Factors associated with poor sleep in children with drug-resistant epilepsy

IF 6.6 1区医学 Q1 CLINICAL NEUROLOGY

Epilepsia Pub Date : 2024-09-10 DOI:10.1111/epi.18112

Renee Proost, Evy Cleeren, Bastiaan Jansen, Lieven Lagae, Wim Van Paesschen, Katrien Jansen

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Abstract

Objective

We aimed to investigate sleep in children with drug-resistant epilepsy (DRE), including developmental and epileptic encephalopathies (DEEs). Next, we examined differences in sleep macrostructure and microstructure and questionnaire outcomes between children with well-controlled epilepsy (WCE) and children with DRE. Furthermore, we wanted to identify factors associated with poor sleep outcome in these children, as some factors might be targets to improve epilepsy and neurodevelopmental outcomes.

Methods

A cross-sectional study was conducted in children 4 to 18-years-old. Children without epilepsy, with WCE, and with DRE were included. Overnight electroencephalography (EEG), including chin electromyography and electrooculography, to allow sleep staging, was performed. Parents were asked to fill out a sleep questionnaire. Classical five-stage sleep scoring was performed manually, spindles were automatically counted, and slow wave activity (SWA) in the first and last hour of slow wave sleep was calculated.

Results

One hundred eighty-two patients were included: 48 without epilepsy, 75 with WCE, and 59 with DRE. We found that children with DRE have significantly lower sleep efficiency (SE%), less time spent in rapid eye movement (REM) sleep, fewer sleep spindles, and a lower SWA decline over the night compared to children with WCE. Subjectively more severe sleep problems were reported by the caregivers and more daytime sleepiness was present in children with DRE. Least absolute shrinkage and selection operator (LASSO) regression showed that multifocal interictal epileptiform discharges (IEDs), benzodiazepine treatment, and longer duration of epilepsy were associated with lower SE% and lower REM sleep time. The presence of multifocal discharges and cerebral palsy was associated with fewer spindles. Benzodiazepine treatment, drug resistance, seizures during sleep, intellectual disability, and older age were associated with lower SWA decline.

Significance

Both sleep macrostructure and microstructure are severely impacted in children with DRE, including those with DEEs. Epilepsy parameters play a distinct role in the disruption REM sleep, spindle count, and SWA decline.

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耐药性癫痫患儿睡眠质量差的相关因素

目的我们旨在调查耐药性癫痫（DRE）儿童（包括发育性癫痫和癫痫性脑病（DEE））的睡眠情况。其次，我们研究了癫痫控制良好的儿童（WCE）与抗药性癫痫儿童在睡眠宏观和微观结构以及问卷调查结果方面的差异。此外，我们还希望找出与这些儿童睡眠质量差相关的因素，因为有些因素可能是改善癫痫和神经发育结果的目标。研究对象为 4 至 18 岁的儿童，包括无癫痫儿童、WCE 患儿和 DRE 患儿。研究人员进行了一夜的脑电图（EEG）检查，包括下巴肌电图和脑电图，以便对睡眠进行分期。要求家长填写睡眠问卷。手动进行经典的五阶段睡眠评分，自动计算棘波，并计算慢波睡眠第一小时和最后一小时的慢波活动（SWA）：其中 48 名无癫痫，75 名有 WCE，59 名有 DRE。我们发现，与 WCE 患儿相比，DRE 患儿的睡眠效率（SE%）明显较低、快速眼动睡眠（REM）时间较短、睡眠棘波较少，而且整夜的 SWA 下降幅度也较低。护理人员报告的主观睡眠问题更为严重，罹患嗜睡症的儿童白天嗜睡现象更为严重。最小绝对收缩和选择算子（LASSO）回归显示，多灶性发作间期癫痫样放电（IED）、苯二氮卓类药物治疗和癫痫持续时间较长与较低的SE%和较低的快速眼动睡眠时间有关。多灶性放电和脑瘫的存在与较少的棘波有关。苯二氮卓治疗、耐药性、睡眠中癫痫发作、智力障碍和年龄较大与SWA下降较低有关。癫痫参数在干扰快速眼动睡眠、纺锤体数量和SWA下降方面起着独特的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epilepsia 医学-临床神经学

CiteScore

10.90

自引率

10.70%

发文量

319

审稿时长

2-4 weeks

期刊介绍： Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.