Study: Epilepsy, Sleep Woes Predict Hyperactivity

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by Steve Bryson, PhD |

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Epilepsy starting at an earlier age and sleep problems independently predicted increased hyperactivity in Norwegian people with Angelman syndrome, a study concluded.

“The results of this study may have potentially important implications for understanding the complex links between hyperactivity, sleep problems and early epilepsy in [Angelman syndrome],” the scientists wrote.

The study, “Hyperactive behaviour in Angelman syndrome: the association with sleep problems and age of epilepsy onset,” was published in the Journal of Intellectual Disability Research.

Angelman syndrome is a genetic disorder characterized by developmental delays, intellectual disability, severe speech impairments, and a lack of coordinated muscle control (ataxia).

Sleep problems, such as abnormal sleep-wake cycles and a reduced need for sleep, also are found in Angelman syndrome, as is hyperactivity, which refers to constant body movements and an inability to concentrate and focus.

Furthermore, about 90% of Angelman patients experience epileptic seizures, typically beginning from 18 months to 2 years of age.

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Although sleep problems, hyperactivity, and epilepsy are more common in Angelman syndrome compared to other genetic conditions with severe intellectual disability, research into the connections between these symptoms is limited.

Now, a collaborative team of researchers at the Oslo University Hospital in Norway and King’s College London in the U.K. examined the relationship between sleep, hyperactivity, and epilepsy in a group of Angelman patients.

“The main purpose of the present study was to explore the association between hyperactivity symptoms, sleep problems and age of epilepsy onset in a sample of individuals with [Angelman syndrome],” the team wrote.

All known parents or guardians of people with Angelman syndrome in Norway were invited to participate in the study. A total of 25 males and 17 females with genetically verified Angelman, ranging in age from 2 to 57 years, were included. Information about epilepsy was collected from medical records, whereas hyperactivity and sleep data were obtained from questionnaires.

The Strengths and Difficulties Questionnaire (SDQ) was used to assess hyperactivity, which is a widely used behavioral screening test, and to evaluate people with attention deficit hyperactivity disorder (ADHD) — a condition defined by inattention, hyperactivity, and impulsive behaviors.

However, symptoms such as inattention are challenging to gauge in people with language and intellectual disabilities, including those with Angelman. Thus, the team developed a separate rating for hyperactivity alone based on the two SDQ items: “restless, overactive and cannot sit still for long,” and “constantly fidgeting or squirming.” Both hyperactivity and ADHD symptoms were evaluated.

Another questionnaire assessed sleep disturbances with an overall score based on three questions: “my child often wakes up in the middle of the night,” “when my child wakes up during night, it often takes a long time to go back to sleep,” and “my child sleeps less than his/her peers.”

The analysis revealed that worse sleep problems significantly correlated with the higher hyperactivity scores and ADHD symptoms in general, but not with the overall SDQ difficulties score.

The mean age of the onset of epilepsy was 37 months (about 3 years), ranging from 3 to 94 months (about 8 years).

The onset of epilepsy at an earlier age also correlated with more hyperactivity as well as ADHD symptoms, whereas epilepsy onset was not associated with overall SDQ difficulties or sleep problems.

A more complex statistical model to measure the impact of the age of epilepsy onset and sleep problems on hyperactivity showed a significant relationship with each factor contributing independently to hyperactive behavior.

“Hence, there was a trend for both earlier epilepsy onset and more sleep problems to independently predict increased levels of hyperactivity in this sample,” the researchers wrote.

Further analysis of demographic factors demonstrated age, sex, the presence of epilepsy, or the type of Angelman-associated genetic abnormality did not affect hyperactivity, ADHD symptoms, or sleep problems.

Finally, compared to those not receiving sleep medications, patients taking these therapies were more likely to wake during the night and tended to have more sleep problems overall.

“It may be that individuals who were prescribed medication had particularly poor sleep and thus might have scored even higher on sleep problems had they not been taking medication,” researchers added.

“Our findings suggest that symptoms of hyperactivity, which are often prominent and severe in [Angelman syndrome], should be addressed in conjunction with the systematic assessment of sleep in order to improve functional outcomes,” the authors wrote.

“The findings also point to the possibility that successful treatment of sleep problems could reduce hyperactivity in individuals with [Angelman syndrome], and although successful intervention of sleep problems in [Angelman syndrome] is challenging, targeted treatments might emerge in the future,” they added.