Sleep disturbances in children and adolescents with epilepsy: Clinical, polysomnographic and management aspects

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI:10.1016/j.sleep.2026.108794

Camila dos Santos El Halal , Magda Lahorgue Nunes

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Abstract

Background

Sleep and epilepsy interact through bidirectional neurobiological mechanisms. In children, sleep disturbances are highly prevalent and may exacerbate seizures while adversely affecting cognition, behaviour, and quality of life.

Objective

To synthesise current evidence on sleep disturbances in paediatric epilepsy by integrating subjective reports and objective sleep measures across epilepsy severity, syndromes, and common neurodevelopmental comorbidities, and to discuss implications for clinical management.

Methods

Narrative review of studies assessing sleep in children and adolescents with epilepsy using validated questionnaires and objective tools, including polysomnography/video-EEG–polysomnography, actigraphy, and cyclic alternating pattern analysis. Evidence was summarised according to epilepsy severity, epilepsy syndrome, comorbid ADHD/ASD, caregiver outcomes, and management strategies.

Results

Questionnaire-based studies consistently report high rates of sleep problems and associations with behavioural difficulties and poorer cognitive performance. Objective evidence, including meta-analytic data, demonstrates reduced total sleep time, decreased sleep efficiency, increased sleep fragmentation, and altered sleep-stage distribution compared with healthy controls. Drug-resistant epilepsy shows a severity gradient characterised by marked macrostructural disruption (reduced N3 and REM sleep, increased wake after sleep onset) and microstructural NREM instability, particularly in children with cognitive impairment. Reported sleep alterations appear syndrome-specific and influenced by seizure burden, nocturnal epileptiform activity, and treatment-related factors. Sleep disruption is also prominent in epilepsy with neurodevelopmental comorbidities and is closely associated with caregiver sleep disturbance and mental health burden.

Conclusions

Sleep impairment in childhood epilepsy is common, clinically meaningful, and potentially modifiable. Systematic screening with validated tools and targeted objective assessment may support interventions that improve sleep quality, seizure-related outcomes, daytime functioning, and family well-being.

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儿童和青少年癫痫患者的睡眠障碍：临床、多导睡眠图和管理方面。

背景：睡眠和癫痫通过双向神经生物学机制相互作用。在儿童中，睡眠障碍非常普遍，可能加剧癫痫发作，同时对认知、行为和生活质量产生不利影响。目的：通过整合癫痫严重程度、综合征和常见神经发育合并症的主观报告和客观睡眠测量，综合目前关于儿童癫痫睡眠障碍的证据，并讨论临床管理的意义。方法：使用有效问卷和客观工具，包括多导睡眠图/视频-脑电图-多导睡眠图、活动图和循环交替模式分析，对评估儿童和青少年癫痫患者睡眠的研究进行叙述性回顾。根据癫痫严重程度、癫痫综合征、ADHD/ASD合并症、照护者结局和管理策略对证据进行总结。结果：基于问卷的研究一致报告了睡眠问题的高发率，并与行为困难和较差的认知表现有关。包括元分析数据在内的客观证据表明，与健康对照组相比，总睡眠时间减少，睡眠效率下降，睡眠碎片增加，睡眠阶段分布改变。耐药癫痫表现出严重程度的梯度，其特征是显著的宏观结构破坏（N3和快速眼动睡眠减少，睡眠后醒来增加）和微观结构的非快速眼动不稳定，特别是在有认知障碍的儿童中。报告的睡眠改变似乎是综合征特异性的，受癫痫发作负担、夜间癫痫样活动和治疗相关因素的影响。睡眠中断在伴有神经发育合并症的癫痫中也很突出，并且与护理者睡眠障碍和精神健康负担密切相关。结论：儿童癫痫的睡眠障碍是常见的，有临床意义的，并且可能是可以改变的。采用有效工具和有针对性的客观评估进行系统筛查，可以支持改善睡眠质量、癫痫相关结果、白天功能和家庭福祉的干预措施。

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

Sleep medicine 医学-临床神经学

CiteScore

8.40

自引率

6.20%

发文量

1060

审稿时长

49 days

期刊介绍： Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without. A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry. The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.