Sleep Apnea Comorbidity Tied to Mortality Risk in Children With Epilepsy

Children diagnosed with both severe epilepsy and CSA vs those diagnosed with severe epilepsy and OSA had a higher standard mortality ratio.

Among children with severe epilepsy, sleep apnea is associated with a higher risk for mortality, according to study results presented at the 2025 American Academy of Neurology (AAN) annual meeting, held from April 5 to 9, 2025, in San Diego, California.Sleep apnea is a common sleep condition characterized by recurrent interruptions of breathing during sleep. Sleep apnea is associated with increased risk of cardiovascular disease, cognitive impairment, and all-cause sudden death.Researchers conducted a retrospective, observational study and obtained data from the Komodo US claims database on 968,993 children aged 1 to 17 years with severe epilepsy from January 1, 2018 to December 31, 2022 for a total of 2,355,410 patient-years.

Further research is warranted to inform clinical practice and raise awareness of the elevated mortality risk of sleep apnea in this vulnerable age group.

These individuals met 2 or more of the following required criteria for inclusion in the study:

• status epilepticus diagnosis,
• generalized tonic-clonic seizures, or
• admission to the hospital or emergency department for an epilepsy-related episode.

Of these 968,993 eligible study participants, a total of 15,486 patient-years were calculated for children with central sleep apnea (CSA), and a total of 313,024 patient-years were calculated for children with other sleep apneas (OSA), including obstructive sleep apnea.After examining mortality data for children with severe epilepsy in this age group, the researchers observed that children diagnosed with both severe epilepsy and CSA had a standard mortality ratio of 135.9 and children diagnosed with severe epilepsy and OSA had a standard mortality ratio of 74.2. The standard mortality ratio for all children with severe epilepsy regardless of whether they had sleep apnea was 27.7.Despite the elevated risk for mortality with these comorbid conditions, less than half (46%) of the children with severe epilepsy and CSA or OSA received some form of positive airway pressure treatment, including continuous positive airway pressure (CPAP) or bilevel positive airway pressure (Bi-PAP).The researchers also compared standard mortality ratios for other comorbidities, such as congestive heart failure, hemiplegia/paraplegia, cerebrovascular disease, and chronic pulmonary disease, for this patient population. The standard mortality ratios were 132.3 for children with severe epilepsy and congestive heart failure, 74.9 for those with hemiplegia/paraplegia, 55.3 for those with cerebrovascular disease, and 44.6 for those with chronic pulmonary disease.“Sleep apnea is associated with increased mortality in patients 1 to 17 years old with severe epilepsy,” the researchers concluded. “Further research is warranted to inform clinical practice and raise awareness of the elevated mortality risk of sleep apnea in this vulnerable age group.” Source: neurologyadvisor.com, Maria Arini Lopez