UC Davis

BACKGROUND: Children with epilepsy exhibit heterogeneity and variability in comorbidities including sleep disturbance, cognitive dysfunction, and behavioral impairments. This heterogeneity raises the question of whether there are unique sleep phenotypes associated with epilepsy. Here we investigate the presence and progression of sleep phenotypes in youth with new-onset epilepsy over a three-year period and, in addition, characterize their associated cognitive and behavioral profiles to inform the presence and degree of multimorbidity. METHODS: A total of 312 subjects (aged 6-16 years) were recruited within six weeks of their first recognized seizure. Sleep was evaluated in each child using the Sleep Behavior Questionnaire, assessing five areas of sleep disturbance-bedtime difficulties, parent-child interactions, sleep fragmentation, parasomnia, and daytime drowsiness. Each child also underwent a comprehensive neuropsychologic and behavior assessment. All sleep, cognitive, and behavior measures were evaluated at baseline, 18 months later, and 36 months later. RESULTS: Latent trajectory analysis over the 36-month period identified three sleep phenotypes: a sleep phenotype similar to healthy control subjects (Typical Sleep phenotype), a Moderately Disrupted sleep phenotype, and a Severely Disrupted sleep phenotype. The Typical phenotype exhibited the least sleep disturbance overall with the lowest levels of cognitive and behavior problems. The Moderately and Severely Disrupted sleep phenotypes exhibited more sleep disturbance overall and showed the highest levels of associated cognitive and behavioral dysfunction. CONCLUSIONS: Sleep disturbance phenotypes in youth with new-onset epilepsy are stable and persistent. These distinct phenotypes are also associated with unique cognitive and behavioral patterns-indicating the presence of substantial multimorbidity.