A case-control study to investigate the prevalence of obstructive sleep apnea and the utility of the PSQ-SRBD questionnaire in children and young people with epilepsy

Donald S Urquhart; Ailsa E McLellan; Laura E Hill; Emma Carruthers; Elizabeth A Hill; Richard F Chin; Jay Shetty

doi:10.5664/jcsm.11054

A case-control study to investigate the prevalence of obstructive sleep apnea and the utility of the PSQ-SRBD questionnaire in children and young people with epilepsy

J Clin Sleep Med. 2024 Feb 6. doi: 10.5664/jcsm.11054. Online ahead of print.

Authors

Donald S Urquhart^{1

2}, Ailsa E McLellan^{3

4}, Laura E Hill¹, Emma Carruthers¹, Elizabeth A Hill^{1

5}, Richard F Chin^{2

3

4}, Jay Shetty^{2

3

4}

Affiliations

¹ Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh.
² Department of Child Life and Health, The University of Edinburgh.
³ Department of Paediatric Neurosciences, Royal Hospital for Children and Young People, Edinburgh.
⁴ Muir Maxwell Epilepsy Center, Center for Clinical Brain Sciences, The University of Edinburgh.
⁵ Sir Jules Thorn Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford.

PMID: 38318844
DOI: 10.5664/jcsm.11054

Abstract

Study objectives: Epilepsy and obstructive sleep apnea syndrome (OSAS) are each relatively common in children. OSAS may affect cognition, such that recognition of OSAS is important for children and young people with epilepsy (CYPWE). Published pilot data reported 55% CYPWE had symptoms suggestive of OSAS, compared with 7% typically developing controls. The primary aim of this study was to ascertain OSAS prevalence by polysomnography (PSG) in CYPWE, with secondary aims being to evaluate the utility of sleep questionnaires in CYPWE.

Methods: Children and young people with epilepsy and age- and sex-matched typically developing controls were studied. A single night of level I attended PSG was undertaken, along with questionnaires [Pediatric Sleep Questionnaire (PSQ-SRBD), Pittsburgh Sleep Quality Index (PSQI) and the childhood and adolescent Epworth Sleepiness Scale (ESS-CHAD)]. OSAS was defined as obstructive apnea-hypopnea index (oAHI) of ≥ 1 event/h.

Results: Polysomnography was performed in 72 children including 48 CYPWE (60% male) and 24 controls (54% male). Mean age (11 years) was similar for CYPWE and controls, p= 0.42; with slightly higher BMI z scores (0.7 v 0.1, p=0.03) noted in CYPWE. Mean oAHI was 0.61 in CYPWE versus 0.42 (controls), p=0.62. Despite higher PSQ-SRBD scores in CYPWE (0.38 v 0.12, p<0.001), no difference in OSAS prevalence (10% vs. 4%, p=0.78) was found. Children and young people with epilepsy had higher ESS-CHAD (6 vs. 3.5, p=0.01) and PSQI (5 vs. 3.3, p=0.02) scores indicating greater levels of daytime sleepiness and poorer sleep quality.

Conclusions: The study found no evidence for increased OSAS prevalence in CYPWE, whilst the utility of the PSQ-SRBD in predicting OSAS appears limited for CYPWE. Children and young people with epilepsy are, however demonstrably sleepier with poorer sleep quality. The cause for these findings remains unclear.

Clinical trial registration: Investigation of Sleep Quality and Prevalence of Sleep-disordered Breathing in Children and Young People With Epilepsy; https://www.clinicaltrials.gov/study/NCT03103841.

Keywords: Pediatric Sleep Questionnaire; children and young people with epilepsy; obstructive sleep apnea syndrome.

Associated data

ClinicalTrials.gov/NCT03103841