Abstracts

Rationale: A reciprocal relationship exists between sleep disorders and common neurological conditions such as primary headaches and epilepsy. The aim of our study was to compare differences in pattern of sleep disturbance between these two groups and to determine if presence of significant sleep disturbance is associated with poor response to treatment and school performance. Methods: We performed a prospective cohort study. 56 patients between the ages of 4 and 12 referred to an outpatient pediatric neurology clinic for evaluation of primary headaches (N=28) and seizure disorders (N=28) were recruited. Participants were administered the Children’s Sleep Habits Questionnaire (CSHQ) which is designed to screen for common sleep problems. The validity of this questionnaire is well established with adequate internal consistency and an acceptable test to test reliability.(Owens 2000). Higher scores indicate greater sleep disturbance (A total score of >41 is indicative of a sleep disturbance). Various patterns of sleep disorders including bed time resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, sleep disordered breathing and daytime sleepiness were determined using the 8 subscale items within the questionnaire and comparisons were made across the two groups. Seizure and headache sub types, severity of the underlying disease (MIDAS for migraines and seizure count for epilepsy), medications used and school performance were recorded Results: The prevalence of significant sleep disturbances (CSHQ total score >41) in patients with primary headaches and seizures was 61% (17 out of 28) and 66% (19 out of 28) respectively. Sleep disturbance scores for patients with primary headaches (range of 20-62; 42.9 ±10.7 (mean ± SD)) and for epilepsy (range of 36-69; 45.7 ± 8.2 (mean ± SD)) were no different between the two groups. In patients with significant sleep disturbance, analysis of the eight subscales revealed no differences between the two groups in the pattern of sleep disturbance. However, in those who did not have a significant sleep problem (CSHQ score <41), seizure patients had greater sleep anxiety than patients with headaches (p<0.05). Significant sleep problems were not associated with seizure or headache type, poor school performance, poor response to treatment, increased use of prophylactic daily medications for headaches or polytherapy for seizure control Conclusions: We found a high prevalence of significant sleep disturbance in both patients with epilepsy and primary headaches. However, in these patients, no significant differences were found in the pattern of the underlying sleep disturbance. Interestingly there was a significant increase in sleep anxiety in patients with epilepsy, although these patients did not have a high CHSQ total score. We did not find a correlation between sleep disturbance and disease severity, response to therapy or school performance in spite of a high prevalence of sleep disturbance in these patients. We speculate that this may be due to a small sample size, recall bias or significant ability of these patients to cope with sleep disturbances.