Sleep Disturbances in Chinese Children with Epilepsy: Associations with Behavioral Problems and Quality of Life

Abstract

Objective

To investigate the association between sleep disturbances and behavioral problems as well as quality of life (QOL) in Chinese children with epilepsy.

Methods

Caregivers of 167 epileptic children aged 3 to 12 years completed the Child Sleep Habits Questionnaire (CSHQ), the Strengths and Difficulties Questionnaire (SDQ), and the Pediatric Quality of Life Inventory (PedsQL™, 4.0 Core).

Results

The prevalence of sleep disturbances (CSHQ total score >41) in epileptic children was 73.7% [95% CI (66.9%.80.4%)]. Epileptic children with sleep disturbances demonstrated more behavioral problems and lower QOL compared to those without sleep disturbances. Sleep disturbances such as sleep anxiety and daytime sleepiness were associated with more behavioral problems and lower QOL (p <0.05). Linear regression analyses showed that higher disturbance in sleep duration domain were associated with more behavioral problems, while higher sleep disordered breathing domains was associated with lower QOL (p <0.05). The interaction between sleep disturbances and behavioral problems in predicting QOL was not significant. The sensitivity analysis using 48 as an alternative cutoff for CSHQ total score obtained consistent results.

Conclusion

Sleep disturbances occur frequently among Chinese children with epilepsy, and are associated with more behavioral problems and lower QOL. The sleep disturbance-QOL association is unlikely contingent on behavioral problems. This study highlights the necessity of evaluating and treating sleep disturbances multidimensionally among children with epilepsy to promote their whole health and wellbeing.

Keywords:

• sleep disturbances
• behavioral problems
• quality of life
• epilepsy
• children

Abbreviations

QOL, quality of life; CSHQ, Children’s Sleep Habits Questionnaire; SDQ, the Strengths and Difficulties Questionnaire; PedsQL™, the Pediatric Quality of Life Inventory; ILAE, the International League Against Epilepsy; ADHD, Attention Deficit Hyperactivity Disease; ASD, Autism Spectrum Disorder; TD, Tic Disorder; AEDs, antiepileptic drugs; PSG, polysomnography; BECTS, Benign Epilepsy with Centrotemporal Spikes; ADNFLE, Autosomal Dominant Nocturnal Frontal Lobe Epilepsy.

Acknowledgment

Special thanks to the children and families who participated in the study. This work was supported by National Natural Science Foundation of China (82071493), Shanghai Science and Technology Commission (18JC1420305, 19QA1405800, 19411968800) and Shanghai Pudong District Technology Development Funds (PKJ2018-Y45).

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by National Natural Science Foundation of China (82071493), Shanghai Science and Technology Commission (18JC1420305, 19QA1405800, 19411968800) and Shanghai Pudong District Technology Development Funds (PKJ2018-Y45).