Authors :
Presenting Author: Stefanie Dedeurwaerdere, PhD, MBA – UCB Pharma
Daniel Lloyd, MS – UCB Pharma
Alexis Davis, MS – UCB Pharma
Michael McLinden, MS – mck2x
John Van Zÿl, BSc – UCB Pharma S.A.
Amélie Lothe, PhD – UCB Pharma S.A.
Chris Clark, BS – UCB Pharma
Rationale:
Sleep apnea is a common and serious sleep disorder characterized by recurrent interruptions of breathing during sleep. This condition can lead to major health issues, including cardiovascular disease, cognitive impairment, and increased risk of all-cause sudden death. While sleep disorders such as sleep apnea have been extensively documented in epilepsy literature, the specific link between sleep apnea and mortality in individuals with severe epilepsy remains poorly understood. This retrospective observational study aims to describe the mortality risk of sleep apnea in patients with severe epilepsy by analyzing data from a US claims database.Methods:
Patients with severe epilepsy were identified within the KOMODO US claims database based on having two or more of the following criteria in their claims history: an epilepsy-related emergency department visit or hospital admission, status epilepticus diagnosis, or generalized tonic-clonic seizures. Over 2 million patient-years (2,355,410) were captured from 968,993 unique patients, covering the period from January 1, 2018, to December 31, 2022. Using ICD-10 codes, patients with severe epilepsy were categorized based on the presence or absence of Central Sleep Apnea (CSA: 15,486 patient-years) and Other Sleep Apnea (OSA which includes obstructive apnea: 313,024 patient-years). Additional comorbidities were defined based on the Charlson Comorbidity Index. Each patient-year by age group was associated with an all-cause death probability, based on data from the US general population in the year of observation. These death probabilities were compared with observed deaths in the claims data to calculate a standardized mortality ratio (SMR) for each age group.Results:
Children (ages 1-17) with CSA and severe epilepsy had an SMR of 135.9, and children with OSA and severe epilepsy had an SMR of 74.2. The SMRs for children with severe epilepsy and other severe comorbidities were 132.3 for congestive heart failure, 74.9 for hemiplegia/paraplegia, 55.3 for cerebrovascular disease, and 44.6 for chronic pulmonary disease, versus 27.7 for all severe epilepsy. SMR decreases with age in patients with sleep apnea or other comorbidities and severe epilepsy (Figure 1). Forty-six percent of patients with sleep apnea (CSA & OSA) and severe epilepsy were on positive airway pressure treatments (CPAP & Bi-PAP).
Conclusions:
Although claims databases have significant limitations, our results highlight that any sleep apnea comorbidity is an important and potentially actionable factor associated with increased mortality in children and young adults with severe epilepsy. These observations identify a particularly vulnerable age group and, as such, warrant further research to inform clinical practice, while also emphasizing the need to raise awareness of the elevated risk associated with sleep apnea comorbidities in pediatric patients with epilepsy.Funding:
UCB Pharma.