Medical professionals have been reminded of the need to take full account of the close and often complicated relationship between childhood epilepsy and sleep apnoea.
A team from the Aristotle University of Thessaloniki in Greece carried out a review of existing studies assessing the prevalence of sleep apnoea in children with epilepsy in order to identify possible mechanisms linking the two conditions, as well as to gauge the impact of sleep apnoea on the prognosis of these patients.
Obstructive sleep apnoea is a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. Patients often snore loudly during the night and suffer from poor-quality sleep.
For this new study, the researchers examined the existing body of evidence catalogued on the PubMed medical database, with articles selected and classified according to their originality, level of evidence and relevance to the broad scope of the review.
It was observed that children with epilepsy generally have a higher prevalence of sleep breathing disorders, though this prevalence varied widely depending on the methodology of each study.
Major risk factors for sleep apnoea in childhood epilepsy included poor seizure control and antiepileptic drug polytherapy, with epilepsy often found to trigger sleep apnoea as a consequence of abnormal electrical discharges amplifying sleep-induced breathing instability.
The disruption caused by antiepileptic drugs to muscle tone and the way that vagus nerve stimulation modulates neurotransmission to airway muscles also contribute to this association, while it was also noted that because sleep apnoea can lead to greater sleep fragmentation, it can reduce the threshold for the appearance of seizures.
Additionally, sleep disorders of this kind were shown to have a negative effect on the patients’ neurocognitive profile, as they disturb neuroplasticity mechanisms, and also have a probable association with sudden unexpected death in epilepsy. Surgical treatment of sleep apnoea has been found to reduce seizure frequency, potentially offering new therapeutic choices.
The researchers concluded: “Between sleep apnoeas and childhood epilepsy, there is a complex relationship with reciprocal interactions. The presence of sleep apnoeas should be taken into account when designing the management of these children, as it creates therapeutic opportunities and limitations.”
Publication abstract: http://link.springer.com/article/10.1007/s11325-014-1076-8