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Sleep and Breathing

, Volume 19, Issue 2, pp 421–432 | Cite as

Sleep apneas and epilepsy comorbidity in childhood: a systematic review of the literature

  • Maria Gogou
  • Katerina Haidopoulou
  • Maria Eboriadou
  • Evaggelos Pavlou
Review

Abstract

Purpose

Our aim is to review studies which assess the prevalence of sleep apneas in children with epilepsy and discuss possible mechanisms linking these two conditions, as well as the impact of sleep apneas on the prognosis of these children.

Methods

PubMed was used as the medical database source, and articles were selected and classified according to their originality, level of evidence, and relevance to the broad scope of the review.

Results

Children with epilepsy have a higher prevalence of sleep breathing disorders in comparison to healthy children, but this prevalence varies widely depending on the methodology of each study. Major risk factors for sleep apneas in childhood epilepsy include mainly poor seizure control and antiepileptic drug polytherapy. Indeed, epilepsy can trigger sleep apneas, as abnormal electrical discharge amplifies sleep-induced breathing instability, antiepileptic drugs disturb muscle tone, and vagus nerve stimulation modulates neurotransmission to airway muscles. On the other hand, sleep apneas enhance sleep fragmentation, thus reducing the threshold for the appearance of seizures. Moreover, they have a negative effect on the neurocognitive profile of these children, as they disturb neuroplasticity mechanisms and also have a probable association with sudden unexpected death in epilepsy. The surgical treatment of sleep apneas has been found to reduce seizure frequency, and this can offer new therapeutic choices.

Conclusions

Between sleep apneas and childhood epilepsy, there is a complex relationship with reciprocal interactions. The presence of sleep apneas should be taken into account when designing the management of these children, as it creates therapeutic opportunities and limitations.

Keywords

Sleep Apneas Epilepsy Children Antiepileptic drugs Cognitive function 

Abbreviations

SA

Sleep apneas

OAHI

Obstructive apnea-hypopnea index

OSAS

Obstructive sleep apnea (syndrome)

OSAHS

Obstructive sleep apnea-hypopnea syndrome

SBD

Sleep breathing disorder(s)

AED

Antiepileptic drug(s)

VNS

Vagus nerve stimulation

SUDEP

Sudden unexpected death in epilepsy

Notes

Conflict of interest

None.

References

  1. 1.
    Wirrell E, Blackman M, Barlow K, Mah J, Hamiwka L (2005) Sleep disturbances in children with epilepsy compared with their nearest-aged siblings. Dev Med Child Neurol 47:754–759CrossRefPubMedGoogle Scholar
  2. 2.
    Gaitatzis A, Sisodiya SM, Sander JW (2012) The somatic comorbidity of epilepsy: a weighty but often unrecognized burden. Epilepsia 53:1282–1293CrossRefPubMedGoogle Scholar
  3. 3.
    Larson AM, Ryther RC, Jennesson M, Geffrey AL, Bruno PL, Anagnos CJ et al (2012) Impact of pediatric epilepsy on sleep patterns and behaviors in children and parents. Epilepsia 53:1162–1169CrossRefPubMedGoogle Scholar
  4. 4.
    Edlund W, Gronseth G, Yuen S, Franklin G (2004) Clinical practice guideline process manual. American Academy of Neurology, St. PaulGoogle Scholar
  5. 5.
    Chang SJ, Chae KY (2010) Obstructive sleep apnea syndrome in children: epidemiology, pathophysiology, diagnosis and sequelae. Korean J Pediatr 53:863–871CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Iber C, Ancoli-Israel S, Chesson AL Jr, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Am Acad Sleep Med 47–48Google Scholar
  7. 7.
    Spruyt K, Gozal D (2011) Pediatric sleep questionnaires as diagnostic or epidemiological tools: a review of currently available instruments. Sleep Med Rev 15:19–32CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Spruyt K, Gozal D (2011) Development of pediatric sleep questionnaires as diagnostic or epidemiological tools: a brief review of dos and don'ts. Sleep Med Rev 15:7–17CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J et al (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130:714–755CrossRefGoogle Scholar
  10. 10.
    Goodwin JL, Kaemingk KL, Mulvaney SA, Morgan WJ, Quan SF (2005) Clinical screening of school children for polysomnography to detect sleep-disordered breathing—the Tucson Children's Assessment of Sleep Apnea study (TuCASA). J Clin Sleep Med 1:247–254PubMedCentralPubMedGoogle Scholar
  11. 11.
    Chervin RD, Weatherly RA, Garetz SL, Ruzicka DL, Giordani BJ, Hodges EK et al (2007) Pediatric sleep questionnaire: prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg 133:216–222CrossRefPubMedGoogle Scholar
  12. 12.
    van Someren V, Burmester M, Alusi G, Lane R (2000) Are sleep studies worth doing? Arch Dis Child 83:76–81CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Villa MP, Paolino MC, Castaldo R, Vanacore N, Rizzoli A, Miano S et al (2013) Sleep clinical record: an aid to rapid and accurate diagnosis of paediatric sleep disordered breathing. Eur Respir J 41:1355–1361CrossRefPubMedGoogle Scholar
  14. 14.
    Chan B, Cheong EY, Grace Ng SF, Chan YC, Lee QU, Chan KY (2011) Evaluation of sleep disturbances in children with epilepsy: a questionnaire-based case–control study. Epilepsy Behav 21:437–440CrossRefPubMedGoogle Scholar
  15. 15.
    Maganti R, Hausman N, Koehn M, Sandok E, Glurich I, Mukesh BN (2006) Excessive daytime sleepiness and sleep complaints among children with epilepsy. Epilepsy Behav 8:272–277CrossRefPubMedGoogle Scholar
  16. 16.
    Samaitienė R, Norkūnienė J, Tumienė B, Grikinienė J (2013) Sleep and behavioral problems in rolandic epilepsy. Pediatr Neurol 48:115–122CrossRefPubMedGoogle Scholar
  17. 17.
    Tang SS, Clarke T, Owens J, Pal DK (2010) Sleep behavior disturbances in rolandic epilepsy. J Child Neurol 26:239–243CrossRefPubMedGoogle Scholar
  18. 18.
    Ong LC, Yang WW, Wong SW, alSiddiq F, Khu YS (2010) Sleep habits and disturbances in Malaysian children with epilepsy. J Ped Child Health 46:80–84CrossRefGoogle Scholar
  19. 19.
    Jain SV, Simakajornboon S, Shapiro SM, Morton LD, Leszczyszyn DJ, Simakajornboon N (2012) Obstructive sleep apnea in children with epilepsy: prospective pilot trial. Acta Neurol Scand 125:3–6CrossRefGoogle Scholar
  20. 20.
    Jain SV, Simakajornboon N, Glauser TA (2013) Provider practices impact adequate diagnosis of sleep disorders in children with epilepsy. J Child Neurol 28:589–595CrossRefPubMedGoogle Scholar
  21. 21.
    Kaleyias J, Cruz M, Goraya JS, Valencia I, Khurana DS, Legido A et al (2008) Spectrum of polysomnographic abnormalities in children with epilepsy. Pediatr Neurol 39:170–176CrossRefPubMedGoogle Scholar
  22. 22.
    Becker DA, Fennell EB, Carney PR (2004) Daytime behavior and sleep disturbance in childhood epilepsy. Epilepsy Behav 5:708–715CrossRefPubMedGoogle Scholar
  23. 23.
    Miano S, Bruni O, Aricò D, Elia M, Ferri R (2010) Polysomnographic assessment of sleep disturbances in children with developmental disabilities and seizures. Neurol Sci 3:575–583CrossRefGoogle Scholar
  24. 24.
    Maganti R, Sheth RD, Hermann BP, Weber S, Gidal BE, Fine J (2005) Sleep architecture in children with idiopathic generalized epilepsy. Epilepsia 46:104–109CrossRefPubMedGoogle Scholar
  25. 25.
    Blunden S, Lushington K, Lorenzen B, Ooi T, Fung F, Kennedy D (2004) Are sleep problems under-recognised in general practice? Arch Dis Child 89:708–712CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Vitelli O, Miano S, Tabarrini A, Mazzotta AR, Supino MC, Forlani M, Villa MP (2014) Epilepsy and sleep-disordered breathing as false friends: a case report. J Child Neurol 29:114–117CrossRefGoogle Scholar
  27. 27.
    Lumeng JC, Chervin RD (2008) Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 5:242–252CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Hoellinger P, Khatami R, Gugger M, Hess CW, Bassetti CL (2006) Epilepsy and obstructive sleep apnea. Eur Neurol 55:74–79CrossRefGoogle Scholar
  29. 29.
    Jain SV, Horn PS, Simakajornboon N, Glauser TA (2013) Obstructive sleep apnea and primary snoring in children with epilepsy. J Child Neurol 28:77–82CrossRefPubMedGoogle Scholar
  30. 30.
    Venturi M, Neves GS, Pontes IM, Valois A, Gomes Mda M (2011) Risk and determinant factors for obstructive sleep apnea in patients with epilepsy. Arq Neuropsiquiatr 69:924–927CrossRefPubMedGoogle Scholar
  31. 31.
    Aurora RN, Lamm CI, Zak RS, Kristo DA, Bista SR, Rowley JA, Casey KR (2012) Practice parameters for the non-respiratory indications for polysomnography and multiple sleep latency testing for children. Sleep 35:1467–1473PubMedCentralPubMedGoogle Scholar
  32. 32.
    Miyagawa T, Sotero M, Avellino AM, Kuratani J, Saneto RP, Ellenbogen RG et al (2007) Apnea caused by mesial temporal lobe mass lesions in infants: report of 3 cases. J Child Neurol 22:1079–1083CrossRefPubMedGoogle Scholar
  33. 33.
    Ramelli GP, Donati F, Bianchetti M, Vassella F (1998) Apnoeic attacks as an isolated manifestation of epileptic seizures in infants. Eur J Paediatr Neurol 2:187–191CrossRefPubMedGoogle Scholar
  34. 34.
    Sharma VK, Teoh HL, Chan BP (2010) Cerebral vasomotor reactivity in epilepsy patients. J Neurol 257:1565CrossRefPubMedGoogle Scholar
  35. 35.
    O’Regan ME, Brown JK (2005) Abnormalities in cardiac and respiratory function observed during seizures in childhood. Dev Med Child Neurol 47:4–9CrossRefPubMedGoogle Scholar
  36. 36.
    McKay LC, Atalla A, Morrell MJ (2010) Physiology and neural control of breathing during sleep. Eur Respir Monogr 50:1–16Google Scholar
  37. 37.
    Gutierrez MJ, Zhu J, Rodriguez-Martinez CE, Nino CL, Nino G (2013) Nocturnal phenotypical features of obstructive sleep apnea (OSA) in asthmatic children. Pediatr Pulmonol 48:592–600CrossRefPubMedGoogle Scholar
  38. 38.
    Dempsey JA, Smith CA, Blain GM, Xie A, Gong Y, Teodorescu M (2012) Role of central/peripheral chemoreceptors and their interdependence in the pathophysiology of sleep apnea. Adv Exp Med Biol 758:343–349CrossRefPubMedGoogle Scholar
  39. 39.
    Foresman BH (2000) Sleep and breathing disorders: the genesis of obstructive sleep apnea. J Am Osteopath Assoc 100:1–8Google Scholar
  40. 40.
    Terzano MG, Parrino L, Anelli S, Boselli M, Clemens B (1992) Effects of generalized interictal EEG discharges on sleep stability: assessment by means of cyclic alternating pattern. Epilepsia 33:317–326CrossRefPubMedGoogle Scholar
  41. 41.
    Kaada BR, Jasper H (1952) Respiratory responses to stimulation of temporal pole, insula, and hippocampal and limbic gyri in man. AMA Arch Neurol Psychiatry 68:609–619CrossRefPubMedGoogle Scholar
  42. 42.
    Bonvallet M, Bobo EG (1972) Changes in phrenic activity and heart rate elicited by localized stimulation of amygdala and adjacent structures. Electroencephalogr Clin Neurophysiol 32:1–16CrossRefPubMedGoogle Scholar
  43. 43.
    St-John WM, Rudkin AH, Homes GL, Leiter JC (2006) Changes in respiratory-modulated neural activities, consistent with obstructive and central apnea, during fictive seizures in an in situ anaesthetized rat preparation. Epilepsy Res 70:218–228CrossRefPubMedGoogle Scholar
  44. 44.
    Terndrup TE, Darnall R, Knuth SL, Bartlett D Jr (1999) Effects of experimental cortical seizures on respiratory motor nerve activities in piglets. J Appl Physiol 86:2052–2058PubMedGoogle Scholar
  45. 45.
    Kanemura H, Sano F, Maeda Y, Sugita K, Aihara M (2012) Valproate sodium enhances body weight gain in patients with childhood epilepsy: a pathogenic mechanisms and open-label clinical trial of behavior therapy. Seizure 21:496–500CrossRefPubMedGoogle Scholar
  46. 46.
    Verrotti A, Laus M, Scardapane A, Franzoni E, Chiarelli F (2009) Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate. Eur J Endocrinol 160:81–86CrossRefPubMedGoogle Scholar
  47. 47.
    Legros B, Bazil CW (2003) Effects of antiepileptic drugs on sleep architecture: a pilot study. Sleep Med 4:51–55CrossRefPubMedGoogle Scholar
  48. 48.
    Bertorelli R, Ferri N, Adami M, Ongini E (1996) Effects of four antiepileptic drugs on sleep and waking in the rat under both light and dark phases. Pharmacol Biochem Behav 53:559–565CrossRefPubMedGoogle Scholar
  49. 49.
    Bazil CW (2003) Effects of antiepileptic drugs on sleep structure: are all drugs equal? CNS Drugs 17:719–728CrossRefPubMedGoogle Scholar
  50. 50.
    Manni R, Terzaghi M (2010) Comorbidity between epilepsy and sleep disorders. Epilepsy Res 90:171–177CrossRefPubMedGoogle Scholar
  51. 51.
    Parhizgar F, Nugent K, Raj R (2011) Obstructive sleep apnea and respiratory complications associated with vagus nerve stimulators. J Clin Sleep Med 7:401–407PubMedCentralPubMedGoogle Scholar
  52. 52.
    Khurana DS, Reumann M, Hobdell EF, Neff S, Valencia I, Legido A et al (2007) Vagus nerve stimulation in children with refractory epilepsy: unusual complications and relationship to sleep-disordered breathing. Childs Nerv Syst 23:1309–1312CrossRefPubMedGoogle Scholar
  53. 53.
    Nagarajan L, Walsh P, Gregory P, Stick S, Maul J, Ghosh S (2003) Respiratory pattern changes in sleep in children on vagal nerve stimulation for refractory epilepsy. Can J Neurol Sci 30:224–227CrossRefPubMedGoogle Scholar
  54. 54.
    Hsieh T, Chen M, McAfee A, Kifle Y (2008) Sleep-related breathing disorder in children with vagal nerve stimulators. Pediatr Neurol 38:99–103CrossRefPubMedGoogle Scholar
  55. 55.
    Zaaimi B, Grebe R, Berquin P, Wallois F (2009) Vagus nerve stimulation induces changes in respiratory sinus arrhythmia of epileptic children during sleep. Epilepsia 50:2473–2480CrossRefPubMedGoogle Scholar
  56. 56.
    Malow BA, Edwards J, Marzec M, Sagher O, Fromes G (2000) Effects of vagus nerve stimulation on respiration during sleep: a pilot study. Neurology 55:1450–1454CrossRefPubMedGoogle Scholar
  57. 57.
    Ebben MR, Sethi NK, Conte M, Pollak CP, Labar D (2008) Vagus nerve stimulation, sleep apnea, and CPAP titration. J Clin Sleep Med 4:471–473PubMedCentralPubMedGoogle Scholar
  58. 58.
    Liu DB, Zhou LF, Zhong JW, Wang J (2004) Changes of sleep architecture in children with obstructive sleep apnea syndrome. Zhonghua Er Ke Za Zhi 42:284–286PubMedGoogle Scholar
  59. 59.
    Aneja S, Gupta M (2005) Sleep and childhood epilepsy. Indian J Pediatr 72:687–690CrossRefPubMedGoogle Scholar
  60. 60.
    Scholle S, Zwacka G (2001) Arousals and obstructive sleep apnea syndrome in children. Clin Neurophysiol 112:984–991CrossRefPubMedGoogle Scholar
  61. 61.
    Gu XQ, Haddad GG (2003) Maturation of neuronal excitability in hippocampal neurons of mice chronically exposed to cyclic hypoxia. Am J Physiol Cell Physiol 284:1156–1163CrossRefGoogle Scholar
  62. 62.
    Miano S, Paolino MC, Peraita-Adrados R, Montesano M, Barberi S, Villa MP (2009) Prevalence of EEG paroxysmal activity in a population of children with obstructive sleep apnea syndrome. Sleep 32:522–529PubMedCentralPubMedGoogle Scholar
  63. 63.
    Miano S, Tabarrini A, Vitelli O, Mazzotta A, Del Pozzo M, Rabasco J et al (2013) The cooccurrence of interictal discharges and seizures in pediatric sleep-disordered breathing. Epilepsy Behav 29:508–512CrossRefPubMedGoogle Scholar
  64. 64.
    Verrotti A, Filippini M, Matricardi S, Agostinelli MF, Gobbi G (2014) Memory impairment and Benign Epilepsy with centrotemporal spike (BECTS): a growing suspicion. Brain Cogn 84:123–131CrossRefPubMedGoogle Scholar
  65. 65.
    Lopes R, Simões MR, Leal AJ (2014) Neuropsychological abnormalities in children with the Panayiotopoulos syndrome point to parietal lobe dysfunction. Epilepsy Behav 31:50–55CrossRefPubMedGoogle Scholar
  66. 66.
    Kwon S, Seo HE, Hwang SK (2012) Cognitive and other neuropsychological profiles in children with newly diagnosed benign rolandic epilepsy. Korean J Pediatr 55:383–387CrossRefPubMedCentralPubMedGoogle Scholar
  67. 67.
    Braakman HM, Ijff DM, Vaessen MJ, Debeij-van Hall MH, Hofman PA, Backes WH et al (2012) Cognitive and behavioural findings in children with frontal lobe epilepsy. Eur J Paediatr Neurol 16:707–715CrossRefPubMedGoogle Scholar
  68. 68.
    O'Brien LM, Mervis CB, Holbrook CR, Bruner JL, Smith NH, McNally N et al (2004) Neurobehavioral correlates of sleep-disordered breathing in children. J Sleep Res 13:165–172CrossRefPubMedGoogle Scholar
  69. 69.
    Bourke R, Anderson V, Yang JS, Jackman AR, Killedar A, Nixon GM et al (2011) Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing. Sleep Med 12:489–496CrossRefPubMedGoogle Scholar
  70. 70.
    Hamasaki Uema SF, Nagata Pignatari SS, Fujita RR, Moreira GA, Pradella-Hallinan M, Weckx L (2007) Assessment of cognitive learning function in children with obstructive sleep breathing disorders. Braz J Otorhinolaryngol 73:315–320PubMedGoogle Scholar
  71. 71.
    Honaker SM, Gozal D, Bennett J, Capdevila OS, Spruyt K (2009) Sleep-disordered breathing and verbal skills in school-aged community children. Dev Neuropsychol 34:588–600CrossRefPubMedCentralPubMedGoogle Scholar
  72. 72.
    Jackman AR, Biggs SN, Walter LM, Embuldeniya US, Davey MJ, Nixon GM et al (2012) Sleep-disordered breathing in preschool children is associated with behavioral, but not cognitive, impairments. Sleep Med 13:621–631CrossRefPubMedGoogle Scholar
  73. 73.
    Parisi P, Bruni O, Pia Villa M, Verrotti A, Miano S, Luchetti A et al (2010) The relationship between sleep and epilepsy: the effect on cognitive functioning in children. Dev Med Child Neurol 52:805–810CrossRefPubMedGoogle Scholar
  74. 74.
    Morentin B, Alcaraz R (2002) Sudden unexpected death in epilepsy in children and adolescents. Rev Neurol 34:462–465PubMedGoogle Scholar
  75. 75.
    Terra VC, Scorza FA, Arida RM, Fernandes RM, Wichert-Ana L, Machado HR et al (2011) Mortality in children with severe epilepsy: 10 years of follow-up. Arq Neuropsiquiatr 69:766–769CrossRefPubMedGoogle Scholar
  76. 76.
    Singh K, Katz ES, Zarowski M, Loddenkemper T, Llewellyn N, Manganaro S et al (2013) Cardiopulmonary complications during pediatric seizures: a prelude to understanding SUDEP. Epilepsia 54:1083–1091CrossRefPubMedGoogle Scholar
  77. 77.
    Meyer S, Shamdeen MG, Gottschling S, Strittmatter M, Gortner L (2011) Sudden unexpected death in epilepsy in children. J Paediatr Child Health 47:326–331CrossRefPubMedGoogle Scholar
  78. 78.
    Camfield P, Camfield C (2005) Sudden unexpected death in people with epilepsy: a pediatric perspective. Semin Pediatr Neurol 12:10–14CrossRefPubMedGoogle Scholar
  79. 79.
    Langan Y, Nashef L, Sander JW (2000) Sudden unexpected death in epilepsy: a series of witnessed deaths. J Neurol Neurosurg Psychiatry 68:211–213CrossRefPubMedCentralPubMedGoogle Scholar
  80. 80.
    Weber P, Bubl R, Blauenstein U, Tillmann BU, Lütschg J (2005) Sudden unexplained death in children with epilepsy: a cohort study with an eighteen-year follow-up. Acta Paediatrm 94:564–567CrossRefGoogle Scholar
  81. 81.
    Terra VC, Scorza FA, Sakamoto AC, Pinto KG, Fernandes RM, Arida RM et al (2009) Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency? Arq Neuropsiquiatr 67:1001–1002CrossRefPubMedGoogle Scholar
  82. 82.
    Andersen ML, Tufik S, Cavalheiro EA, Arida RM, de Albuquerque M, Matos G et al (2012) Lights out! It is time for bed. Warning: obstructive sleep apnea increases risk of sudden death in people with epilepsy. Epilepsy Behav 23:510–511CrossRefPubMedGoogle Scholar
  83. 83.
    Segal E, Vendrame M, Gregas M, Loddenkemper T, Kothare SV (2012) Effect of treatment of obstructive sleep apnea on seizure outcomes in children with epilepsy. Pediatr Neurol 46:359–362CrossRefPubMedGoogle Scholar
  84. 84.
    Malow BA, Weatherwax KJ, Chervin RD, Hoban TF, Marzec ML, Martin C et al (2003) Identification and treatment of obstructive sleep apnea in adults and children with epilepsy: a prospective pilot study. Sleep Med 4:509–515CrossRefPubMedGoogle Scholar
  85. 85.
    Koh S, Ward SL, Lin M, Chen LS (2000) Sleep apnea treatment improves seizure control in children with neurodevelopmental disorders. Pediatr Neurol 22:36–39CrossRefPubMedGoogle Scholar
  86. 86.
    Hitomi T, Oga T, Tsuboi T, Yoshimura C, Kato T, Ikeda A et al (2012) Transient increase in epileptiform discharges after the introduction of nasal continuous positive airway pressure in a patient with obstructive sleep apnea and epilepsy. Intern Med 51:2453–2456CrossRefPubMedGoogle Scholar
  87. 87.
    Miano S, Pelliccia A, Evangelisti M, Pagani J, Villa MP (2008) Role of continuous positive airway pressure therapy on the pathogenesis of sleep-related frontal lobe epilepsy in a child with obstructive sleep apnea syndrome. J Child Neurol 23:124–128CrossRefPubMedGoogle Scholar
  88. 88.
    Zanzmera P, Shukla G, Gupta A, Goyal V, Srivastava A, Garg A et al (2013) Effect of successful epilepsy surgery on subjective and objective sleep parameters—a prospective study. Sleep Med 14:333–338CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Maria Gogou
    • 1
    • 3
  • Katerina Haidopoulou
    • 2
  • Maria Eboriadou
    • 2
  • Evaggelos Pavlou
    • 1
  1. 1.2nd Department of Pediatrics, School of MedicineAristotle University of Thessaloniki, University General Hospital of Thessaloniki AHEPAThessalonikiGreece
  2. 2.4th Department of Pediatrics, School of MedicineAristotle University of Thessaloniki, General Hospital of Thessaloniki PapageorgiouThessalonikiGreece
  3. 3.KateriniGreece

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