Sleep Problems and Daytime Behavior in Childhood Idiopathic Epilepsy

Abstract

Summary:Purpose: To evaluate the presence of sleep problems and their association with behavioral and adjustment problems in children with idiopathic epilepsy.Methods: A parental questionnaire was used to assess sleep problems in 89 children with idiopathic epilepsy for comparisons with 49 siblings and 321 healthy control children, equally distributed for age and sex. Sleep problems were clustered into five factors: parasomnias, parenuchild interaction during the night, sleep fragmentation, daytime drowsiness, and bedtime difficulties. Daytime behavior and psychological adjustment were assessed by means of the Child Behavior Checklist. Maternal distress and disturbance was evaluated by the Malaise Inventory. The better to identify factors associated with sleep problems in the children with epilepsy, multiple regression analysis was performed.Results: Children with epilepsy showed significantly more sleep problems than did both siblings and healthy controls. Within the epileptic group, children with current seizures complained more of sleep problems than did the seizure-free children. Moreover, children with epilepsy showed more behavioral problems and maladjustment. Age, paroxysmal activity density, duration of illness, seizure frequency, and behavioral problems were significantly associated with sleep problems in the epileptic group.Conclusions: The results of this study in a highly selected sample pointed out the presence of sleep problems, and adjustment and behavioral problems in children with idiopathic epilepsy. The presence of epilepsy, although benign, in childhood is associated with adaptive problems of the child. From this point of view, the alteration of some sleep habits may be a sign of emotional maladjustment. Although parents failed to perceive them as a problem, our findings indicate that attention to sleep and behavioral problems is important in clinical management of children with idiopathic epilepsy. Key Words: Sleep-Daytime behavior-Epilepsy-Child.Sleep problems in general were commonly described in patients with epilepsy (1-6). Hoeppner et al. (l), in a study of self-reported sleep patterns of adult subjects with epilepsy, found more sleep-disorder symptoms in the patients with epilepsy than in controls; furthermore, they found that patients with partial epilepsy and most frequent seizures had more sleep disturbances such as frequent night wakings and parasomnias than did patients with other types of seizures. In a more recent study, Vaught et al. (2) found a high rate of excessive daytime sleepiness and unrefreshing sleep in adults with epilepsy.Studies on sleep problems in children with epilepsy are limited. Zaiwalla and Stores (7,8) found a generally higher rate of severe and persistent sleep problems, es-

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