AAN 2025 | The association between sleep apnea and mortality risk in children with epilepsy

It’s a pleasure to share a little bit about our research that we did and we really benefited from being able to ask the question about sleep apnea in uncontrolled epilepsy to a large claims database. We use the Komodo US-based database. It captures a lot of patients and the way we structured is that we looked at like a five-year sliding window to understand what the mortality rate is in uncontrolled epilepsy with sleep apnea. We used ICD-10 codes to identify those patients and also to extract a couple of comorbidities of interest. So what we are seeing is that we can look across ages with such an approach because more than 2.3 million patient years are captured in that database, patients with uncontrolled epilepsy, which is about a little bit under one million of unique patients with uncontrolled epilepsy. So significant numbers here. And this allowed us to look into the mortality risk across ages. and what we observed is that to our surprise actually that central sleep apnea has a very high actually the highest mortality risk of the comorbidities that we evaluated and some others were like cardiovascular failure or pulmonary comorbidities. So besides that we also saw that in general if you have sleep apnea codes, ICD-10 codes, your mortality rate is similar to a middle-aged patient with uncontrolled epilepsy. So for children, that’s usually not the case, right? They have very low mortality rates. And we’re also able to look at standardized measures across the general US population, so to get like a standardized mortality rate. And there we see that if you take a kid of like 10 years old, it would have 100-fold increased risk of mortality if there is a sleep apnea code of obstructive sleep apnea and other sleep apneas, and up to 200-fold if there’s a central sleep apnea code. So, significant findings. Also, we wanted to look what would be the association with positive airway pressure treatment in those patients. Very interesting, we see that in the older patients, there’s actually improved mortality outcomes when patients are on pap therapy. but this was not the case in the children or the younger patients. So we believe that we really identified a vulnerable population here where it’s important to raise awareness on that topic because it’s potentially actionable. And given the significance of that outcome in relation to mortality, we believe it’s important to bring that to the attention here at the AAN meeting. Particularly because it’s not the first question that usually doctors are asking to the patients. They will ask like how have your seizures been, but not so much like how have you been sleeping, are you snoring, are you having sleep apnea.

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