Obstructive sleep apnea in children with cerebral palsy and epilepsy

Abstract

Aim To examine the risk of obstructive sleep apnea (OSA) in children with cerebral palsy (CP) and/or epilepsy. Method This cross‐sectional study employs the Pediatric Sleep Questionnaire (PSQ), the Gross Motor Function Classification System (GMFCS), and chart review to identify symptoms of OSA in children presenting to a multi‐specialty pediatric healthcare institution. Results Two‐hundred and fifteen patients were grouped into those with epilepsy (n=54), CP (n=18), both (n=55), and neither (comparison group, n=88). The comparison group comprised children with developmental disabilities but not children with typical development. Significantly increased PSQ scores (indicating increased risk of OSA) were found among children with CP (58%) and CP with epilepsy (67%) than among the comparison group (27%; p<0.001 and p<0.0001 respectively). Children with both CP and epilepsy had a greater number of increased PSQ scores compared with CP alone (p<0.05). Increased PSQ scores were observed with increasing CP severity as measured using the GMFCS. The PSQ identified more children at risk of OSA (46%) than did the medical record review for symptoms of OSA (8.2%, p<0.001). Interpretation Children with CP of greater severity or comorbid epilepsy are at increased risk of OSA. This study supports the routine questionnaire‐based assessment for OSA as a regular part of the care of all children with CP, especially in those with more severe CP and those with epilepsy.

Asthma and obesity as predictors of severe obstructive sleep apnea in an adolescent pediatric population

“…We chose these ages due to prior research indicating that the OSA effects associated with obesity might be more pronounced in late childhood and adolescence . In addition to limiting the study by age, we also excluded patients with Downs syndrome, cerebral palsy, craniofacial disorders, or neuromuscular disease due to the increased baseline associations with OSA in these populations . We additionally excluded patients who had undergone tonsillectomy, adenoidectomy, or tracheostomy, as well as patients with incomplete clinical data.…”

Cerebral palsy and sleep disordered breathing

“…The main issue that this case study highlighted was that even with a diagnosis of cerebral palsy, which is well known to increase the risk of sleep disturbance [1], and regular attendance at a variety of medical clinics, the patient was slow to be diagnosed as having a significant sleep disorder. It is likely that this was not caused by an individual factor but due to a combination of issues related to muscle tone, neuromuscular regulation of the airway, posture and chest deformity.…”

“…Sleep breathing issues in children have been described for some considerable time and it is well established that children with neurodisability such as cerebral palsy are at increased risk of sleep disturbances [1, 2] when compared to the general population. However, there are concerns that awareness amongst clinicians remains patchy, and that many children with neurodisability have sleep breathing problems that remain undiagnosed and untreated.…”

“…Sleep problems associated with epilepsy can be a major complicating factor. Epilepsy disrupts sleep quality [1, 4], which in turn exacerbates the epilepsy. Furthermore, antiepileptic drugs may then adversely affect the quality of sleep attained.…”

Respiratory Care Considerations for Children with Medical Complexity

“…However, all three types of SDB can occur in children with CMC. Sleep disordered breathing has been shown to be up to ten times more prevalent in particular subsets of children with medical complexity (e.g., spina bifida, Chiari malformations, cerebral palsy (CP), neuromuscular disease (NMD)) than in healthy children although the prevalence of SDB in the CMC population overall has yet to be determined [11,12,13,14]. Obstructive sleep apnea is characterized by recurrent periods of increased upper airway resistance with partial or complete intermittent obstruction of the upper airway during sleep.…”