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Abstract
Introduction Epilepsy and OSA are common conditions, affecting 0.5%1 and 6%2 of children respectively. Pilot data utilising the PSQ-SRBD reported a high risk of OSA in 55% of CWE versus 7% of controls.3 This study assessed symptoms of OSA in CWE and typically-developing children using subjective questionnaires, and compared these with objective level I polysomnography.
Methods Ethical approval was granted. Written informed consent/assent was obtained from participants/caregivers. CWE aged 5–18 years were recruited from an NHS epilepsy clinic during 2017–2019, along with age- and sex-matched typically-developing controls. Children with significant co-morbidities were excluded.
Anthropometric data were collected. OSA symptoms were rated by child/caregiver using the children’s Epworth Sleepiness Scale (cESS) and PSQ-SRBD, with PSQ-SRBD ≥0.33 indicative of OSA (reported sensitivity 81%, specificity 87%).4 Polysomnography (SOMNOScreen plus™, SOMNOmedics, Randersacker, Germany) was conducted in accordance with AASM Version 2.3 (2016) guidelines.5 Standard statistical analyses were undertaken using SPSS 25 (IBM Corp., Armonk, NY, USA). Significance was taken as p<0.05.
Results Fifty-two children completed the protocol (35 CWE, 17 controls), with polysomnography data available for 44 children. Table 1 summarises anthropometric, questionnaire and polysomnography data; CWE were significantly sleepier on cESS and more likely to score ≥0.33 on PSQ-SRBD. Children with PSQ-SRBD ≥0.33 had higher BMI (22.3±6.0 v. 19.1±3.7 kg/m2, p=0.03), higher cESS (8(4–12) v. 3(1–5), <0.0001) and lower SpO2 nadir on polysomnography (92±3 v. 94±2, p=0.039). The positive predictive value of a score of ≥0.33 on the PSQ-SRBD in CWE was low (18%), with sensitivity 60% and specificity 42% noted in predicting OSA (oAHI>1/hour); see table 2.
Summary of anthropometric, questionnaire and polysomnographic data for children with epileptic control children. Groups compared using Student’s t-test for continuous variables and chi-square test for discrete variables. Results presented as number(%), mean± SD or median (IQR25-75%) as appropriate.
Utility of PSQI-SRBD questionnaire in predicting obstructive apnoea/hypopnoea index (oAHI)≥1/hr on polysomnography in children with epilepsy. Results presented as number(%).
Discussion Study limitations include small study numbers and low (o)AHI. Notwithstanding these limitations, CWE had significantly higher cESS and PSQ-SRBD scores than controls, reflecting previously published data. The utility of PSQ-SRBD in predicting OSA in CWE is low, in contrast to studies performed in healthy children. The study is ongoing.
References
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