Multicenter Study

. 2025 Mar:278:114412.

doi: 10.1016/j.jpeds.2024.114412. Epub 2024 Nov 17.

Sleep Disorders Five Years After Acute Provoked Neonatal Seizures

Renée A Shellhaas¹, Linda S Franck², Betsy Pilon³, Courtney J Wusthoff⁴, Shavonne L Massey⁵, Catherine J Chu⁶, Janet S Soul⁷, Monica E Lemmon⁸, Adam L Numis⁹, Julie S Sturza¹⁰, Cameron Thomas¹¹, Giulia M Benedetti¹⁰, Stephanie M D Rau¹⁰, Tayyba Anwar¹², Madison M Berl¹³, Charles E McCulloch¹⁴, Hannah C Glass¹⁵

Affiliations

¹ Department of Neurology, Washington University School of Medicine, St Louis, MO. Electronic address: rshellhaas@wustl.edu.
² Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA; Department of Family Health Care Nursing, University of California, San Francisco, CA.
³ Hope for HIE, West Bloomfield, MI.
⁴ Department of Neurology, University of California, Davis, Sacramento, CA.
⁵ Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
⁶ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
⁷ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
⁸ Departments of Pediatrics and Population Health Sciences, Duke University, School of Medicine, Durham, NC.
⁹ Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA; Department of Neurology and Weill Institute for Neuroscience, University of California, San Francisco, CA.
¹⁰ Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI.
¹¹ Division of Neurology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
¹² Division of Neurology, Children's National Hospital, Washington, DC.
¹³ Division of Neuropsychology, Children's National Hospital, Washington, DC.
¹⁴ Department of Epidemiology & Biostatistics University of California, San Francisco, CA.
¹⁵ Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA; Department of Neurology and Weill Institute for Neuroscience, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics University of California, San Francisco, CA.

PMID: 39557387
PMCID: PMC12377511
DOI: 10.1016/j.jpeds.2024.114412

Multicenter Study

Sleep Disorders Five Years After Acute Provoked Neonatal Seizures

Renée A Shellhaas et al. J Pediatr. 2025 Mar.

. 2025 Mar:278:114412.

doi: 10.1016/j.jpeds.2024.114412. Epub 2024 Nov 17.

Authors

Affiliations

¹ Department of Neurology, Washington University School of Medicine, St Louis, MO. Electronic address: rshellhaas@wustl.edu.
² Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA; Department of Family Health Care Nursing, University of California, San Francisco, CA.
³ Hope for HIE, West Bloomfield, MI.
⁴ Department of Neurology, University of California, Davis, Sacramento, CA.
⁵ Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
⁶ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
⁷ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
⁸ Departments of Pediatrics and Population Health Sciences, Duke University, School of Medicine, Durham, NC.
⁹ Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA; Department of Neurology and Weill Institute for Neuroscience, University of California, San Francisco, CA.
¹⁰ Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI.
¹¹ Division of Neurology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
¹² Division of Neurology, Children's National Hospital, Washington, DC.
¹³ Division of Neuropsychology, Children's National Hospital, Washington, DC.
¹⁴ Department of Epidemiology & Biostatistics University of California, San Francisco, CA.
¹⁵ Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA; Department of Neurology and Weill Institute for Neuroscience, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics University of California, San Francisco, CA.

PMID: 39557387
PMCID: PMC12377511
DOI: 10.1016/j.jpeds.2024.114412

Abstract

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.

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Conflict of interest statement

Declaration of Competing Interest Renée Shellhaas reports financial support for this study was provided by National Institute of Neurological Disorders and Stroke and the Patient-Centered Outcomes Research Institute. Renée Shellhaas reports a relationship with Pediatric Epilepsy Research Foundation that includes: board membership and employment. Renée Shellhaas reports a relationship with The Epilepsy Study Consortium that includes: consulting or advisory. Renée Shellhaas reports a relationship with UptoDate Inc that includes: royalties for authorship of topics related to neonatal seizures. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Figure 1:**
Among 118 survivors of neonatal seizures, 77/118 (65%) scored above the healthy sleep threshold of 41. Abnormal CSHQ scores were not different for children with epilepsy (11/13 with epilepsy vs. 66/105 without, p=0.3) or cerebral palsy (19/31 with cerebral palsy vs. 58/86 without, p=0.52). Boxplot legend: middle line = median, box ends = 25^th and 75^th percentiles, whiskers = (25^th or 75^th percentile)*1.5xIQR, dots = outliers; horizontal line = abnormal CSHQ threshold score (41).

**Figure 2:**
Among 119 survivors of neonatal seizures, abnormal PSQ-SRBD scores were associated with epilepsy (7/13, 54% with epilepsy vs. 25/105, 24% without, p=0.02) and with cerebral palsy 13/31, 42% with cerebral palsy vs. 19/84, 22% without, p=0.03). Boxplot legend: middle line = median, box ends = 25^th and 75^th percentiles, whiskers = (25^th or 75^th percentile)*1.5xIQR, dots = outliers; horizontal line = abnormal PSQ-SRBD threshold score (0.33).

See this image and copyright information in PMC

References

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Sleep Disorders Five Years After Acute Provoked Neonatal Seizures

Affiliations

Sleep Disorders Five Years After Acute Provoked Neonatal Seizures

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical