Sleep disorders are common in patients with epilepsy. In adults, treatment of obstructive sleep apnea (OSA) improves seizure frequency. However, limited data exists in children. 

To identify the prevalence and if treatment of sleep disorders improves outcomes in children with epilepsy.

The local institution review board approved the study. For clinical care, the children with epilepsy were screened for sleep problems with Sleep Disturbance Scale for Children (SDSC) questionnaire and/or by a clinical interview. Subjects with suspected sleep disorders had a polysomnography performed. Retrospectively, with medical chart review, characteristics of epilepsy and sleep disorders were collected. Seizures were defined as controlled if a subject was seizure-free for > 6 months. T-tests were performed to identify the differences between the groups with and without sleep disorders. 

We identified 132 subjects with epilepsy, of which, 78.9% were screened for sleep problems clinically, 52% with SDSC and 47.54% by both. Forty-two subjects (31.8%) had polysomnography performed, out of which 86% were abnormal. The most common sleep disorders were OSA and periodic limb movement disorder. Treatments included flonase, positive airway pressure treatment, tonsillectomy and adenoidectomy, iron supplementation, gabapentin, sleep hygiene improvement and melatonin. Long-term follow-up was available for 34 subjects with sleep disorders. Of these, 10 subjects (27.8% of the subjects with sleep disorders) had an improvement in seizures frequency after only sleep disorder treatment. Subjects with sleep disorders had significantly high SDSC scores (Mean: 54.2, SD:12.1 vs 43.4,13.1; p=<0.0001) and uncontrolled seizures (86% Vs 70%, p=0.006).

The prevalence of sleep disorders was 34.6% in screened subjects, out of which 27.8% had improvement in seizure frequency just by sleep disorders treatment. Predictors of sleep disorders were high scores on SDSC questionnaire and uncontrolled seizures. Hence, screening and management of sleep disorders improved seizure frequency in children with epilepsy.  Large-scale studies are needed.