The impact of sleep and neurodevelopmental characteristics on quality of life in children with epilepsy

Winsor, Alice ORCID: 0000-0001-6689-2425 (2022). The impact of sleep and neurodevelopmental characteristics on quality of life in children with epilepsy. University of Birmingham. Ph.D.

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Abstract

This thesis set out to explore the complex relationship between sleep and health related quality of life (HRQOL) in children with epilepsy (CWE). Sleep disturbances and neurodevelopmental characteristics are common co-occurrences in CWE; however, they are often overlooked in epilepsy management. In CWE, their impact on HRQOL is expected to be amplified. Despite this, there is limited relevant research, thus it is unknown whether sleep disturbances directly impact HRQOL or whether they behave as a marker of neurodevelopmental characteristics, which are indeed driving this impact. Furthermore, HRQOL is multifactorial, and epilepsy does not occur in isolation, but can have a systemic impact on parents. Consequently, the contribution of parental variables compared to child variables, specifically co-occurrences were also considered, in order to construct a broad picture of HRQOL.The first study based on informant reports of sleep showed that sleep problems were significantly predictive of HRQOL above seizure severity and number of AEDs. In contrast, sleep problems were no longer predictive of HRQOL when neurodevelopmental characteristics were considered. There were also no significant differences in sleep, neurodevelopmental characteristics or HRQOL across epilepsy types. The second study based on actigraphy defined sleep revealed that there were no significant differences between CWE and children without epilepsy (CWOE), or between epilepsy types. However, there was a trend for higher intra-individual variability in sleep onset latency (SOL) in CWE compared to CWOE. Variability in SOL did not significantly predict HRQOL above seizure severity. However, it was shown that inclusion of ADHD characteristics possibly mediated the relationship between sleep and HRQOL. Interestingly, both autistic characteristics and variability in SOL were found to uniquely predict HRQOL. In the third study, parents of CWE were found to be vulnerable to poor sleep quality and mental health symptoms. Furthermore, all parental variables were initially significantly predictive of HRQOL, however when considered in the presence of co-occurrences, this effect was no longer significant. In summary this research elucidates the consistent role of co-occurrences in impacting HRQOL, which holds important clinical and research implications. Improvement of HRQOL in CWE requires an integrated approach, consisting of input from both neurodevelopmental and epilepsy fields.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):