Sleep Apnea is Associated with High Mortality Risk in Children with Severe Epilepsies: An Observational Analysis from Large Scale US Claims Data
Stefanie Dedeurwaerdere1, Daniel Lloyd1, Alexis Davis1, Michael McLinden2, John Van Zÿl1, Amélie Lothe1, Chris Clark1
1UCB, 2mck2x
Objective:
To describe the mortality risk of sleep apnea in patients with severe epilepsy by analyzing data from a US claims database.
Background:
Sleep apnea is a common and serious sleep disorder characterized by recurrent breathing interruptions during sleep that may cause cardiovascular disease, cognitive impairment, and increased risk of all-cause sudden death. The association between sleep apnea and mortality in individuals with severe epilepsy remains poorly understood.
Design/Methods:
In this retrospective observational study using the Komodo US claims database, patients with severe epilepsy were included if they met ≥2 of the following criteria between January 1, 2018, to December 31, 2022: an epilepsy-related emergency department or hospital admission, status epilepticus diagnosis, or generalized tonic-clonic seizures. A total of 2,355,410 patient-years were captured from 968,993 unique patients. Patients with Central Sleep Apnea (CSA: 15,486 patient-years) and Other Sleep Apnea (OSA, including obstructive apnea: 313,024 patient-years) were identified. Additional comorbidities were defined using the Charlson Comorbidity Index. Standardized mortality ratios (SMRs) were reported by age group.
Results:
Children (ages 1-17) with severe epilepsy and CSA or OSA had an SMR of 135.9 and 74.2, respectively. SMRs for children with congestive heart failure, hemiplegia/paraplegia, cerebrovascular disease, and chronic pulmonary disease were 132.3, 74.9, 55.3, and 44.6, respectively, versus 27.7 for all severe epilepsy. SMRs decreased with age for all comorbidities analyzed. Forty-six percent of patients with sleep apnea (CSA & OSA) and severe epilepsy were on positive airway pressure treatments (CPAP & Bi-PAP).
Conclusions:
We show that sleep apnea is associated with increased mortality in patients 1-17 years old with severe epilepsy. Further research is warranted to inform clinical practice and raise awareness of the elevated mortality risk of sleep apnea in this vulnerable age group.
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