title: Impact of pediatric epilepsy on sleep patterns and behaviors in children and parents.
abstract: OBJECTIVE
  Disrupted sleep patterns in children with epilepsy and their parents are commonly described clinically. A number of studies have shown increased frequency of sleep disorders among pediatric epilepsy patients; however, few have characterized the association between epilepsy and parental sleep quality and household sleeping arrangements. The purpose of this study was to explore the effect of pediatric epilepsy on child sleep, parental sleep and fatigue, and parent-child sleeping arrangements, including room sharing and cosleeping.
  
  
  METHODS
  Parents of children 2 to 10 years of age with and without epilepsy completed written questionnaires assessing seizure history, child and parent sleep, and household sleeping arrangements. Children's Sleep Habits Questionnaire (CSHQ) scores were used to evaluate sleep disturbances for the child. The Pittsburgh Sleep Quality Index (PSQI) and the Iowa Fatigue Scale (IFS) were used to evaluate parental sleep and fatigue, respectively. The Early Childhood Epilepsy Severity Scale (E-Chess) was used to assess epilepsy severity.
  
  
  RESULTS
  One hundred five households with a child with epilepsy and 79 controls participated in this study. Households with a child with epilepsy reported increased rates of both parent-child room sharing (p < 0.001) and cosleeping (p = 0.005) compared to controls. Children with epilepsy were found to have greater sleep disturbance by total CSHQ score (p < 0.001) and the following subscores: parasomnias (p < 0.001), night wakings (p < 0.001), sleep duration (p < 0.001), daytime sleepiness (<0.001), sleep onset delay (p = 0.009), and bedtime resistance (p = 0.023). Parents of children with epilepsy had increased sleep dysfunction (p = 0.005) and were more fatigued (p < 0.001). Severity of epilepsy correlated positively with degree of child sleep dysfunction (0.192, p = 0.049), parental sleep dysfunction (0.273, p = 0.005), and parental fatigue (0.324, p = 0.001). Antiepileptic drug polytherapy was predictive of greater childhood sleep disturbances. Nocturnal seizures were associated with parental sleep problems, whereas room sharing and cosleeping behavior were associated with child sleep problems. Within the epilepsy cohort, 69% of parents felt concerned about night seizures and 44% reported feeling rested rarely or never. Finally, 62% of parents described decreased sleep quality and/or quantity with cosleeping.
  
  
  CONCLUSIONS
  Pediatric epilepsy can significantly affect sleep patterns for both the affected child and his or her parents. Parents frequently room share or cosleep with their child, adaptations which may have detrimental effects for many households. Clinicians must not only be attentive to the sleep issues occurring in pediatric patients with epilepsy, but also for the household as a whole. These data provide evidence of a profound clinical need for improved epilepsy therapeutics and the development of nocturnal seizure monitoring technologies.
authors.affiliation: Pediatric Epilepsy Program, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Larson
authors.forename: Robin C C
authors.initials: RC
authors.lastname: Ryther
authors.forename: Melanie
authors.initials: M
authors.lastname: Jennesson
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Geffrey
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Bruno
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Anagnos
authors.forename: Ali H
authors.initials: AH
authors.lastname: Shoeb
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Thibert
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Thiele
mesh_terms: D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology*; D002675:Child, Preschool; D004827:Epilepsy / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010372:Pediatrics; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires