Sleep Disorders Five Years After Acute Provoked Neonatal Seizures.

OBJECTIVE: To evaluate whether abnormal sleep is associated with adverse outcomes for children who survived acute provoked neonatal seizures, and their parents. STUDY DESIGN: This 9-center study prospectively followed newborns with acute provoked seizures. When children reached age 5 years, parents completed the Children's Sleep Habits Questionnaire (CSHQ), the Pediatric Sleep Questionnaire-Sleep Related Breathing Disorders (PSQ-SRBD) subscale, the Vineland Adaptive Behavior Scales-3, and the Hospital Anxiety Depression Scale. Children were also assessed with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Spearman correlations and multivariable analyses were used to evaluate risk factors for sleep problems. RESULTS: The mean CSHQ score was 45 ± 7; 77 of 118 children (65%) had an abnormal score (above the healthy sleep threshold of 41). On the PSQ-SRBD, 32 of 119 children (27%) screened positive for sleep-disordered breathing (SDB). SDB symptoms were more common among children with cerebral palsy (42% with vs 22% without; P = .03) and epilepsy (54% with vs 24% without; P = .02). Children with lower scores on the Vineland-3 (rho = -0.25; P = .01) and WPPSI-IV (rho = -0.31; P = .004) at 5 years of age were more likely to have symptoms of SDB. Worse CSHQ and PSQ-SRBD scores were associated with higher parental anxiety (rho = 0.28 [P = .002] and rho = 0.34 [P = .0002], respectively) and depression scores on the Hospital Anxiety Depression Scale (rho = 0.16 [P = .08] and rho = 0.17 [P = .07], respectively). CONCLUSIONS: Two-thirds of early school-aged survivors of acute provoked neonatal seizures had parent-reported sleep abnormalities and one-quarter screened positive for SDB. Early screening and effective treatment for sleep disorders could be an innovative, practice-changing approach to improve outcomes after neonatal seizures.

Duke Scholars

Author Monica Elizabeth Lemmon Pediatrics, Neurology