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What did the project achieve?
“Our findings establish that a sleep study – rather than using questionnaires – is needed to determine whether or not a child with epilepsy who is experiencing breathing problems at night has obstructive sleep apnoea,” says Dr Don Urquhart of Edinburgh’s Royal Hospital for Sick Children.
Estimates suggest more than 78,000 children and young people aged under 18 years are living with epilepsy in the UK.1,2 Around one in five people with epilepsy also has a learning disability – and both may be caused by the same underlying problem in the way their brain works.3
Dr Urquhart investigated whether children with epilepsy are more likely than other children to experience breathing problems at night because of a condition called obstructive sleep apnoea (OSA). If it’s spotted, OSA can almost always be treated, but when it’s missed, it disturbs children’s sleep and can lead to problems with growth, learning and behaviour.
Previous studies had suggested that children with epilepsy are unusually susceptible to OSA – but these relied heavily on using questionnaires to establish a diagnosis rather than measuring breathing in a sleep study. Dr Urquhart’s team studied 69 children ranging in age from six to 17 years – including 47 children with epilepsy and 22 unaffected children – using a sleep study that measures sleep stage, breathing effort and airflow to confidently detect OSA or rule it out.
“We found that around one in 10 children with epilepsy in our study had OSA – which is double the expected levels for the general population,” says Dr Urquhart. “However, this figure is much lower than those suggested in previous research – indicating that questionnaires aren’t very good at helping predict which children with epilepsy are likely to have OSA.”
This work has led to an immediate change in local clinical practice – with the recognition that questionnaires for sleep problems in children are of limited value, and are not recommended in children with epilepsy.
“A larger study involving other hospitals is now needed to confirm whether OSA is more common in children with epilepsy compared to the general population,” says Dr Urquhart. “If so, it may then be useful to carry out a clinical trial to find out whether treating the condition is beneficial for children with epilepsy – particularly if it can help prevent any additional impact on their learning abilities.”
This research was completed on
Over 60,000 children and young people aged 18 and under have epilepsy in the UK.1 Dr Don Urquhart, of Edinburgh’s Royal Hospital for Sick Children, is investigating suggestions that children with epilepsy are unusually susceptible to breathing problems at night because of a disorder called obstructive sleep apnoea (OSA). If it’s spotted, OSA can almost always be treated, but when it’s missed, it disturbs children’s sleep and can lead to problems with growth, learning and behaviour. Better diagnosis and treatment of OSA in children with epilepsy may prevent unnecessary suffering.
This project is funded by a generous donation from The R S Macdonald Charitable Trust.
How are children’s lives affected now?
Children with OSA stop breathing for a few seconds at a time during their sleep. This happens when the walls of the throat relax, blocking the flow of air. Oxygen levels in the blood fall and may cause children to wake up briefly and start breathing again, often gasping or snorting as they do so.
Children tend to go back to sleep so quickly that they usually don’t remember waking up and parents may not notice what’s happening during the night.
OSA can almost always be treated, but if undiagnosed it may affect children’s health and their quality of life: “When children have OSA, their breathing can be interrupted many times a night, which can severely disturb their sleep,” says Dr Urquhart. “This sleep disruption is thought to be the reason why, if left untreated, children with OSA can have daytime symptoms too, such as difficulties paying attention and problems with learning and behaviour. Children can also have high blood pressure and poor growth.”
How could this research help?
The team is investigating whether children with epilepsy are more likely to have OSA than other children.
Overall, it’s thought that up to six per cent of children have OSA, but preliminary evidence suggests that number is much higher in children with epilepsy – possibly as high as 55 per cent– and Dr Urquhart aims to find out more about whether that’s true.2,3
“Children with epilepsy often have learning problems,” says Dr Urquhart. “If children with epilepsy also have OSA, and their OSA is going undiagnosed and untreated, this might be contributing to their learning problems and treatment might help to counter that.”
“If our results show children with epilepsy are prone to having OSA, we plan further work to assess the effects of treatment,” adds Dr Urquhart. “The benefits of detecting and treating OSA in children without epilepsy are already well-established, with improvements in, for example, learning and quality of life.”
References
1. Joint Epilepsy Council of the UK and Ireland. Epilepsy prevalence, incidence and other statistics. September 2011. http://www.epilepsyscotland.org.uk/pdf/Joint_Epilepsy_Council_Prevalence_and_Incidence_September_11_(3).pdf
2. Marcus CL et al. Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics 2012;130:576–584. http://pediatrics.aappublications.org/content/130/3/576 Website accessed 14 July 2016.
3. 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; Jun 18. doi: 10.1111/dmcn.13173. [Epub ahead of print]
| Project Leader | Dr Don S Urquhart MD FRCPCH |
| Project Team | Dr Ailsa E McLellan FRCP FRCPCHDr Jay Shetty FRCPCHDr Richard FM Chin MD PhD |
| Project Location | Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh |
| Project Location Other | Department of Paediatric Neurosciences, Royal Hospital for Sick Children, EdinburghDepartment of Child Life and Health, University of Edinburgh |
| Project duration | 2 years |
| Date awarded | 21 June 2016 |
| Project start date | 1 March 2017 |
| Project end date | 20 June 2021 |
| Grant amount | £43,868 |
| Grant code | GN2392 |
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