Correlation between sleep disorders and ADHD in children with absence epilepsy: An observational study

Objective: The authors investigated sleep disorders (SD) and ADHD in children with absence epilepsy (AE) and the correlation with adverse effects of antiepileptics drugs (AED). Methods: Inclusion criteria: age 5-16 years, epilepsy with typical absences diagnosis, normal neurological examination. Parents completed questionnaires on sleep, AED side effects, school performances, learning problems, ADHD rating scale. Results were compared to an healthy sample. Our population was then divided into 2 groups: with and without seizures at last examination. Number, gender, family and personal history for epilepsy or febrile convulsions, AED, neuropsychological tests results when available, presence of SD were analyzed. The statistical relationships between a) SD and ADHD with AED adverse effects, b) SD and ADHD symptoms, c) the variance analysis between ADHD and SD considering the presence of seizures with the adverse effects as covariate, were considered. Results: Seventy children with absence seizures were included in the study; 59% controlled by AED. Neuropsychological evaluation was performed in 63%, in 51% identifying one or more deficient domains. 50% had ADHD clinical diagnosis, ADHD Rating scale, performed by all sample, was positive in 37%. SD were reported in 43 % of patients: 21% breath disorders, 16% insomnia, 19% parasomnia, 11% non-restoring sleep and 11% excessive sleepiness. Statistical difference for SD was found between children with epilepsy and healthy controls (p < 0.001), no difference in SD between subgroups with and without seizures; statistical correlation respectively of SD (p<0.001), and ADHD (p=0.000) with AD adverse effects, significative correlation between SD and ADHD (p=0.000). Conclusion: SD are not rare in children with AE. ADHD symptoms may also be present. In everyday clinical practice we advise a systematic investigation of this children, using validated questionnaires, ideally at epilepsy diagnosis and before treatment. A control at 6 months would allow early detection of eventual comorbidities and appropriate adjustment of therapeutic strategies.