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Journal Article•DOI•

Paroxysmal activity and seizures associated with sleep breathing disorder in children: A possible overlap between diurnal and nocturnal symptoms

Silvia Miano1, Carmen Bachiller2, Manuel Gutiérrez2, Antonio Salcedo2, Maria Pia Villa1, Rosa Peraita-Adrados2 •
Sapienza University of Rome1, Hospital General Universitario Gregorio Marañón2
01 Nov 2010-Seizure-european Journal of Epilepsy (Elsevier)-Vol. 19, Iss: 9, pp 547-552
TL;DR: This study demonstrated a close relationship between pediatric SBD, PA during sleep, and epilepsy that may aggravate the prognosis of SBD.
Abstract: Purpose: Sleep breathing disorders (SBD) can trigger paroxysmal events. We recently found a higher percentage of paroxysmal activity (PA) in a sample of Italian children with obstructive sleep apnea syndrome (OSAS) and no history of epilepsy. The signs of nocturnal seizures can overlap with sleep respiratory events. The aim of this study was to confirm the high frequency of PA or interictal epileptiform discharges (IEDs) during sleep in a cohort of Spanish children who underwent polysomonography (PSG) for suspected SBD and to ascertain the eventual presence of seizures by means of a video-PSG with an extended electroencephalogram (EEG). Methods: PSG was performed in a population of children with no previous history of epileptic seizures recruited prospectively for suspected OSAS from January to December 2007. Recordings included at least 13 EEG channels. Results: In total, 25 children (mean age, 6.6 3.8 years, 14 males) were diagnosed with SBD, and 4/25 (16%) children met the criteria for OSAS and epilepsy, with IEDs and/or seizures during sleep. We diagnosed benign epilepsy with centro-temporal spikes in 2 cases, partial symptomatic epilepsy in one, and nocturnal frontal lobe epilepsy in another, while we found PA in 2 patients. The body mass index and the apnea–hypopnea index were significantly higher in children without IEDs/PA. Conclusions: Our study demonstrated a close relationship between pediatric SBD, PA during sleep, and epilepsy that may aggravate the prognosis of SBD. Due to the possibility of an overlap of symptoms, a video-PSG with extended EEG montage is necessary.
Citations
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Journal Article•DOI•
Sleep clinical record: an aid to rapid and accurate diagnosis of paediatric sleep disordered breathing

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Maria Pia Villa1, Maria Chiara Paolino1, Rosa Castaldo1, Nicola Vanacore2, Alessandra Rizzoli1, Silvia Miano1, Marco Del Pozzo1, Marilisa Montesano1 •
Sapienza University of Rome1, National Institutes of Health2
01 Jun 2013-European Respiratory Journal
TL;DR: A simple, PSG-validated tool to screen SDB, thus reducing the use of PSG, and may effectively be used to screen patients as candidates for PSG study for suspected OSA syndrome, and to enable those with a mild form of SDB to receive early treatment.
Abstract: Overnight polysomnography (PSG) is an expensive procedure which can only be used in a minority of cases, although it remains the gold standard for the diagnosis of sleep disordered breathing (SDB). The objective of this study was to develop a simple, PSG-validated tool to screen SDB, thus reducing the use of PSG. For every participant we performed PSG and a sleep clinical record was completed. The sleep clinical record consists of three items: physical examination, subjective symptoms and clinical history. The clinical history analyses behavioural and cognitive problems. All three items were used to create a sleep clinical score (SCS). We studied 279 children, mean ± SD age 6.1 ± 3.1 years, 63.8% male; 27.2% with primary snoring and 72.8% with obstructive sleep apnoea (OSA) syndrome. The SCS was higher in the OSA syndrome group compared to the primary snoring group (8.1 ± 9.6 versus 0.4 ± 0.3, p<0.005), correlated with apnoea/hypopnoea index (p=0.001) and had a sensitivity of 96.05%. Positive and negative likelihood ratios were 2.91 and 0.06, respectively. SCS may effectively be used to screen patients as candidates for PSG study for suspected OSA syndrome, and to enable those with a mild form of SDB to receive early treatment.

88 citations

Journal Article•DOI•
Respiratory Disturbances in Rett Syndrome Don’t Forget to Evaluate Upper Airway Obstruction

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Eveline E. O. Hagebeuk, Rob P. G. M. Bijlmer, Johannes H. T. M. Koelman, Bwee Tien Poll-The
30 Jan 2012-Journal of Child Neurology
TL;DR: In children, hypertrophied tonsils and adenoids are a common cause of obstructive sleep apnea syndrome, which may benefit from therapeutic intervention, and polysomnography in patients with Rett syndrome is recommended.
Abstract: Rett syndrome is characterized by loss of motor and social functions, development of stereotypic hand movements, seizures, and breathing disturbances. This study evaluates the presence of overnight respiratory disturbances. Polysomnography in combination with a questionnaire (the Sleep Disturbance Scale for Children) was performed in 12 Dutch patients with Rett. Respiratory disturbances were present in all, clinically relevant in 10 (apnea hypopnea per hour 1.0-14.5). In 8 children, central apneas were present during the day often with obstructive apneas at night. In 6, obstructive sleep apnea syndrome was diagnosed, in 3 severe, with frequent oxygen desaturations. Significant respiratory complaints were present in 3 patients, all had obstructive sleep apnea syndrome. Of the 12 patients with Rett, 8 (67%) snored, and in 5 obstructive sleep apnea syndrome was present. In children, hypertrophied tonsils and adenoids are a common cause of obstructive sleep apnea syndrome, which may benefit from therapeutic intervention. We recommend performing polysomnography in patients with Rett syndrome and respiratory complaints.

36 citations

Book Chapter•DOI•
Obstructive sleep apnea and other sleep-related syndromes.

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Teresa Paiva, Hrayr Attarian1•
Northwestern University1
01 Jan 2014-Handbook of Clinical Neurology
TL;DR: Treatment for obstructive sleep apnea syndrome includes continuous positive airway pressure and its variants, oral appliances, weight loss, upper airway surgery, and rarely maxillofacial procedures.
Abstract: Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by repetitive episodes of breathing cessation due to complete or partial collapse of the upper airway therefore affecting ventilation. It is quite common, with a prevalence of about 2-4%, has a strong genetic component, and creates a proinflammatory state with elevated TNFα and other cytokines. If untreated, OSA can lead to significant neurological problems that include stroke, cognitive decline, depression, headaches, peripheral neuropathy, and nonarteritic ischemic optic neuropathy (NAION). Treatment reverses some of these neurological problems. Treatment includes continuous positive airway pressure and its variants, oral appliances, weight loss, upper airway surgery, and rarely maxillofacial procedures. Other sleep breathing disorders such as hypoventilation, central sleep apnea, complex sleep apnea, and Cheyne-Stokes respiration are less common and are sometimes associated with neuromuscular disorders causing diaphragmatic paralysis, but can also be seen in opiate exposure and severe obesity.

31 citations

Journal Article•DOI•
Melatonin secretion in children with epilepsy

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Ruta Praninskiene1, Irena Dumalakiene, Robertas Kemezys2, Mykolas Mauricas, Aurelija Jucaite3 •
Boston Children's Hospital1, Vilnius University2, Karolinska Institutet3
01 Nov 2012-Epilepsy & Behavior
TL;DR: There were no associations between MLT secretion/excretion parameters (diurnal profile, peak nocturnal concentrations, area under the time curve, duration of elevated concentrations, acrophase) and seizure characteristics (time, type of seizures, antiepileptic medications).

15 citations

Cites background from "Paroxysmal activity and seizures as..."

  • ...Disturbed sleepwake rhythm, longer sleep latency, parasomnias, obstructive sleep apnea, sleep fragmentation and daytime drowsiness have been reported for children with epilepsy [5,51–53] and have been related to the exacerbation of epileptic seizures....

    [...]

Journal Article•DOI•
The cooccurrence of interictal discharges and seizures in pediatric sleep-disordered breathing.

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Silvia Miano1, Alessandra Tabarrini1, Ottavio Vitelli1, Annamaria Mazzotta1, Marco Del Pozzo1, Jole Rabasco1, Mario Barreto1, Pasquale Parisi1, Alessandro Ferretti1, Maria Pia Villa1 •
Sapienza University of Rome1
01 Dec 2013-Epilepsy & Behavior
TL;DR: This study confirms the high prevalence of interictal epileptiform discharges in children with SDB and indicates that they may recede over time, accompanied by an improvement of sleep respiratory parameters.

13 citations

Cites background or methods from "Paroxysmal activity and seizures as..."

  • ...In a previous study, we reported IEDs and/or seizures in 6 of the 25 children with sleep-disordered breathing we had enrolled; 4 out of 6 fulfilled the criteria for epilepsy: 2 had BECTS, 1 had symptomatic epilepsy, and 1 had nocturnal frontal lobe epilepsy [15]....

    [...]

  • ...In addition, a few studies have demonstrated an increased prevalence of interictal epileptiform discharges (IEDs) or of nocturnal seizures in children with sleep-disordered breathing without a previous history of epilepsy [14,15]....

    [...]

  • ..., snoring and/or apnea; vocalizations; coughing; tachypnea; tachycardia; bruxism; salivation; and head, body, or limb movements during sleep) can mimic OSA, thus leading clinicians to mistake symptoms of epileptic seizures for obstructive sleep respiratory events [15,35]....

    [...]

References
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Book•
A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects

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Allan Rechtschaffen
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Journal Article•DOI•
A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects.

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Edward A. Wolpert
01 Feb 1969-Archives of General Psychiatry
TL;DR: Techniques of recording, scoring, and doubtful records are carefully considered, and Recommendations for abbreviations, types of pictorial representation, order of polygraphic tracings are suggested.
Abstract: With the vast research interest in sleep and dreams that has developed in the past 15 years, there is increasing evidence of noncomparibility of scoring of nocturnal electroencephalograph-electroculograph records from different laboratories. In 1967 a special session on scoring criteria was held at the seventh annual meeting of the Association for the Psychophysiological Study of Sleep. Under the auspices of the UCLA Brain Information, an ad hoc committee composed of some of the most active current researchers was formed in 1967 to develop a terminology and scoring system for universal use. It is the results of the labors of this group that is now published under the imprimatur of the National Institutes of Health. The presentation is beautifully clear. Techniques of recording, scoring, and doubtful records are carefully considered. Recommendations for abbreviations, types of pictorial representation, order of polygraphic tracings are suggested.

8,001 citations

"Paroxysmal activity and seizures as..." refers methods in this paper

  • ...Sleep was subdivided into 30-s epochs, and sleep stages were scored according to the standard criteria of Rechtschaffen and Kales.(28) We evaluated the following parameters of sleep architecture: sleep period time (SPT defined as time from sleep onset to the end of the final sleep epoch minus wake time during sleep); sleep efficiency (defined as the percentage ratio between time from sleep onset to the end of the final sleep and time in bed); sleep-onset latency (time from lights out to sleep onset, which was further defined as the first of 2 consecutive epochs of stage 1 sleep or 1 epoch of any other stage, in minutes); REM latency (time from sleep onset to the first epoch of REM sleep); wakefulness after sleep onset (WASO, time spent awake between sleep onset and end of sleep, in minutes); percentage of SPT in stage 1, stage 2, and slow wave sleep (SWS, defined as the sum of the stages 3 and 4 percentage); percentage of REM sleep; and number of stage shifts per hour....

    [...]

  • ...Sleep was subdivided into 30-s epochs, and sleep stages were scored according to the standard criteria of Rechtschaffen and Kales.28 We evaluated the following parameters of sleep architecture: sleep period time (SPT defined as time from sleep onset to the end of the final sleep epoch minus wake time during sleep); sleep efficiency (defined as the percentage ratio between time from sleep onset to the end of the final sleep and time in bed); sleep-onset latency (time from lights out to sleep onset, which was further defined as the first of 2 consecutive epochs of stage 1 sleep or 1 epoch of any other stage, in minutes); REM latency (time from sleep onset to the first epoch of REM sleep); wakefulness after sleep onset (WASO, time spent awake between sleep onset and end of sleep, in minutes); percentage of SPT in stage 1, stage 2, and slow wave sleep (SWS, defined as the sum of the stages 3 and 4 percentage); percentage of REM sleep; and number of stage shifts per hour....

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The American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications

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C Iber, S Ancoli-Israel, A Chesson, Quan Sf
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7,150 citations

The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Techinical Specifications

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C Iber, S Ancoli-Isreal, A Chesson, Quan Sf
01 Jan 2007

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International Classification of Sleep Disorders

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Aasm
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1,690 citations

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01 Sep 1986-Neurologia I Neurochirurgia Polska
Bacia T, Czarkwini-Pacak L, Fryze C
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[...]

15 Sep 1984-Anales Espanoles De Pediatria
Ortiz Camúñez Ma, Martiń de Agar y Valverde Mc, Lluch Fernández, Quesada Lucas Mm, González Hachero J 
The complementary value of sleep-deprived EEG in childhood onset epilepsy.

[...]

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