Investigation of Sleep Quality and Prevalence of Sleep-disordered Breathing in Children and Young People With Epilepsy
Condition: Epilepsy; Obstructive Sleep Apnea
MeSH terms: Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Epilepsy
Study type: Observational

Summary: 
      Obstructive sleep apnoea (OSA) is a condition that affects around one in 20 children. In
      children with OSA, repeated episodes of airway obstruction can severely disturb and fragment
      sleep, leading to subsequent cognitive and behavioural problems .

      Epilepsy affects 60,000 children in the UK and up to 30% of children with epilepsy have
      learning problems. Evidence suggests that OSA is more common in children with epilepsy, such
      that sleep disturbance could account for some of the learning problems they experience.

      The aim of this study is to determine the prevalence of OSA in children with epilepsy. The
      investigators plan carry out detailed sleep studies in children with epilepsy and healthy
      controls to determine if children with epilepsy are more likely to have OSA than healthy
      children of the same age.

      OSA is almost always treatable and the benefits of detecting and treating the condition in
      healthy children are well-established. If OSA proves to be a common finding in children with
      epilepsy, it will be important to carry out further studies to see if treating the condition
      has beneficial effects on learning and behaviour. This project could lead doctors to target
      sleep-disordered breathing as a way of improving learning outcomes in children with epilepsy.
    

Detailed description: 
      Obstructive sleep apnoea (OSA) is a condition that affects around one in 20 children. In OSA,
      the muscles and soft tissues in the throat relax and collapse during sleep causing the upper
      airway to become blocked. Breathing is briefly interrupted, blood oxygen levels fall and this
      causes the child to wake and start breathing again. These episodes can happen many times a
      night causing severely disturbed sleep. Untreated OSA may leave children with daytime
      attention difficulties and problems with learning and behaviour. Epilepsy affects
      approximately 60,000 children in the UK and up to 30 per cent of these children have
      associated learning problems.

      There is evidence, including pilot work undertaken by the study team to suggest that OSA is
      more common in children with epilepsy, in which case, sleep disturbance could account for
      some of the learning problems they experience. The aim of this study is to determine the
      prevalence of OSA in children with epilepsy.

      The investigators plan to carry out detailed polysomnography sleep studies in 55 children
      with epilepsy and 28 healthy children (controls). These studies will measure the length and
      quality of sleep over one night spent at the hospital. Seizure activity during this period
      will be monitored by video recordings combined with electroencephalograms (EEG).
      Sleep-disordered will be assessed using a variety of tests to measure air-flow, lung
      expansion and blood oxygen levels. This study should help to determine if children with
      epilepsy are more likely to have OSA than healthy children of the same age. OSA is almost
      always treatable and the benefits of detecting and treating the condition in healthy children
      are well-established.

      If OSA proves to be a common finding in children with epilepsy, it will be important to carry
      out further studies to see if treating the condition has beneficial effects on learning and
      behaviour. This project could lead doctors to target sleep-disordered breathing as a way of
      improving learning outcomes in children with epilepsy.

      Children with epilepsy attending Royal Hospital for Children, Edinburgh will be invited to
      take part in the study. Children without epilepsy (controls) will also be recruited. The
      children without epilepsy are included because although there are statistics for incidence of
      OSA in the general population, information for all the measures of sleep the team will
      collect are not available.

      The study will assess sleep time, sleep efficiency, sleep architecture and respiratory events
      in children with epilepsy and control subjects.

      To be sufficiently powered, it is planned to test 50 children with epilepsy and 25 healthy
      controls.

      A sleep physiologist will work with participants to measure:

        -  Polysomnography (to record body functions in sleep - airflow in and out of the lungs,
           oxygen level in the blood, body position, breathing effort and rate, electrical activity
           of muscles, eye movement and heart rate)

        -  EEG or electroencephalography (to measure the electrical activity of the brain),

        -  Electrooculography (to measure rapid eye movements along horizontal and vertical axes),

        -  Chin electromyogram (to measure electrical impulses to chin muscles),

        -  Sleep quality.

      A neurologist and physiologist will assess seizure frequency and discharges between seizures,
      and epilepsy types using video EEG monitoring. Further information will be collected: height,
      weight, body mass index, antiepileptic medication use, tonsillar size, Mallampati score (a
      measure of base of tongue to hard palate), completion of sleep questionnaires by participants
      and their parents, to include sleepiness scales and sleep quality index.
    

Intervention name(s): Sleep studies [Polysomnography]
Intervention type(s): Procedure
Intervention description(s): Undertaking of sleep measurements by polysomnography and use of validated sleep questionnaires
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Children with epilepsy
      
Keywords: Children