The contribution of sleep and co-occurring neurodevelopmental conditions to quality of life in children with epilepsy

Alice A Winsor; Caroline Richards; Stefano Seri; Ashley Liew; Andrew P Bagshaw

doi:10.1016/j.eplepsyres.2023.107188

The contribution of sleep and co-occurring neurodevelopmental conditions to quality of life in children with epilepsy

Epilepsy Res. 2023 Aug:194:107188. doi: 10.1016/j.eplepsyres.2023.107188. Epub 2023 Jul 5.

Authors

Alice A Winsor¹, Caroline Richards², Stefano Seri³, Ashley Liew⁴, Andrew P Bagshaw⁵

Affiliations

¹ Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK; Maurice Wohl Clinical Neuroscience Institute, King's College London, UK. Electronic address: alice.winsor@kcl.ac.uk.
² School of Psychology, University of Birmingham, UK.
³ Children's Epilepsy Surgery Programme, Birmingham Children's Hospital, UK; Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, UK.
⁴ South London and Maudsley NHS Foundation Trust, University of Warwick, UK; Evelina London Children's Hospital, University of Warwick, UK.
⁵ Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK.

PMID: 37421713
DOI: 10.1016/j.eplepsyres.2023.107188

Abstract

Background: Health-related quality of life (HRQOL) in children with epilepsy (CWE) is multifactorial and can be affected not only by epilepsy-specific variables but also co-occurring conditions such as sleep disturbances, autism, and attention deficit hyperactivity disorder (ADHD). While highly prevalent in CWE, these conditions are underdiagnosed despite having a significant impact on HRQOL. Sleep problems have a complex relationship with epilepsy and neurodevelopmental characteristics. However, little is known about how these issues interact and contribute to HRQOL.

Objectives: The current study aims to explore the relationship between sleep and neurodevelopmental characteristics on HRQOL in CWE.

Methods: 36 CWE aged 4-16 years old were recruited from two hospitals and asked to wear an actiwatch for a period of 14 days and caregivers completed a series of questionnaires assessing co-occurrences and epilepsy-specific variables.

Results: A high proportion of CWE (78.13%) presented significant sleep problems. Informant-reported sleep problems were significantly predictive of HRQOL above seizure severity and the number of antiseizure medications. Interestingly, informant-reported sleep problems were no longer significantly predictive of HRQOL when neurodevelopmental characteristics were considered, indicating a possible mediating effect. Similarly, actigraphy-defined sleep (variability in sleep onset latency) displayed a similar effect but only for ADHD characteristics, whereas autistic characteristics and variability in sleep onset latency continued to exert an individual effect on HRQOL.

Conclusion: These data from our study shed light on the complicated relationship between sleep, neurodevelopmental characteristics and epilepsy. Findings suggest that the impact of sleep on HRQOL in CWE is possibly mediated by neurodevelopmental characteristics. Furthermore, the impact this triangular relationship exerts on HRQOL is dependent on the type of tool used to measure sleep. These findings highlight the importance of a multidisciplinary approach to epilepsy management.

Keywords: Neurodevelopment; Pediatric Epilepsy; Quality of Life; Sleep.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Child, Preschool
Epilepsy* / drug therapy
Humans
Quality of Life
Seizures
Sleep
Sleep Wake Disorders* / complications
Surveys and Questionnaires