or near diagnosis, the relationship between these clusters remains underexplored. This study aims to examine the relationship between cognitive and behavioral clusters and the impact of SDOH among children with new-onset seizures. METHODS We recruited 312 children (ages 6-16) within six weeks of their first recognized seizure. Each participant underwent a comprehensive neuropsychological assessment, from which factor analysis identified four primary domains: language, processing speed, executive function, and verbal memory. Parents also completed the Child's Behavior Checklist (CBCL). K-means cluster analysis was applied to the mean factor scores and CBCL T-scores to identify unique clusters. We assessed SDOH factors, including maternal education level, child's race, household income, and parental marital status, along with clinical epilepsy characteristics such as age at seizure onset, seizure frequency/intensity, seizure syndrome, MRI/EEG abnormalities, and neurologic examination findings to distinguish these clusters. RESULTS We identified two primary clusters within both cognitive and behavioral scores: Resilient and At-Risk. Children in the Resilient Cognitive Cluster exhibited fewer behavioral problems, while those in the Resilient Behavior Cluster demonstrated higher cognitive performance. Conversely, the At-Risk Cognitive Cluster was associated with greater behavioral problems, and the At-Risk Behavior Cluster correlated with lower cognitive performance. Notably, almost two-thirds of participants showed congruence in clustering, either displaying resilience in both cognition and behavior or vulnerability in both domains. Resilient children exhibited lower levels of sociodemographic disadvantage, whereas those in the At-Risk Clusters faced significant disadvantages. Sociodemographic factors were more pronounced in differentiating clusters compared to traditional clinical epilepsy characteristics. CONCLUSIONS Among children with new-onset seizures, some display significant resilience to multimorbidities, while others are particularly vulnerable to neurobehavioral challenges, often linked to sociodemographic disadvantages. Future research should explore whether early interventions targeting SDOH can mitigate these risks and improve outcomes for children with new-onset epilepsy.
Collapse
Affiliation(s)
- Karina Morales
- Department of Neurology, University of California Davis, Sacramento, CA 94518, USA
| | - Tracy De Los Santos
- Department of Neurology, University of California Davis, Sacramento, CA 94518, USA
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Davis, CA 95616, USA
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, IN 46202, USA
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, OH 45229, USA
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, IN 46202, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | | |
Collapse
|
|
3
|
Hoyer S, Dietz M, Ambrosi-Schneider AS, Krishnasamy N, Buss C, Lee Shing Y, Kaindl AM. Memory Consolidation and Sleep in Children With Epilepsy: A Systematic Review. Pediatr Neurol 2024; 158:66-70. [PMID: 38971074 DOI: 10.1016/j.pediatrneurol.2024.05.020] [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: 06/27/2023] [Revised: 03/03/2024] [Accepted: 05/27/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Sleep is essential in the process of memory consolidation. Children and adolescents with epilepsy hold a significantly higher risk for memory impairment. Understanding the relationship between sleep and memory impairment in adolescents with epilepsy will help us to develop effective support services for this patient population. The present study provides a summary of the current research on the influence of epilepsy-related altered sleep patterns on memory consolidation in children and adolescents with epilepsy. The aim of this systematic review is to investigate the influence of epilepsy-related altered sleep conditions in children and adolescents and their impact on memory performance. MATERIALS A systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses using the search terms "memory," "sleep," "epilepsy," "children," and "adolescents." A total of 4 studies met the inclusion criteria. The review focused on the association of sleep disorders and memory performance in children and adolescents aged up to 21 years without psychiatric comorbidities. RESULTS The reviewed studies highlight a higher risk of sleep disturbance and lower sleep quality in children with epilepsy in comparison to control groups. Group differences in memory consolidation were found before, but not after one night of sleep. Three studies reported a significant association between sleep and memory performance. Two studies demonstrated an association between nocturnal interictal epileptiform discharges and memory performance in adolescents. CONCLUSION Children and adolescents with epilepsy have a higher risk of sleep and memory disorders. Nocturnal interictal epileptiform discharges have been shown to interfere with memory consolidation. Conclusions on underlying mechanisms remain unclear. Further case-control studies addressing sleep and its influence on memory problems in pediatric epilepsy patients are needed.
Collapse
Affiliation(s)
- Sebastian Hoyer
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Marie Dietz
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Nadashree Krishnasamy
- Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Buss
- Institute of Cell Biology and Neurobiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Yee Lee Shing
- Department of Psychology, Goethe Universität Frankfurt am Main, Hessen, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
|
4
|
Lah S, Karapetsas G, Winsor A, Gonzalez L, Mandalis A, Pertini M, Gascoigne M. Sleep and functional outcomes in children and adolescents with epilepsy: A scoping review. Seizure 2024; 120:89-103. [PMID: 38924846 DOI: 10.1016/j.seizure.2024.06.006] [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: 03/31/2024] [Revised: 05/24/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
AIM In children and adolescents with epilepsy (CAWE), disturbed sleep and functional difficulties are frequently present, but their relationship is unclear. In this scoping review we aimed to explore associations between sleep and functional outcomes in CAWE. METHOD We registered the protocol with open science framework and conducted the review according to the PRISMA Extension for Scoping Reviews. We searched Medline, Embase, PsycINFO and PubMed for original studies reporting on relations between sleep and functional outcomes (adaptive/quality of life, behavioural/mood, cognitive & academic) in CAWE. To assess the quality of studies we used an extended version of the checklist employed by Winsor and colleagues [1]. RESULTS We identified 14 studies that included 1,785 CAWE and 1,260 control children, with a mean age of 9.94 and 10.13 years, respectively. The studies were highly heterogeneous with respect to samples, epilepsy variables, and methods used to assess sleep and functional outcomes. The quality of studies was medium. Associations between sleep and adaptive/quality of life, behavioural/mood, cognitive and academic outcomes were examined in 2, 10, 6, and 0 studies, respectively. Across studies, in CAWE, greater sleep disturbances were related to worse behavioural/mood outcomes, ranging from depression/anxiety to ADHD symptoms. Sleep disturbances did not consistently relate to cognitive outcomes, but they related to worse adaptive outcomes in both studies that examined their relationship. CONCLUSIONS Our study provides evidence of relationship between disturbed sleep and behavioural/mood difficulties, which alerts to the need for careful evaluation and treatment of sleep disturbances in CAWE. Our study also highlights the need to examine relationships between sleep and other functional outcomes in CAWE, as studies conducted in the general population suggest that sleep disturbances may be modifiable and associated with improved functional outcomes.
Collapse
Affiliation(s)
- Suncica Lah
- School of Psychology, University of Sydney, Sydney, Australia; Australian Paediatric Neuropsychology Research Network, Australia.
| | - George Karapetsas
- Australian Paediatric Neuropsychology Research Network, Australia; Macquarie University, Macquarie Park, New South Wales, Australia
| | - Alice Winsor
- Maurice Wohl clinical neuroscience institute, kings college London, United Kingdom
| | - Linda Gonzalez
- Australian Paediatric Neuropsychology Research Network, Australia; Matrix Neuropsychology Melbourne, Australia and University of Melbourne, Parkville, Victoria, Australia
| | - Anna Mandalis
- Australian Paediatric Neuropsychology Research Network, Australia; Sydney Children's Hospital Randwick, Sydney Australia
| | - Mark Pertini
- Australian Paediatric Neuropsychology Research Network, Australia; Consultation Liaison Service, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michael Gascoigne
- Australian Paediatric Neuropsychology Research Network, Australia; School of Psychology & Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| |
Collapse
|
|
5
|
Jiang N, Yang CM, Wang JL, Ye XF, Yang B. The Association Between Sleep Problems and Attentional Network Functions in Patients with Self-Limited Epilepsy with Centrotemporal Spikes. Nat Sci Sleep 2024; 16:751-760. [PMID: 38894978 PMCID: PMC11182751 DOI: 10.2147/nss.s460558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose To investigate sleep problems in children with self-limited epilepsy with central temporal spiking (SeLECTS) and to assess the relationship between sleep problems and attention network dysfunction. Patients and methods 107 children 6-14 years of age with SeLECTS and 90 age- and sex-matched healthy controls were recruited for this study. The sleep status of these participants was evaluated using the Children's Sleep Habits Questionnaire (CSHQ), while attentional network function was assessed with the attention network function test (ANT). Results Together, these analyses revealed that children with SeLECTS exhibited higher total CSHQ scores and sleep disorder incidence relative to healthy controls (P< 0.001). Children with SeLECTS had higher scores in delayed sleep onset, sleep duration, night awakenings, parasomnias, daytime sleepiness and sleep anxiety (P<0.01). Total CSHQ scores were negatively correlated with average ANT correct rates (ρ= -0.253, P<0.01), while they were positively correlated with total reaction time (ρ=0.367, P<0.01) and negatively correlated with the efficiency of the alerting and executive control networks (ρ=-0.344 P<0.01; ρ=-0.418 P<0.01). Conclusion Children with SeLECTS face a higher risk of experiencing sleep disorders relative to age-matched healthy children, while also demonstrating that the magnitude of the impairment of attentional network function in these children is positively correlated with sleep disorder severity. Thus, the prognosis and quality of life of children with SeLECTS can be improved by interventions addressing sleep disorders.
Collapse
Affiliation(s)
- Nan Jiang
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- The Fifth Clinical College Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Chun Mei Yang
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- The Fifth Clinical College Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Jia Le Wang
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- The Fifth Clinical College Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xiao Fei Ye
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Bin Yang
- Children’s Medical Centre of Anhui Medical University, Hefei, Anhui, People’s Republic of China
- The Fifth Clinical College Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| |
Collapse
|
|
6
|
Eisner J, Harvey D, Dunn D, Jones J, Byars A, Fastenau P, Austin J, Hermann B, Oyegbile-Chidi T. Long-term characterization of cognitive phenotypes in children with seizures over 36 months. Epilepsy Behav 2024; 154:109742. [PMID: 38554647 PMCID: PMC12006876 DOI: 10.1016/j.yebeh.2024.109742] [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: 10/15/2023] [Revised: 01/19/2024] [Accepted: 03/10/2024] [Indexed: 04/02/2024]
Abstract
RATIONALE Children with new-onset epilepsies often exhibit co-morbidities including cognitive dysfunction, which adversely affects academic performance. Application of unsupervised machine learning techniques has demonstrated the presence of discrete cognitive phenotypes at or near the time of diagnosis, but there is limited knowledge of their longitudinal trajectories. Here we investigate longitudinally the presence and progression of cognitive phenotypes and academic status in youth with new-onset seizures as sibling controls. METHODS 282 subjects (6-16 years) were recruited within 6 weeks of their first recognized seizure along with 167 unaffected siblings. Each child underwent a comprehensive neuropsychological assessment at baseline, 18 and 36 months later. Factor analysis of the neuropsychological tests revealed four underlying domains - language, processing speed, executive function, and verbal memory. Latent trajectory analysis of the mean factor scores over 36 months identified clusters with prototypical cognitive trajectories. RESULTS Three unique phenotypic groups with distinct cognitive trajectories over the 36-month period were identified: Resilient, Average, and Impaired phenotypes. The Resilient phenotype exhibited the highest neuropsychological factor scores and academic performance that were all similar to controls; while the Impaired phenotype showed the polar opposite with the worst performances across all test metrics. These findings remained significant and stable over 36 months. Multivariate logistic regression indicated that age of onset, EEG, neurological examination, and sociodemographic disadvantage were associated with phenotype classification. CONCLUSIONS This study demonstrates the presence of diverse latent cognitive trajectory phenotypes over 36 months in youth with new-onset seizures that are associated with a stable neuropsychological and academic performance longitudinally.
Collapse
Affiliation(s)
- Jordan Eisner
- Department of Neurology, University of California Davis, Sacramento, CA 95817, USA
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Davis, CA 95616, USA
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, IN 46202, USA
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, OH 45229, USA
| | - Philip Fastenau
- Department of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, IN 46202, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | | |
Collapse
|
|
7
|
Liu WK, Kothare S, Jain S. Sleep and Epilepsy. Semin Pediatr Neurol 2023; 48:101087. [PMID: 38065633 DOI: 10.1016/j.spen.2023.101087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 12/18/2023]
Abstract
The relationship between sleep and epilepsy is both intimate and bidirectional. The molecular mechanisms which control circadian rhythm and the sleep/wake cycle are dysregulated in epileptogenic tissue and are themselves effected by molecular pathways for epilepsy. Sleep affects the frequency of interictal epileptiform discharges and recent research has raised new questions regarding the impact of discharges on sleep function and cognition. Epileptiform discharges themselves affect sleep architecture and increase the risk of sleep disorders. Several sleep-related epilepsy syndromes have undergone changes in their classification which highlights their intimate relationship to sleep and novel screening tools have been developed to help clinicians better differentiate epileptic seizures from sleep-related paroxysmal events. Improving sleep and addressing sleep disorders has been associated with improved seizure control and increased well-being in people with epilepsy. These interactions are discussed in detail in this review.
Collapse
Affiliation(s)
- Wei K Liu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital, Cincinnati, OH.
| | - Sanjeev Kothare
- Division of Pediatric Neurology, Department of Pediatrics, Cohen Children's Medical Center, New York, NY
| | - Sejal Jain
- Department of Anesthesiology and Pain Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| |
Collapse
|
|
8
|
Oyegbile-Chidi T, Harvey D, Dunn D, Jones J, Byars A, Fastenau P, Austin J, Hermann B. The Impact of Sociodemographic Disadvantage on Cognitive Outcomes in Children With Newly Diagnosed Seizures and Their Unaffected Siblings Over 36 Months. Pediatr Neurol 2023; 148:178-188. [PMID: 37742443 PMCID: PMC11972614 DOI: 10.1016/j.pediatrneurol.2023.08.028] [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: 05/02/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Accumulating evidence indicates that children with newly diagnosed epilepsy have comorbidities including cognitive challenges. Research investigating comorbidities has focused on clinical epilepsy characteristics and neurobiological/genetic correlates. The role that sociodemographic disadvantage (SD) may play has received less attention. We investigated the role of SD in cognitive status in youth with newly diagnosed epilepsy over a follow-up of 36 months to determine the degree, extent, and duration of the role of disadvantage. METHODS A total of 289 children (six to 16 years) within six weeks of their first seizure along with 167 siblings underwent comprehensive neuropsychological assessments (intelligence, language, memory, executive function, processing speed, and academic achievement) at baseline, 18 months later, and at 36 months from baseline. Baseline demographic information (race, caregivers education, household income, and parental marital status), clinical epilepsy characteristics (e.g., age of onset), and magnetic resonance imaging (MRI) and electroencephalographic (EEG) information was collected. RESULTS An SD index was computed for each family and categorized into four groups by level of disadvantage. In children and siblings, the least disadvantaged group exhibited the highest Full-Scale IQ, neuropsychological factor scores, and academic performances, whereas the most disadvantaged showed the polar opposite with the worst performances across all tests. Findings remained stable and significant over 36 months. Linear regression analyses indicated that disadvantage was a more constant and stable predictor of cognitive and academic performance over time compared with clinical epilepsy characteristics and MRI/EEG abnormalities. CONCLUSIONS This study indicates the strong association between SD and cognitive/academic performance in children with newly diagnosed epilepsy and their siblings is significant and predictive of three-year cognitive outcomes.
Collapse
Affiliation(s)
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, Ohio
| | - Philip Fastenau
- Department of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, Indiana
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
|
9
|
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.
Collapse
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.
| |
Collapse
|
|
10
|
Orr C, Fisher C, O'Donnell M, Glauert R, Preen DB. Epilepsy in children exposed to family and domestic violence in the first 5 years of life. J Paediatr Child Health 2022; 58:2183-2189. [PMID: 36054645 PMCID: PMC10087942 DOI: 10.1111/jpc.16179] [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: 08/19/2021] [Revised: 04/03/2022] [Accepted: 07/17/2022] [Indexed: 11/27/2022]
Abstract
AIM To investigate childhood (0-18 years) hospitalisation and emergency department (ED) contacts for epilepsy in Western Australian (WA) children exposed to family and domestic violence (FDV) pre 5 years of age compared to children with no FDV exposure. METHODS A retrospective, population-based cohort study included children born 1987-2010 who were identified as being exposed to FDV (n = 7018) from two sources: WA Police Information Management System and WA Hospital Morbidity Data Collection (HMDC) and a non-exposed comparison group (n = 41 996). Epilepsy contact was identified in HMDC and ED Data Collection records. Cox regression was used to estimate the adjusted and unadjusted hazard ratio and 95% confidence interval (CI) for epilepsy contact; adjustment was made for a range of demographic characteristics known to impact health outcomes. Analyses were stratified by Aboriginal and Torres Strait Islander status to account for higher rates of FDV and epilepsy hospital admissions in Aboriginal and Torres Strait Islander children. RESULTS Children exposed to FDV had a 62% (HR 1.62, 95% CI: 1.33-1.98) increased risk of epilepsy contact than non-exposed counterparts. Furthermore, the children exposed to FDV had a 50% longer average hospital stay for epilepsy than non-exposed children (4.7 days vs. 3 days, P = 0.006). When stratified by Aboriginal status, we found that Aboriginal children exposed to FDV stayed (on average) 2 days longer in hospital for epilepsy than their non-exposed counterparts (5.1 days vs. 3.1 days, P = 0.018). CONCLUSIONS FDV exposure in early childhood is associated with increased risk of requiring secondary health care and longer hospital stays for childhood epilepsy.
Collapse
Affiliation(s)
- Carol Orr
- The School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Collen Fisher
- The School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Melissa O'Donnell
- The Australian Centre for Child ProtectionThe University of South AustraliaAdelaideSouth AustraliaAustralia
| | - Rebecca Glauert
- The School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - David B Preen
- The School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| |
Collapse
|
|
11
|
Oyegbile-Chidi T, Harvey D, Dunn D, Jones J, Hermann B, Byars A, Austin J. Characterizing Sleep Phenotypes in Children With Newly Diagnosed Epilepsy. Pediatr Neurol 2022; 137:34-40. [PMID: 36215818 PMCID: PMC9970008 DOI: 10.1016/j.pediatrneurol.2022.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with epilepsy frequently have sleep, behavior, and cognitive problems at the time of or before the epilepsy diagnosis. The primary goal of this study was to determine if specific sleep disturbance phenotypes exist in a large cohort of children with new-onset epilepsy and if these phenotypes are associated with specific cognitive and behavioral signatures. METHODS A total of354 children with new-onset epilepsy, aged six to 16 years, were recruited within six weeks of initial seizure onset. Each child underwent evaluation of their sleep along with self, parent, and teacher ratings of emotional-behavioral status. Two-step clustering using sleep disturbance (Sleep Behavior Questionnaire), naps, and sleep latency was employed to determine phenotype clusters. RESULTS Analysis showed three distinct sleep disturbance phenotypes-minimal sleep disturbance, moderate sleep disturbance, and severe sleep disturbance phenotypes. Children who fell into the minimal sleep disturbance phenotype had an older age of onset with the best cognitive performance compared with the other phenotypes and the lowest levels of emotional-behavioral problems. In contrast, children who fell into the severe sleep disturbance phenotype had the youngest age of onset of epilepsy with poor cognitive performance and highest levels of emotional-behavioral problems. CONCLUSIONS This study indicates that there are indeed specific sleep disturbance phenotypes that are apparent in children with newly diagnosed epilepsy and are associated with specific comorbidities. Future research should determine if these phenotypic groups persist over time and are predictive of long-term difficulties, as these subgroups may benefit from targeted therapy and intervention.
Collapse
Affiliation(s)
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, Ohio
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, Indiana
| |
Collapse
|
|
12
|
Khambadkone SG, Benjamin SE. Sleep Disturbances in Neurological Disease: A Target for Intervention. Semin Neurol 2022; 42:639-657. [PMID: 36216356 DOI: 10.1055/a-1958-0710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sleep is a biological function required for neurological and general health, but a significant and under-recognized proportion of the population has disturbed sleep. Here, we briefly overview the biology of sleep, sleep requirements over the lifespan, and common sleep disorders. We then turn our attention to five neurological diseases that significantly contribute to global disease burden and neurology practice makeup: epilepsy, headache, ischemic stroke, Parkinson's disease, and Alzheimer's disease. For each disease, we review evidence that sleep disturbances contribute to disease risk and severity and discuss existing data that addressing sleep disturbances may have disease-modifying effects. We provide recommendations derived from the literature and existing clinical guidelines to facilitate the evaluation and management of sleep disturbances within the context of each neurological disease. Finally, we synthesize identified needs and commonalities into future directions for the field and practical sleep-related recommendations for physicians caring for patients at risk for or currently suffering from neurological disease.
Collapse
Affiliation(s)
- Seva G Khambadkone
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Sara E Benjamin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins Center for Sleep, Columbia, Maryland
| |
Collapse
|
|
13
|
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: 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: 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.
Collapse
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
| |
Collapse
|
|
14
|
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: 7] [Impact Index Per Article: 2.3] [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.
Collapse
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.
| |
Collapse
|
|
15
|
Gupta G, Dang LT, O'Brien LM, Shellhaas RA. Parent-Reported Sleep Profile of Children With Early-Life Epilepsies. Pediatr Neurol 2022; 128:9-15. [PMID: 34992036 PMCID: PMC8857052 DOI: 10.1016/j.pediatrneurol.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/27/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sleep comorbidities are common, and sometimes severe, for children with early-life epilepsies (ELEs). Yet, there is a paucity of data regarding the profile of these sleep disturbances and their complications. METHODS Participants registered with the Rare Epilepsy Network (REN) were queried about sleep via online questionnaires. Descriptive statistics and logistic regression were performed. RESULTS Median age of the 356 children was 56 months (interquartile range 30 to 99), 56% were female, and 53% (188/356) endorsed a sleep concern. Frequent nighttime awakenings (157 of 350; 45%), difficulty falling asleep (133 of 350; 38%), and very restless sleep (118 of 345; 34%) were most endorsed. Nocturnal seizures were associated with sleep concerns and were reported in 75% (268 of 356) of children. Of the children with nocturnal seizures, 56% (118 of 268) had sleep concerns. Of the children without nocturnal seizures, 43% (38 of 88) had sleep concerns. Sleep concerns were most common in dup15q syndrome (16 of 19; 84%). Children aged 4 to ≤10 years (adjusted odds ratio [aOR] 16.1; 95% confidence interval [CI] 2.0, 131.0) and 10 to <13 years (aOR 22.2; 95% CI 2.6, 188.6) had a greater odds of having a sleep concern compared with children aged ≤6 months. Female sex appeared protective for sleep concerns (aOR 0.6; 95% CI 0.4, 0.9). The association between sleep concerns and nocturnal seizures was weaker when adjusted for sex and age category in a logistic regression model. CONCLUSIONS Reported sleep concerns are highly prevalent in children with ELEs and persist with age, in contrast to what is expected in healthy children. There may be unmet sleep-related clinical needs in children with ELEs.
Collapse
Affiliation(s)
- Gita Gupta
- Division of Pediatric Neurology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Louis T Dang
- Division of Pediatric Neurology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Louise M O'Brien
- Departments of Neurology, Obstetrics and Gynecology and Oral and Maxillofacial Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Renée A Shellhaas
- Division of Pediatric Neurology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|
|
16
|
Oyegbile-Chidi T, Harvey D, Eisner J, Dunn D, Jones J, Byars A, Hermann B, Austin J. The Relationship Between Sleep, Cognition and Behavior in Children With Newly-Diagnosed Epilepsy Over 36 Months. Front Neurol 2022; 13:903137. [PMID: 35959398 PMCID: PMC9360804 DOI: 10.3389/fneur.2022.903137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction There is substantial evidence that children with epilepsy experience more sleep, behavior and cognitive challenges than children without epilepsy. However, the literature is limited in describing the relationship between sleep, epilepsy, cognition and behavioral challenges and the interactions amongst these factors over time. This study aims to understand the nature and strength of the relationship between sleep, cognition, mood and behavior in children with new-onset epilepsy as assessed by multiple informants at multiple time periods using multiple different dependent measures. Methods 332 participants (6-16years) were recruited within 6 weeks of their first recognized seizure. The comparison group was comprised of 266 healthy siblings. Participants underwent sleep evaluation by a parent using the Sleep Behavioral Questionnaire (SBQ), cognitive evaluation using a comprehensive neuropsychological test battery, a behavioral evaluation using the Child Behavior Checklist (CBCL from parents and TRF from teachers) and the Children's Depression Inventory (CDI). These evaluations were completed at baseline (B), at 18 months, and at 36 months. Results Compared to siblings, children with new-onset epilepsy had more sleep disturbance (SBQ), higher rates of behavioral problems (CBCL and TRF), lower cognitive testing scores, and higher rates of depression; which persisted over the 36-month study. Sleep significantly correlated with behavioral problems, cognitive scores and depression. When divided into categories based of sleep disturbance scores, 39.7% of children with epilepsy experienced "Persistently Abnormal Sleep", while 14.8% experienced "Persistently Normal Sleep". Children with persistently abnormal sleep experienced the highest rates of behavioral problems, depression and cognitive impairment compared to those with persistently normal sleep, regardless of epilepsy syndrome. Younger age of seizure onset, younger age at testing, and lower grade level at baseline were associated with persistently abnormal sleep. Conclusions To our knowledge, this is the first demonstration of the nature, strength, reliability, stability and persistence of the relationship between sleep, cognition, and behavioral problems over time in a large cohort of children with newly diagnosed epilepsy, as assessed by multiple informants at different timepoints. The results of this study indicate that children with epilepsy are at a high risk of significant persisting neurobehavioral multimorbidity. Therefore, early screening for these challenges may be essential for optimizing quality of life long-term.
Collapse
Affiliation(s)
- Temitayo Oyegbile-Chidi
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Danielle Harvey
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Jordan Eisner
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - David Dunn
- Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, University of Cincinnati, Cincinnati, OH, United States
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Joan Austin
- School of Nursing, Indiana University, Indianapolis, IN, United States
| |
Collapse
|
|
17
|
Zhao F, Sun X, Wang Y, Zhou Y, He Y, Wang C, Han F, Liu J, Tsai SY, Wang G, Wang J. Sleep Disturbances in Chinese Children with Epilepsy: Associations with Behavioral Problems and Quality of Life. Nat Sci Sleep 2022; 14:1225-1236. [PMID: 35814490 PMCID: PMC9258772 DOI: 10.2147/nss.s367900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the association between sleep disturbances and behavioral problems as well as quality of life (QOL) in Chinese children with epilepsy. METHODS Caregivers of 167 epileptic children aged 3 to 12 years completed the Child Sleep Habits Questionnaire (CSHQ), the Strengths and Difficulties Questionnaire (SDQ), and the Pediatric Quality of Life Inventory (PedsQL™, 4.0 Core). RESULTS The prevalence of sleep disturbances (CSHQ total score >41) in epileptic children was 73.7% [95% CI (66.9%.80.4%)]. Epileptic children with sleep disturbances demonstrated more behavioral problems and lower QOL compared to those without sleep disturbances. Sleep disturbances such as sleep anxiety and daytime sleepiness were associated with more behavioral problems and lower QOL (p <0.05). Linear regression analyses showed that higher disturbance in sleep duration domain were associated with more behavioral problems, while higher sleep disordered breathing domains was associated with lower QOL (p <0.05). The interaction between sleep disturbances and behavioral problems in predicting QOL was not significant. The sensitivity analysis using 48 as an alternative cutoff for CSHQ total score obtained consistent results. CONCLUSION Sleep disturbances occur frequently among Chinese children with epilepsy, and are associated with more behavioral problems and lower QOL. The sleep disturbance-QOL association is unlikely contingent on behavioral problems. This study highlights the necessity of evaluating and treating sleep disturbances multidimensionally among children with epilepsy to promote their whole health and wellbeing.
Collapse
Affiliation(s)
- Fen Zhao
- Department of Pediatric Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaoning Sun
- Paediatric Translational Medicine Institute, Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yingyan Wang
- Department of Pediatric Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yunqing Zhou
- Department of Pediatric Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yingzhong He
- Department of Pediatric Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Cuijin Wang
- Department of Pediatric Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Feng Han
- Department of Pediatric Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jie Liu
- Department of Pediatric Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Shao-Yu Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Guanghai Wang
- Paediatric Translational Medicine Institute, Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiwen Wang
- Department of Pediatric Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| |
Collapse
|
|
18
|
Nobili L, Beniczky S, Eriksson SH, Romigi A, Ryvlin P, Toledo M, Rosenzweig I. Expert Opinion: Managing sleep disturbances in people with epilepsy. Epilepsy Behav 2021; 124:108341. [PMID: 34619543 DOI: 10.1016/j.yebeh.2021.108341] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/21/2022]
Abstract
Poor sleep and daytime sleepiness are common in people with epilepsy. Sleep disorders can disrupt seizure control and in turn sleep and vigilance problems can be exacerbated by seizures and by antiepileptic treatments. Nevertheless, these aspects are frequently overlooked in clinical practice and a clear agreement on the evidence-based guidelines for managing common sleep disorders in people with epilepsy is lacking. Recently, recommendations to standardize the diagnostic pathway for evaluating patients with sleep-related epilepsies and comorbid sleep disorders have been presented. To build on these, we adopted the Delphi method to establish a consensus within a group of experts and we provide practical recommendations for identifying and managing poor night-time sleep and daytime sleepiness in people with epilepsy. We recommend that a comprehensive clinical history of sleep habits and sleep hygiene should be always obtained from all people with epilepsy and their bed partners. A psychoeducational approach to inform patients about habits or practices that may negatively influence their sleep or their vigilance levels should be used, and strategies for avoiding these should be applied. In case of a suspected comorbid sleep disorder an appropriate diagnostic investigation should be performed. Moreover, the possible presence of sleep fragmentation induced by sleep-related seizures should be ruled out. Finally, the dose and timing of antiepileptic medications and other co-medications should be optimized to improve nocturnal sleep and avoid daytime sedation.
Collapse
Affiliation(s)
- Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy; Child Neuropsychiatry Unit, Istituto G. Gaslini, Genoa, Italy.
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre and Aarhus University Hospital, Denmark.
| | - Sofia H Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK.
| | | | - Philippe Ryvlin
- Department of Clinical Neurosciences, Vaud University Hospital Center, Lausanne, Switzerland
| | - Manuel Toledo
- Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Kings College London and Sleep Disorders Centre, GSTT NHS Trust, London, UK.
| |
Collapse
|
|
19
|
Dreier LA, Kapanci T, Lonnemann K, Koch-Hogrebe M, Wiethoff-Ubrig L, Rauchenzauner M, Blankenburg M, Zernikow B, Wager J, Rostasy K. Assessment of Sleep-Related Problems in Children with Cerebral Palsy Using the SNAKE Sleep Questionnaire. CHILDREN (BASEL, SWITZERLAND) 2021; 8:772. [PMID: 34572204 PMCID: PMC8468412 DOI: 10.3390/children8090772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022]
Abstract
Cerebral palsy (CP) represents the most common motor impairment in childhood. The presence of sleep problems has not yet been investigated with an instrument specifically designed for this population. In this hospital-based, prospective study, N = 100 children (M = 7.9, range: 2-18 years) with CP were included. All patients underwent pediatric neurologists' screening incorporating instruments (Data Collection Form; Gross Motor Functions Classification System, GMFCS; Bimanual Fine Motor Function, BFMF) recommended by the "Surveillance of Cerebral Palsy in Europe (SCPE)". Parents completed the "Sleep Questionnaire for Children with Severe Psychomotor Impairment (SNAKE)". Children's sleep behavior was increasingly conspicuous, with greater gross motor (SNAKE scales: disturbances remaining asleep, daytime sleepiness) and fine motor (additionally SNAKE scale arousal and breathing problems) functional impairment. Overall, a proportion of children showed sleep behavior outside the SNAKE's normal range. No relevant sleep differences were identified between different CP subtypes and comorbidities. Applying a population-specific questionnaire, children's functional impairment seems to be more relevant to their sleep behavior than the CP subtype or CP comorbidities.
Collapse
Affiliation(s)
- Larissa Alice Dreier
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany; (L.A.D.); (M.B.); (B.Z.); (J.W.)
- PedScience Research Institute, 45711 Datteln, Germany
| | - Tugba Kapanci
- Department of Pediatric Neurology, Children’s and Adolescents’ Hospital Datteln, Witten/Herdecke University, 58448 Witten, Germany; (T.K.); (K.L.); (M.K.-H.); (L.W.-U.)
| | - Katharina Lonnemann
- Department of Pediatric Neurology, Children’s and Adolescents’ Hospital Datteln, Witten/Herdecke University, 58448 Witten, Germany; (T.K.); (K.L.); (M.K.-H.); (L.W.-U.)
| | - Margarete Koch-Hogrebe
- Department of Pediatric Neurology, Children’s and Adolescents’ Hospital Datteln, Witten/Herdecke University, 58448 Witten, Germany; (T.K.); (K.L.); (M.K.-H.); (L.W.-U.)
| | - Lucia Wiethoff-Ubrig
- Department of Pediatric Neurology, Children’s and Adolescents’ Hospital Datteln, Witten/Herdecke University, 58448 Witten, Germany; (T.K.); (K.L.); (M.K.-H.); (L.W.-U.)
| | - Markus Rauchenzauner
- Department of Pediatrics, Hospital Kaufbeuren, 87600 Kaufbeuren, Germany;
- Department of Pediatrics, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Markus Blankenburg
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany; (L.A.D.); (M.B.); (B.Z.); (J.W.)
- Paediatric Neurology, Psychosomatics and Pain Therapy, Center for Child, Youth and Women’s Health, Klinikum Stuttgart, Olgahospital/Frauenklinik, 70174 Stuttgart, Germany
| | - Boris Zernikow
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany; (L.A.D.); (M.B.); (B.Z.); (J.W.)
- PedScience Research Institute, 45711 Datteln, Germany
| | - Julia Wager
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany; (L.A.D.); (M.B.); (B.Z.); (J.W.)
- PedScience Research Institute, 45711 Datteln, Germany
| | - Kevin Rostasy
- Department of Pediatric Neurology, Children’s and Adolescents’ Hospital Datteln, Witten/Herdecke University, 58448 Witten, Germany; (T.K.); (K.L.); (M.K.-H.); (L.W.-U.)
| |
Collapse
|
|
20
|
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: 40] [Impact Index Per Article: 10.0] [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.
Collapse
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
| |
Collapse
|
|
21
|
Abstract
There is increasing recognition that epilepsy can be associated with a broad spectrum of comorbidities. While epileptic seizures are an essential element of epilepsy in children, there is a spectrum of neurological, mental health and cognitive disorders that add to the disease burden of childhood epilepsy resulting in a decreased quality of life. The most common comorbid conditions in childhood epilepsy include depression, anxiety, autism spectrum disorders, sleep disorders, attention deficits, cognitive impairment, and migraine. While epilepsy can result in comorbidities, many of the comorbidities of childhood have a bi-directional association, with the comorbid condition increasing risk for epilepsy and epilepsy increasing the risk for the comorbid condition. The bidirectional feature of epilepsy and the comorbidities suggest a common underlying pathological basis for both the seizures and comorbid condition. While recognition of the comorbid conditions of pediatric epilepsies is increasing, there has been a lag in the development of effective therapies partly out of concern that drugs used to treat the comorbid conditions could increase seizure susceptibility. There is now some evidence that most drugs used for comorbid conditions are safe and do not lower seizure threshold. Unfortunately, the evidence showing drugs are effective in treating many of the childhood comorbidities of epilepsy is quite limited. There is a great need for randomized, placebo-controlled drug trials for efficacy and safety in the treatment of comorbidities of childhood epilepsy.
Collapse
Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Stafford Hall, 118C, Burlington, VT, 05405, USA.
| |
Collapse
|
|
22
|
Chan SYS. Sleep architecture and homeostasis in children with epilepsy: a neurodevelopmental perspective. Dev Med Child Neurol 2020; 62:426-433. [PMID: 31879946 DOI: 10.1111/dmcn.14437] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
Abstract
Although the influence of sleep on epilepsy has long been recognized, this relationship has yet to be fully exploited to benefit patients. The past decade has seen significant advances in understanding paediatric sleep, providing a framework by which to properly evaluate the sleep of children with epilepsy, which itself has been subject to increasing scrutiny. The role of sleep in learning and the potential for interictal discharges to disrupt sleep-related memory consolidation provide a novel perspective for understanding the association of childhood epilepsy with a high rate of intellectual disability. In this review, I outline the evolution of sleep duration, architecture, and homeostasis across childhood, relating this to the development of cognitive functions. I describe how these may be disrupted or preserved in children with epilepsy; in particular, collating data from polysomnography. Finally, I explore how sleep may, in the future, be modulated to improve cognitive outcome in these patients. WHAT THIS PAPER ADDS: Children with epilepsy have less rapid eye movement sleep than controls, but this improves with seizure cessation. Deep or slow-wave sleep is highly conserved in children with epilepsy. Sleep homeostasis may be disrupted either at a local or global level by the presence of interictal epileptiform discharges.
Collapse
Affiliation(s)
- Samantha Yuen-Sum Chan
- Clinical Neurosciences Section, Developmental Neurosciences Programme, UCL GOS Institute of Child Health, London, UK
| |
Collapse
|
|
23
|
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: 2.3] [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.
Collapse
|
|
24
|
Dehghani M, Fayyazi A, Cheraghi F, Hakimi H, Mosazadeh S, Almasi S. The Relationship Between Severity of Epilepsy and Sleep Disorder in Epileptic Children. IRANIAN JOURNAL OF CHILD NEUROLOGY 2019; 13:77-88. [PMID: 31037081 PMCID: PMC6451861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 02/13/2018] [Accepted: 02/18/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Sleep disturbances are one of the most common behavioral problems in childhood. Sleep problems have an even greater prevalence in children with epilepsy and are one of the most common comorbid conditions in childhood epilepsy. MATERIALS & METHODS This descriptive-correlation study with the general goal of determining the effects of epilepsy on sleep habits of epileptic children was conducted in Hamadan, western Iran, in 2014. Sampling was done using convenience sampling techniques. Data were collected using the Early Childhood Epilepsy Severity Scale (E-Chess) and Children's Sleep Habits Questionnaire (CSHQ) and analyzed using SPSS and descriptive and inferential statistics. RESULTS The mean score of sleep habits was 55/08±6/71. Bedtime resistance (12/14±2/93), parasomnias (11/02±1/84) and sleep anxiety (8/29±2/46) were the most frequent sleep disorders in the studied sample. Based on Pearson's r, there were significant positive bidirectional relationships between bedtime resistance (rs =0.129, P<0.019), parasomnias (rs =0.298, P<0.005), sleep-disordered breathing (rs =0.295, P<0.005), CSHQ total score (rs =0.144, P<0.022) on the one hand, and children's epilepsy severity on the other. CONCLUSION Sleep problems should not be overlooked, and a comprehensive review of the sleep habits of this group of patients should be conducted.
Collapse
Affiliation(s)
- Maryam Dehghani
- Department of Pediatrics Nursing, School of Nahavand Paramedical, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Afshin Fayyazi
- Hearing Disorders Research Center, hamadan university of medical sciences, hamedan, Iran
| | - Fatemeh Cheraghi
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamideh Hakimi
- Department of Nursing, Islamic Azad University of Lahijan, Lahijan, Iran
| | - Somayeh Mosazadeh
- Department of nursing student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeideh Almasi
- Department of Pediatric Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
|
25
|
Jain SV, Dye T, Kedia P. Value of combined video EEG and polysomnography in clinical management of children with epilepsy and daytime or nocturnal spells. Seizure 2018; 65:1-5. [PMID: 30590283 DOI: 10.1016/j.seizure.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/07/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Sleep disorders are common in epilepsy. Additionally, events of staring, jerking, or nocturnal behaviors are common presentations in neurology or sleep practice. Moreover, sleepiness and nocturnal awakenings are common symptoms in children with epilepsy and differentiation form ongoing seizures and sleep disorders is needed. However, limited data exist for the best evaluation methods. This study evaluated the usefulness of combined video electroencephalography (EEG) and polysomnography (PSG) studies (vEEG/PSG). METHODS Polysomnography custom database was searched for combined vEEG/PSG studies, performed from July 2010 to April 2014, which identified 240 studies. From chart review, data were collected for presenting symptoms, sleep disorder and epilepsy/neurology diagnoses, and EEG and PSG results. RESULTS Most common indications for performing combined vEEG/PSG were correlating sleep events with seizure occurrence, evaluating sleepiness, nocturnal awakenings and nocturnal events. Sleep physician evaluation and/or PSG were abnormal in 94% of the studies. The EEG was abnormal in 53% and events or seizures were recorded in 40% of the studies. Hence, vEEG/PSG addressed the diagnostic questions. Additionally, as compared to children with epilepsy, a significantly larger number of children with spells/parasomnia had a normal sleep evaluation including a normal PSG (9 Vs 37%, p = 0.00003). CONCLUSIONS This study demonstrates that combined video EEG and polysomnography is useful in addressing the common management questions in children with epilepsy and suspicious nocturnal events. Additionally, sleep disorders are more common in children with epilepsy than parasomnia. Hence sleep evaluation is important in children with epilepsy. Further prospective studies are needed.
Collapse
Affiliation(s)
- Sejal V Jain
- Department of Neurology, University of Arizona/Banner University Medical Center, Tucson AZ, United States.
| | - Thomas Dye
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Puja Kedia
- Dental School, Virginia Commonwealth University, United States
| |
Collapse
|
|
26
|
Abstract
PURPOSE OF REVIEW This article provides a review of disturbances of sleep comorbid with common neurologic disorders. RECENT FINDINGS A wide variety of neurologic disorders are frequently complicated by comorbid sleep disturbances. In many cases, a bidirectional relationship appears to occur between sleep function and the neurologic disease, such that treatment of comorbid sleep disturbances may improve the symptoms of the neurologic disease. SUMMARY Neurologic disorders are often associated with abnormalities of sleep. Sleep influences the severity of both epilepsy and headache, and treatment of comorbid sleep disorders may improve seizure and headache frequency. Alzheimer disease is characterized by circadian phase delay and poor nighttime sleep and is strongly associated with obstructive sleep apnea. Parkinson disease is associated with several sleep disorders, including insomnia, restless legs syndrome, rapid eye movement (REM) sleep behavior disorder, daytime hypersomnia, and sleep-disordered breathing. Hypoventilation in amyotrophic lateral sclerosis and other neuromuscular disorders often presents initially with sleep problems, and treatment with noninvasive ventilation improves survival and quality of life.
Collapse
|
|
27
|
Dreier LA, Wager J, Blankenburg M, Zernikow B. The Unfavorable Alliance of Pain and Poor Sleep in Children with Life-Limiting Conditions and Severe Psychomotor Impairment. CHILDREN 2018; 5:children5070082. [PMID: 29933542 PMCID: PMC6068563 DOI: 10.3390/children5070082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 01/16/2023]
Abstract
A high prevalence of sleep problems exists in children and adolescents with life-limiting conditions (LLC) and severe psychomotor impairment (SPMI). This study aimed to compare the impacts of various child-related (pain, epilepsy, repositioning, medical care) and environment-related (light, noise, TV/radio, open door) factors on sleep in this vulnerable population. Data were obtained through the “Sleep Questionnaire for Children with Severe Psychomotor Impairment” (SNAKE) by proxy assessment. n = 212 children (mean age: 10.4 years) were included in the analyses. Logistic and linear regression models were used to compare child- and environment-related factors against the global rating of children’s sleep quality, five SNAKE scales, children’s sleep duration, and sleep efficacy. Pain increased the risk of sleeping poorly four-fold (OR (odds ratio) = 4.13; 95% CI (confidence interval): 1.87–9.13) and predicted four sleep problems as assessed by the SNAKE. Children who needed to reposition during the night were at three times greater risk of sleeping poorly (OR = 3.08; 95% CI: 1.42–6.69). Three of the five SNAKE scales were predicted through nocturnal repositioning. Repositioning and epilepsy predicted a reduced sleep duration and low sleep efficacy. None of the environment-related factors exhibited statistically significant results. This study emphasizes the urgent need for reliable pain detection in the context of sleep disturbances in severely ill children.
Collapse
Affiliation(s)
- Larissa Alice Dreier
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
| | - Julia Wager
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
| | - Markus Blankenburg
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
- Paediatric Neurology, Psychosomatics and Pain Therapy, Center for Child, Youth and Women's Health, Klinikum Stuttgart, Olgahospital/Frauenklinik, 70174 Stuttgart, Germany.
| | - Boris Zernikow
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
| |
Collapse
|
|
28
|
Dreier LA, Zernikow B, Blankenburg M, Wager J. A Sleep Questionnaire for Children with Severe Psychomotor Impairment (SNAKE)-Concordance with a Global Rating of Sleep Quality. CHILDREN-BASEL 2018; 5:children5020020. [PMID: 29389907 PMCID: PMC5835989 DOI: 10.3390/children5020020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/14/2018] [Accepted: 01/30/2018] [Indexed: 11/25/2022]
Abstract
Sleep problems are a common and serious issue in children with life-limiting conditions (LLCs) and severe psychomotor impairment (SPMI). The “Sleep Questionnaire for Children with Severe Psychomotor Impairment” (Schlaffragebogen für Kinder mit Neurologischen und Anderen Komplexen Erkrankungen, SNAKE) was developed for this unique patient group. In a proxy rating, the SNAKE assesses five different dimensions of sleep(-associated) problems (disturbances going to sleep, disturbances remaining asleep, arousal and breathing disorders, daytime sleepiness, and daytime behavior disorders). It has been tested with respect to construct validity and some aspects of criterion validity. The present study examined whether the five SNAKE scales are consistent with parents’ or other caregivers’ global ratings of a child’s sleep quality. Data from a comprehensive dataset of children and adolescents with LLCs and SPMI were analyzed through correlation coefficients and Mann–Whitney U testing. The results confirmed the consistency of both sources of information. The highest levels of agreements with the global rating were achieved for disturbances in terms of going to sleep and disturbances with respect to remaining asleep. The results demonstrate that the scales and therefore the SNAKE itself is well-suited for gathering information on different sleep(-associated) problems in this vulnerable population.
Collapse
Affiliation(s)
- Larissa Alice Dreier
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
| | - Boris Zernikow
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
| | - Markus Blankenburg
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
- Paediatric Neurology, Psychosomatics and Pain Therapy, Center for Child, Youth and Women's Health, Klinikum Stuttgart, Olgahospital/Frauenklinik, 70174 Stuttgart, Germany.
| | - Julia Wager
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711 Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany.
| |
Collapse
|
|
29
|
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: 1.4] [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.
Collapse
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
| |
Collapse
|
|
30
|
Chan S, Pressler R, Boyd SG, Baldeweg T, Cross JH. Does sleep benefit memory consolidation in children with focal epilepsy? Epilepsia 2017; 58:456-466. [DOI: 10.1111/epi.13668] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Samantha Chan
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| | - Ronit Pressler
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| | - Stewart G. Boyd
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| | - Torsten Baldeweg
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
| | - J. Helen Cross
- Developmental Neurosciences Programme; UCL Great Ormond Street Institute of Child Health; London United Kingdom
- Great Ormond Street Hospital NHS Trust; London United Kingdom
| |
Collapse
|
|
31
|
|
|
32
|
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: 3.3] [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
|
|
33
|
|
|
34
|
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: 1.1] [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.
Collapse
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.
| |
Collapse
|
|
35
|
Salehi B, Yousefichaijan P, Safi Arian S, Ebrahimi S, Naziri M. Comparison of Relation between Attention Deficit Hyperactivity Disorder in Children with and without Simple Febrile Seizure Admitted in Arak Central Iran. IRANIAN JOURNAL OF CHILD NEUROLOGY 2016; 10:56-61. [PMID: 27843467 PMCID: PMC5100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 08/17/2016] [Accepted: 08/24/2016] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Febrile seizure is one of the most prevalent childhood convulsions with the most common age of onset at 14-18 mo old. Fever decreases the brain threshold for seizure. Attention Deficit Hyperactivity Disorder (ADHD) is also a neurologic-behavioral problem defined by attention deficit and hyperactivity according to DSM-IV criteria in which the child must have these signs in two different environments. There is controversy on the possible relation between febrile seizure and ADHD; while some studies approve a strong relation, some exclude any relation and some attribute ADHD to the side effects of other reasons. MATERIALS & METHODS This descriptive-analytic study enrolled all children of 3-12 yr old with febrile seizure (according to Nelson Pediatrics Textbook diagnosed by the pediatrician in charge) referring to Amir Kabir Hospital, Arak, central Iran in 2010-2011. Overall, 103 of them with no corporeal or psychological disorder (like depression, anxiety, schizophrenia and other CNS maternal disease) were compared to 103 children of the same age and gender admitted due to disease other than febrile seizure utilizing DSM IV criteria for ADHD. Data were analyzed using SPSS version 18. RESULTS The hyperactivity disorder in the control and case group was 34.3% and 16.7%, respectively, denoted a significant relation between simple febrile seizure and hyperactivity. CONCLUSION Hyperactivity has a significant relation with febrile seizure in male gender, making further investigation in these children prudent for early diagnosis and management.
Collapse
Affiliation(s)
- Bahman Salehi
- Psychiatric Department, Arak University of Medical Sciences, Arak, Iran
| | - Parsa Yousefichaijan
- Pediatric Nephrology Department, Nephrology Department, Arak University of Medical Sciences, Arak, Iran
| | - Smira Safi Arian
- General Practitioner, Arak University of Medical Sciences, Arak, Iran
| | - Somaieh Ebrahimi
- Psychology Department, Islamic Azad University of Arak, Arak, Iran
| | - Mahdyieh Naziri
- Base Sciences Department, Clinical Research Office of Amir almomenin hospital, Arak University of Medical Sciences, Arak, Iran
| |
Collapse
|
|
36
|
Abstract
Sleep and epilepsy are common bedfellows. Sleep can affect frequency and occurrence of interictal spikes and occurrence, timing, and threshold of seizure. Epilepsy can worsen sleep architecture and severity of sleep disorders. Thus, a vicious cycle is set. Certain epilepsy syndromes are so intertwined with sleep that they are considered sleep-related epilepsies. Poor sleep in epilepsy is multifactorial and is worsened by poorly controlled seizures. On the contrary, poor sleep is associated with worsened quality of life, psychological function, and memory. Improving sleep has been noted to improve seizure frequency and an overall well-being in patients with epilepsy. Hence, an emphasis should be given to address sleep in patients with epilepsy. These interactions are discussed in detail in this review.
Collapse
|
|
37
|
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: 60] [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.
Collapse
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
| |
Collapse
|
|
38
|
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: 13] [Impact Index Per Article: 1.3] [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.
Collapse
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
| |
Collapse
|
|
39
|
Becker SP, Ramsey RR, Byars KC. Convergent validity of the Child Behavior Checklist sleep items with validated sleep measures and sleep disorder diagnoses in children and adolescents referred to a sleep disorders center. Sleep Med 2015; 16:79-86. [DOI: 10.1016/j.sleep.2014.09.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/13/2014] [Accepted: 09/15/2014] [Indexed: 11/17/2022]
|
|
40
|
Al-Biltagi MA. Childhood epilepsy and sleep. World J Clin Pediatr 2014; 3:45-53. [PMID: 25254184 PMCID: PMC4162437 DOI: 10.5409/wjcp.v3.i3.45] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/16/2014] [Accepted: 06/10/2014] [Indexed: 02/06/2023] Open
Abstract
Sleep and epilepsy are two well recognized conditions that interact with each other in a complex bi-directional way. Some types of epilepsies have increased activity during sleep disturbing it; while sleep deprivation aggravates epilepsy due to decreased seizure threshold. Epilepsy can deteriorate the sleep-related disorders and at the same time; the parasomnias can worsen the epilepsy. The secretion of sleep-related hormones can also be affected by the occurrence of seizures and supplementation of epileptic patients with some of these sleep-related hormones may have a beneficial role in controlling epilepsy.
Collapse
|
|
41
|
Executive function and sleep problems in childhood epilepsy. Epilepsy Behav 2014; 37:20-5. [PMID: 24952234 DOI: 10.1016/j.yebeh.2014.05.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/10/2014] [Accepted: 05/23/2014] [Indexed: 11/21/2022]
Abstract
Pediatric epilepsy has been reported to be associated with both sleep problems and cognitive deficits. In turn, in healthy children, poorer sleep has been associated with deficits in cognitive functioning. We hypothesized that poor sleep in childhood epilepsy may contribute to cognitive deficits. Using actigraphy, we objectively measured the sleep of children with epilepsy alongside that of healthy controls. In contrast to previous reports, we did not find any differences in objectively measured sleep between children with epilepsy and healthy controls. However, significant deficits in cognitive functioning were demonstrated that were not explained by differences in sleep.
Collapse
|
|
42
|
Jain SV, Glauser TA. Effects of epilepsy treatments on sleep architecture and daytime sleepiness: An evidence-based review of objective sleep metrics. Epilepsia 2013; 55:26-37. [DOI: 10.1111/epi.12478] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Sejal V. Jain
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Tracy A. Glauser
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| |
Collapse
|
|
43
|
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: 34] [Impact Index Per Article: 2.8] [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.
Collapse
Affiliation(s)
- Th Gutter
- Department of Clinical Neurophysiology and Sleep Centre SEIN, Zwolle, The Netherlands.
| | | | | |
Collapse
|
|
44
|
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: 1.3] [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.
Collapse
Affiliation(s)
- Sejal V Jain
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | | | | |
Collapse
|
|
45
|
Blankenburg M, Tietze AL, Hechler T, Hirschfeld G, Michel E, Koh M, Zernikow B. Snake: the development and validation of a questionnaire on sleep disturbances in children with severe psychomotor impairment. Sleep Med 2013; 14:339-51. [DOI: 10.1016/j.sleep.2012.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 12/30/2012] [Accepted: 12/31/2012] [Indexed: 11/30/2022]
|
|
46
|
Samaitienė R, Norkūnienė J, Tumienė B, Grikinienė J. Sleep and behavioral problems in rolandic epilepsy. Pediatr Neurol 2013; 48:115-22. [PMID: 23337004 DOI: 10.1016/j.pediatrneurol.2012.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022]
Abstract
Although patients with benign childhood epilepsy with centrotemporal spikes exhibit a benign course of the disease, some of them display sleep and behavioral problems. Sixty-one patients with rolandic epilepsy, aged 6-11 years, were included in this study. The patients were divided into two subgroups according to the presence of seizures over the preceding 6 months. The control group comprised 25 patients without epilepsy and with similar characteristics in terms of age and sex. All patients underwent evaluation of sleep (Sleep Disturbance Scale for Children) and behavior (Lithuanian version of the Child Behaviour Checklist). Only patients who had had seizures over the preceding 6 months displayed significantly higher scores for sleep problems (disorders of excessive daytime sleepiness, disorders of sleep-wake transition, and scores for total sleep problems), worse sleep quality (longer sleep-onset latency), and behavioral problems (anxiety/depression, social problems, thought problems, attention problems, and aggressive behavior) than the patients of the control group. Our data add to evidence that active epilepsy has an impact on sleep and behavior. Clinically significant sleep problems were related to the higher risk of behavioral problems. Parents' ratings for existing sleep problems were sensitive to Sleep Disturbance Scale for Children scores above normal values.
Collapse
Affiliation(s)
- Rūta Samaitienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania, Vilnius, Lithuania.
| | | | | | | |
Collapse
|
|
47
|
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: 26] [Impact Index Per Article: 2.0] [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.
Collapse
|
|
48
|
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: 92] [Impact Index Per Article: 7.1] [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.
Collapse
Affiliation(s)
- Anna M Larson
- Pediatric Epilepsy Program, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
|
49
|
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: 1.6] [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]
|
|
50
|
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]
|