Abstracts

Rationale: Sleep and epilepsy share a mutual and bidrectional association. Children with epilepsy have higher than normal rates of sleep problems, and epilepsy-related variables (e.g., seizure frequency, nocturnal epileptiform discharges, antiepileptic medications) can contribute to sleep problems. Sleep difficulties are correlated with higher rates of psychological symptoms and poorer quality of life in children with epilepsy. One study found that comorbid sleep difficulties, but not severity of epilepsy, predicted inattention and hyperactivity. The current study examined the rate of sleep problems among children with epilepsy, compared to published normative data. Associations among sleep problems, nocturnal electrographic abnormalities, and psychological symptoms are described. Methods: Twenty-one children (6-16 years) were recruited from the Minnesota Epilepsy Group. The Children's Sleep Habits Questionnaire (CSHQ) and the Child Behavior Checklist (CBCL) were completed by parents. Information about medical background was obtained from medical record review. Average duration of epilepsy was 5.60 years (SD = 2.38). The children's epilepsy was largely well-controlled, with 47.6% of the sample having seizures less often than once per month. Seven participants had been seizure free for one year or greater. All participants were prescribed an AED, and 61.9% were treated with polytherapy (M = 2.05, SD = 1.19). According to parent report, children received an average of 9.98 hours of sleep per night (SD = 0.91). Results: On the CSHQ, 85.7% (18/21) met the clinical cut-off for significant sleep problems (compared to 40% in a published normative sample). Only 52.4% of the overall sample had sleep problems documented in their medical record. Of the patients with sleep problems above the clinical cut-off, 35.29% had not reported these problems to their medical provider, and half of these "missed" patients had actually reported good sleep habits or no complaints. Compared to a previously published normative sample, children with epilepsy in our sample had higher scores on all subscales assessing different aspects of sleep problems (bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night waking, parasomnias, sleep disordered breathing, daytime sleepiness). Even compared to previously published rates among children with sleep disorders, children with epilepsy in our sample had higher rates of daytime sleepiness. Rate of CSHQ sleep problems was positively correlated with CBCL Internalizing (p < .001) and Externalizing (p < .001) symptoms. Conclusions: Results highlight the higher than normal incidence of comorbid sleep difficulties in children with epilepsy, the associated functional impairments, and the challenges in identifying these patients in clinic. Although a large percentage of children with sleep difficulties were identified by standard clinic inquiry, not all patients were identified. The possible role of electrographic abnormalities during sleep will be considered.