Sleep Abnormalities and Sleep Breathing Disorders in Children with Drug- Resistant Catastrophic Epileptic Encephalopathy

Abstract

Sleep breathing disorders (SBD) induce a chronic modification of sleep architecture and a state of intermittent oxygen desaturation, resulting in poor control of seizures and excessive daytime sleepiness. This study is aimed to assess the presence of SBD in a cohort of children with medically refractory catastrophic epileptic encephalopathy. The study group is composed 11 patients (9 males, 2 females), aged between 3 and 11 years. Patients with secondary seizure were excluded from the study. The 11 patients had Obstructive Sleep Apnoea Syndrome (OSAS). In particular, seven patients presented severe OSAS, two presented moderate OSAS and 2 patients were found to have mild OSAS. Nine subjects were referred for snoring or sleep-related breathing problems. The patients also presented alterations of the total time of sleep and of the sleep latency. Apnoea/hypopnea index and average oxygen saturation are negatively correlated with REM sleep percentage (p<0.05). Nadir oxygen saturation negatively correlates with the efficiency of sleep (p<0.05). Our study show that paediatric patients with drug-resistant epilepsy, cerebral palsy and mental retardation are frequently affected by OSAS. In addition, the severity of OSAS strongly influence the quality of sleep. Children with epilepsy report sleep deprivation as a significant seizures-precipitating factor. An improvement in seizure frequency is seen whit the treatment of OSAS. Results support that the screening for SBD in the medically refractory epilepsy population and appropriate intervention strategies may lead to overall improved night oxygen saturation and seizure control.