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

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 charac-teristics 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 medi-cations. 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 char-acteristics, 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, neuro-developmental 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.

Automated summary

This study explored the relationship between sleep and neurodevelopmental characteristics on health-related quality of life (HRQOL) in children with epilepsy (CWE). The results showed that both sleep problems and neurodevelopmental characteristics significantly impact HRQOL, with sleep problems possibly mediating this impact through neurodevelopmental characteristics. These findings highlight the importance of a multidisciplinary approach to epilepsy management.