Impact of pediatric epilepsy on sleep patterns and behaviors in children and parents

Abstract

SUMMARYPurpose: 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.

Differences in Sleep Patterns and Problems by Race in a Clinical Sample of Black and White Preschoolers

“…11, 40 Black and White children in this sample did not significantly differ in their rates of perinatal or birth complications, allergies, or asthma; however, other medical conditions more likely to be associated with bed sharing (epilepsy, sickle cell anemia) 40,41 were not studied. Future research should consider differences in such medical conditions and their association with bed sharing.…”

The contribution of illness perceptions to fatigue and sleep problems in youngsters with epilepsy

“…In addition, parents of children with epilepsy appear to be more fatigued than controls. 42 It should however be noted that the majority of these studies dealt with children with epilepsy that are 10 years old or younger and that patient inclusion criteria differed from ours (i.e. co-morbid conditions such as autism spectrum disorders and attention deficit hyperactivity disorder were included).…”

“…In addition, they may affect seizure control. 41,42 Although some general information regarding these disorders could be drawn from items from the AIS questionnaire such as sleep induction, awakenings during the night, overall quality of sleep and sleepiness during the day, in the present study we did not aim to diagnose these specific sleep disorders, but mainly focused on the general sleep quality of our patients. Future studies should also take existing sleep disturbances into account.…”

“…Nevertheless, it has been reported that parents have strong concerns about nocturnal seizures as well as sudden unexplained death. 42 Parent-child co-sleeping has reached rates up to 38% 43 and daytime dysfunction and habitual sleep efficacy have been found to be the two parental sleep domains with the greatest divergence between epilepsy and control cohorts. In addition, parents of children with epilepsy appear to be more fatigued than controls.…”

Gangguan Tidur pada Anak dengan Epilepsi dan Faktor yang Memengaruhi

“…Meskipun gangguan tidur sering terjadi pada anak sehat, angka kejadiannya lebih tinggi pada anak dengan epilepsi. 6,17,18 Hasil penelitian mendapatkan prevalensi gangguan tidur pada anak dengan epilepsi 67,7%. Prevalensi ini lebih rendah dibandingkan penelitian Ong dkk 21 (73,7%) yang juga menggunakan kuesioner SDSC, tetapi terdapat perbedaan rentang usia subyek dan populasi yang digunakan.…”