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.
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.
Joint Epilepsy Council of the UK and Ireland. Epilepsy prevalence, incidence and other statistics 2011.
Marcus CL, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130: e714-e755.
Urquhart DS, et al. Observational pilot study of reported symptoms of Obstructive Sleep Apnoea (OSA) in children with epilepsy and healthy controls. Dev Med Child Neurol 2016; 58: 1063–1068.
Chervin RD, et al. Pediatric sleep questionnaire (PSQ): Validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med 2000; 1: 21–32.
Berry RB, et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.3. 2016; Westchester, IL: American Academy of Sleep Medicine.
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