Substantially Higher Mortality Risk Demonstrated for Children and Adolescents with Severe Epilepsy and Sleep Apnea

Study results presented at the American Academy of Neurology (AAN) 2025 Annual Meeting demonstrate that central sleep apnea (CSA) and other sleep apnea, including obstructive sleep apnea (OSA), are associated with an increased risk of mortality in children and adolescents aged 1 to 17 years with severe epilepsy. These findings emphasize the importance of early detection and management of sleep apnea in children with severe epilepsy to mitigate mortality risks.

The retrospective observational study comprised data from Komodo, a US healthcare claims database. Researchers analyzed data from January 1, 2018, to December 31, 2022, which included a total of 2,355,410 patient-years from 968,993 individuals with severe epilepsy who met at least 2 of the following criteria: epilepsy-related emergency department or hospital admission, status epilepticus diagnosis, or generalized tonic-clonic seizures. Researchers identified patients with CSA (15,486 patient-years) and OSA (313,024 patient-years) alongside other comorbidities defined by the Charlson Comorbidity Index and calculated standardized mortality ratios (SMRs) across age groups to assess mortality risk.

• Children and adolescents with severe epilepsy and CSA or OSA had SMRs of 135.9 and 74.2, respectively.
• SMRs for children and adolescents with congestive heart failure, hemiplegia/paraplegia, cerebrovascular disease, and chronic pulmonary disease were 132.3, 74.9, 55.3, and 44.6, respectively, vs 27.7 for individuals with severe epilepsy.
• SMRs decreased with age for all comorbidities analyzed.
• 46% of patients with CSA and OSA and severe epilepsy were on positive airway pressure treatments (continuous positive airway pressure [CPAP] and bilateral positive airway pressure [BiPAP]).

The study results show that children and adolescents with severe epilepsy and sleep apnea face significantly higher mortality risk as compared with those with severe epilepsy alone. This study was funded by UCB (Atlanta, GA).