Sleep spindle activity is correlated with reading abilities in developmental dyslexia

Parental stress, quality of life, and behavioral alterations in children with dyslexia

INTRODUCTION

Dyslexia is a learning disorder that, in addition to affecting reading skills, has a significant impact on emotional, social, and family well-being. Despite advances in understanding the disorder, its influence on parental stress and children's quality of life remains an underexplored area.

OBJECTIVE

The aim of this study was to analyze differences in parental stress, quality of life, and behavioral profiles between children with dyslexia and those with typical development, as well as to assess possible relationships between these factors.

METHOD

A total of 100 children (50 diagnosed with dyslexia and 50 with typical development), aged between 8 and 10 years, participated in the study along with their caregivers. Variables were measured using the PSI-SF (parental stress), Kiddo-KINDL (quality of life), and BASC-3 (behavior) instruments, complemented by descriptive statistical analyses, t-tests, and a mediation model.

RESULTS

Caregivers of children with dyslexia exhibited significantly higher levels of stress (p < .001) across all evaluated dimensions, with pronounced effects in the subscales of emotional distress and perceived difficulties in the child. Children with dyslexia showed reduced quality of life, particularly in areas such as self-esteem and social relationships, with statistically significant differences (p < .001). Additionally, they exhibited more behavioral problems, especially in aggression and anxiety. However, mediation analyses did not identify problematic behaviors as direct mediators between dyslexia diagnosis and parental stress.

CONCLUSIONS

The findings highlight how dyslexia affects both children and their families, exerting a multidimensional impact. This study underscores the importance of continued research into the interactions between emotional, social, and family factors to optimize support for this population.

The Role of Sleep in Memory Consolidation and Reading in Dyslexia

Dyslexia is a neurodevelopmental disorder characterized by reading difficulty, which has long been attributed to a phonological processing deficit. However, recent research suggests that general difficulties with learning and memory, but also in memory consolidation, may underlie disordered reading. This review article provides an overview of the relationship between learning and memory, memory consolidation during sleep, and reading and explores the emerging literature on consolidation during sleep in individuals with dyslexia. We consider evidence that sleep appears to be less effective for memory consolidation in children with dyslexia and how this may be related to their deficits in reading. This discussion highlights the need for further research to determine the extent to which atypical sleep patterns may contribute to learning deficits associated with disordered reading.

Association of Sleep Spindle Rate With Memory Consolidation in Children With Rolandic Epilepsy

BACKGROUND AND OBJECTIVES

Rolandic epilepsy (RE), the most common childhood focal epilepsy syndrome, is characterized by a transient period of sleep-activated epileptiform activity in the centrotemporal regions and variable cognitive deficits. Sleep spindles are prominent thalamocortical brain oscillations during sleep that have been mechanistically linked to sleep-dependent memory consolidation in animal models and healthy controls. Sleep spindles are decreased in RE and related sleep-activated epileptic encephalopathies. To further evaluate the association between this electrographic biomarker and cognitive dysfunction in this common disease, we investigate whether children with RE have deficient sleep-dependent memory consolidation and whether impaired memory consolidation is associated with reduced sleep spindles in the centrotemporal regions.

METHODS

In this prospective case-control study, children were trained and tested on a validated probe of memory consolidation, the motor sequence task (MST). Sleep spindles were measured from high-density EEG during a 90-minute nap opportunity between MST training and testing using an automated sleep spindle detector validated for use in children with and without epilepsy.

RESULTS

Twenty-three children with RE (9 with active disease, 5F, age 6.9-12.8 years; 14 with resolved disease, 8F, age 8.8-17.8 years) and 19 age-matched and sex-matched controls (8F, age 6.9-18.7 years) were enrolled. Children with active epilepsy had decreased memory consolidation compared with control children (p = 0.001, mean percentage reduction 25.7%, 95% CI 10.3%-41.2%) and compared with children with resolved epilepsy (p = 0.007, mean percentage reduction 21.9%, 95% CI 6.2%-37.6%). Children with active epilepsy had decreased sleep spindle rates in the centrotemporal region compared with controls (p = 0.008, mean decrease 2.5 spindles per minute, 95% CI 0.7-4.4 spindles per minute). Spindle rate, but not spike rate or spike-wave index, correlated with sleep-dependent memory consolidation (p = 0.004, mean MST improvement of 3.9%, 95% CI 1.3%-6.4%, for each unit increase in spindles per minute).

DISCUSSION

Children with RE have impaired sleep-dependent memory consolidation during the active period of disease that correlates with a deficit in the sleep spindle rate. This finding identifies a noninvasive biomarker to aid diagnosis and a potential etiologic mechanism to guide therapeutic discovery of cognitive dysfunction in RE and related sleep-activated epilepsy syndromes.

The role of sleep disturbances in associations between early life adversity and subsequent brain and language development during childhood

Sleep disturbances are posited to play a key role in the development of poor mental and physical health outcomes related to early life adversity (ELA), in part through effects on brain development. Language development is critically important for health and developmental outcomes across the lifespan, including academic achievement and emotion regulation. Yet, very little research has focused on the dynamic contributions of ELA, sleep, and brain development on language outcomes. In this mini review, we summarize the current pediatric literature independently connecting ELA and sleep to language development, as well as the effects of ELA and sleep on language-relevant aspects of brain structure and function. We then propose a framework suggesting that sleep disturbances and subsequent effects on brain structure and function may act as key mechanisms linking ELA and language development. Future research investigating the associations among ELA, sleep, brain, and language development will refine our proposed framework and identify whether sleep should be included as an intervention target to mitigate the effects of early life adversity on language development.

Impaired sleep-dependent memory consolidation predicted by reduced sleep spindles in Rolandic epilepsy

Background and Objectives

Sleep spindles are prominent thalamocortical brain oscillations during sleep that have been mechanistically linked to sleep-dependent memory consolidation in animal models and healthy controls. Sleep spindles are decreased in Rolandic epilepsy and related sleep-activated epileptic encephalopathies. We investigate the relationship between sleep spindle deficits and deficient sleep dependent memory consolidation in children with Rolandic epilepsy.

Methods

In this prospective case-control study, children were trained and tested on a validated probe of memory consolidation, the motor sequence task (MST). Sleep spindles were measured from high-density EEG during a 90-minute nap opportunity between MST training and testing using a validated automated detector.

Results

Twenty-three children with Rolandic epilepsy (14 with resolved disease), and 19 age- and sex-matched controls were enrolled. Children with active Rolandic epilepsy had decreased memory consolidation compared to control children (p=0.001, mean percentage reduction: 25.7%, 95% CI [10.3, 41.2]%) and compared to children with resolved Rolandic epilepsy (p=0.007, mean percentage reduction: 21.9%, 95% CI [6.2, 37.6]%). Children with active Rolandic epilepsy had decreased sleep spindle rates in the centrotemporal region compared to controls (p=0.008, mean decrease 2.5 spindles/min, 95% CI [0.7, 4.4] spindles/min). Spindle rate positively predicted sleep-dependent memory consolidation (p=0.004, mean MST improvement of 3.9%, 95% CI [1.3, 6.4]%, for each unit increase in spindles per minute).

Discussion

Children with Rolandic epilepsy have a sleep spindle deficit during the active period of disease which predicts deficits in sleep dependent memory consolidation. This finding provides a mechanism and noninvasive biomarker to aid diagnosis and therapeutic discovery for cognitive dysfunction in Rolandic epilepsy and related sleep activated epilepsy syndromes.

Sleep Spindle Alterations in Children With Migraine

BACKGROUND

The modulation of thalamocortical activity is the most important site of several levels of interference between sleep spindles and migraine. Thalamocortical circuits are responsible for the electrophysiological phenomenon of sleep spindles. Spindle alterations may be used as a beneficial marker in the diagnosis and follow-up of children with migraine. We aimed to formulate the hypothesis that there is a shared mechanism that underlies migraine and sleep spindle activity.

METHODS

We analyzed the amplitude, frequency, duration, density, and activity of sleep spindles in non-rapid eye movement stage 2 sleep in patients with migraine without aura when compared with healthy control subjects.

RESULTS

The amplitudes of average, slow, and fast sleep spindles were higher in children with migraine without aura (P = 0.020, 0.013, and 0.033, respectively). The frequency of fast spindles was lower in children with migraines without aura when compared with the control group (P = 0.03). Although not statistically significant, the fast sleep spindle duration in the migraine group was shorter (P = 0.055). Multivariate analysis revealed an increased risk of migraine associated with increased mean spindle amplitude and decreased fast spindle frequency and duration.

CONCLUSIONS

Our data suggest that spindle alterations may correlate with the vulnerability to develop migraine and may be used as a model for future research about the association between the thalamocortical networks and migraine.

Impaired extraction and consolidation of morphological regularities in developmental dyslexia: A domain general deficit?

The current study examined whether adults with Developmental Dyslexia are impaired in learning linguistic regularities in a novel language, and whether this may be explained by a domain general deficit in the effect of sleep on consolidation. We compared online learning and offline consolidation of morphological regularities in individuals with Developmental Dyslexia (N = 40) and typical readers (N = 38). Participants learned to apply plural inflections to novel words based on morpho-phonological rules embedded in the input and learned to execute a finger motor sequence task. To test the effects of time and sleep on consolidation, participants were assigned into one of two sleep-schedule groups, trained in the evening or in the morning and tested 12 and 24 h later. Unlike typical readers, Dyslexic readers did not extract the morpho-phonological regularities during training and as a group they did not show offline gains in inflecting trained items 24 h after training, suggesting that the deficit in extraction of regularities during training may be related to the deficit in consolidation. The offline gains in dyslexic readers, were correlated with their prior phonological abilities, and were less affected by sleep than those of typical readers. Although no deficit was found in the consolidation of the motor task, dyslexic readers were again less successful in generating an abstract representation of the motor sequence, reflected in a difficulty to generalize the motor sequence knowledge acquired using one hand to the untrained hand. The results suggest that individuals with Developmental Dyslexia have a domain general deficit in extracting statistical regularities from an input. Within the language domain this deficit is reflected in reduced benefits of consolidation, particularly during sleep, perhaps due to reduced prior phonological abilities, which may impede the individual's ability to extract the linguistic regularities during and after training and thus constrain the consolidation process.

Sleep disturbances in specific learning disorders: a qualitative and quantitative investigation

BACKGROUND

The literature reports a significant association between sleep disorders and learning disabilities. Nevertheless, not all children with learning disorders have sleep alterations, and which sleep characteristics are associated with which learning difficulty is still unknown. The study aimed at acquiring new information on the relation between sleep disturbances or habits and the learning profiles of children with a specific learning disorder (SLD).

METHODS

The Sleep Disturbance Scale for Children (SDSC) and an actigraph (the FitBit-Flex, FB-F) were used in 26 and 16 SLD children respectively; all children were also assessed for learning skills.

RESULTS

Although parents' reports at the SDSC did not differentiate SLD from typical readers, the awakening, respiratory and arousal disturbances at the SDSC correlated with sleep duration at the FB-F. Sleep alterations at the FB-F actigraph characterize SLD with literacy difficulties: children with reading decoding difficulties showed shorter minimum amount of sleep than typical children, and severe SLDs showed shorter maximum sleep duration and a higher number of awakenings in comparison to SLDs with mild learning deficits.

CONCLUSIONS

Mild alterations in the amount, duration and quality of sleep may characterize children with learning disorders and actigraphy proves to be a useful tool in starting the individual monitoring of sleep in these populations.

EEG correlates of developmental dyslexia: a systematic review

Dyslexia is one of the most studied learning disorders. Despite this, its biological basis and main causes are still not fully understood. Electroencephalography (EEG) could be a powerful tool in identifying the underlying mechanisms, but knowledge of the EEG correlates of developmental dyslexia (DD) remains elusive. We aimed to systematically review the evidence on EEG correlates of DD and establish their quality. In July 2021, we carried out an online search of the PubMed and Scopus databases to identify published articles on EEG correlates in children with dyslexia aged 6 to 12 years without comorbidities. We follow the PRISMA guidelines and assess the quality using the Appraisal Tool questionnaire. Our final analysis included 49 studies (14% high quality, 63% medium, 20% low, and 2% very low). Studies differed greatly in methodology, making a summary of their results challenging. However, some points came to light. Even at rest, children with dyslexia and children in the control group exhibited differences in several EEG measures, particularly in theta and alpha frequencies; these frequencies appear to be associated with learning performance. During reading-related tasks, the differences between dyslexic and control children seem more localized in the left temporoparietal sites. The EEG activity of children with dyslexia and children in the control group differed in many aspects, both at rest and during reading-related tasks. Our data are compatible with neuroimaging studies in the same diagnostic group and expand the literature by offering new insights into functional significance.

Restless Legs Syndrome and Restless Sleep Disorder in Children

Restless legs syndrome (RLS) affects 2% of children presenting with symptoms of insomnia, restless sleep, decreased quality of life, and effects on cognition and behavior. The International RLS Study Group and the American Academy of Sleep Medicine have published guidelines for the diagnosis and treatment of RLS in children. Restless sleep disorder has been recently identified in children and presents with frequent movements during sleep and daytime symptoms with polysomnography findings of at least 5 large muscle movements at night. Treatment options for both disorders include iron supplementation, either oral or intravenous with improvement in nighttime and daytime symptoms.

Season is related to the slow wave and sigma activity of infants and toddlers

OBJECTIVE/BACKGROUND

Slow wave activity (SWA) and sigma frequency activity (SFA) are hallmarks of NREM sleep EEG and important indicators of neural plasticity, development of the central nervous system, and cognition. However, little is known about the factors that modulate these sleep EEG activities, especially in small children.

PATIENTS/METHODS

We analyzed the power spectral densities of SWA (1-4 Hz) and SFA range (10-15 Hz) from six EEG derivations of 56 infants (8 months) and 60 toddlers (24 months) during their all-night sleep and during the first and the last half of night sleep. The spectral values were compared between the four seasons.

RESULTS

In the spring group of infants, compared with the darker seasons, SFA was lower in the centro-occipital EEG derivations during both halves of the night. The SWA findings of the infants were restricted to the last half of the night (SWA2) and frontally, where SWA2 was higher during winter than spring. The toddlers presented less frontal SWA2 during winter compared with autumn. Both age groups showed a reduction in both SWA and SFA towards the last half of the night.

CONCLUSIONS

The sleep EEG spectral power densities are more often associated with seasons in infants' SFA range. The results might stem from seasonally changing light exposure, but the exact mechanism warrants further study. Moreover, contrary to the adult-like increment of SFA, the SFA at both ages was lower at the last part of the night sleep. This suggests different regulation of spindle activity in infants and toddlers.

Children with neurodevelopmental disorders: how do they sleep?

PURPOSE OF REVIEW

In this review we summarized the available evidence on sleep disorders in children with neurodevelopmental disorders (NDDs) in particular: intellectual disability (including some genetic conditions such as Prader-Willi Syndrome, Smith-Magenis Syndrome), Autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), Developmental Coordination Disorder, language disorders, and specific learning disorders.

RECENT FINDINGS

Children with NDDs frequently suffer from sleep disturbances, with a higher prevalence than that of the general pediatric population.

SUMMARY

These problems tend to be chronic and may cause additional cognitive and behavioral difficulties, often affecting the whole family's well-being. Sleep behaviors are also related to other important developmental skills, such as attention and listening. Investigating sleep disorders in children with NDDs is therefore crucial in clinical practice. For a systematic approach in clinical practice, we propose the use of a short and easy to remember sleep screening tool.

Restless Sleep Disorder (RSD): a New Sleep Disorder in Children. A Rapid Review

PURPOSE OF REVIEW

Restless sleep disorder (RSD) is a recently identified pediatric sleep disorder characterized by frequent movements during sleep associated with daytime symptoms. In this review we summarize the expanding evidence of the clinical presentation of RSD, potential pathophysiology, associated comorbidities, and current treatment options that will help the pediatrician identify children with RSD in a timely manner.

RECENT FINDINGS

RSD is diagnosed in 7.7% of children referred evaluated in a pediatric sleep center. Children with RSD present with frequent nightly movements during sleep for at least 3 months, and have daytime symptoms related to poor sleep quality including excessive sleepiness, hyperactivity, irritability among other symptoms. Current evidence shows an increased sympathetic predominance, increased NREM sleep instability, and iron deficiency, as well as increased prevalence in parasomnias and attention deficit hyperactivity disorder. Consensus diagnostic criteria were recently published to diagnose RSD and emergent evidence suggests that iron supplementation improves its nighttime and daytime symptoms.

Sleep Disturbances in Children with Attentional Deficit Hyperactivity Disorder and Specific Learning Disorders

Sleep disturbances may be a significant source of distress for children with neurodevelopmental disorders, and consequently also for their families. Crucially, sleep disturbances might be influenced by comorbidity. Attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD) often co-occur, and consequently, investigating sleep disturbances in children with comorbidity of ADHD and SLD is essential. Our study aimed at detecting sleep difficulties in a group of 74 children with ADHD, 78 children with SLD, and 76 children with ADHD and SLD by using the Sleep Disturbances Scale for Children. The results showed that sleep difficulties emerge more clearly in children with comorbid ADHD and SLD compared to children with only ADHD or SLD. These sleep difficulties were not due to differences in ages and behavioral/emotional problems. In conclusion, evaluating sleep disturbances is important when assessing and managing children with ADHD, SLD, and particularly with the two comorbid conditions, to better understand their difficulties and develop tailored interventions.

Association of a novel EEG metric of sleep depth/intensity with attention-deficit/hyperactivity, learning, and internalizing disorders and their pharmacotherapy in adolescence

STUDY OBJECTIVES

Psychiatric/learning disorders are associated with sleep disturbances, including those arising from abnormal cortical activity. The odds ratio product (ORP) is a standardized electroencephalogram metric of sleep depth/intensity validated in adults, while ORP data in youth are lacking. We tested ORP as a measure of sleep depth/intensity in adolescents with and without psychiatric/learning disorders.

METHODS

Four hundred eighteen adolescents (median 16 years) underwent a 9-hour, in-lab polysomnography. Of them, 263 were typically developing (TD), 89 were unmedicated, and 66 were medicated for disorders including attention-deficit/hyperactivity (ADHD), learning (LD), and internalizing (ID). Central ORP during non-rapid eye movement (NREM) sleep was the primary outcome. Secondary/exploratory outcomes included central and frontal ORP during NREM stages, in the 9-seconds following arousals (ORP-9), in the first and second halves of the night, during REM sleep and wakefulness.

RESULTS

Unmedicated youth with ADHD/LD had greater central ORP than TD during stage 3 and in central and frontal regions during stage 2 and the second half of the sleep period, while ORP in youth with ADHD/LD on stimulants did not significantly differ from TD. Unmedicated youth with ID did not significantly differ from TD in ORP, while youth with ID on antidepressants had greater central and frontal ORP than TD during NREM and REM sleep, and higher ORP-9.

CONCLUSIONS

The greater ORP in unmedicated youth with ADHD/LD, and normalized levels in those on stimulants, suggests ORP is a useful metric of decreased NREM sleep depth/intensity in ADHD/LD. Antidepressants are associated with greater ORP/ORP-9, suggesting these medications induce cortical arousability.

Sleep spindles in children with restless sleep disorder, restless legs syndrome and normal controls

OBJECTIVE

To analyze and identify differences in sleep spindles in children with restless sleep disorder (RSD), restless legs syndrome (RLS) and normal controls.

METHODS

PSG (polysomnography) from children with RSD, RLS and normal controls were analyzed. Sleep spindle activity was detected on one frontal and one central electrode, for each epoch of N2 and N3 sleep. Sleep spindle density, duration and intensity (density × duration) were then obtained and used for analysis.

RESULTS

Thirty-eight children with RSD, twenty-three children with RLS and twenty-nine controls were included. The duration of frontal spindles in sleep stage N2 was longer in children with RSD than in controls. Frontal spindle density and intensity tended to be increased in RSD children. No significant differences were found for central spindles.

CONCLUSION

Children with RSD had longer frontal spindles. This finding may contribute to explain the occurrence of excessive movement activity during sleep and the presence of daytime symptoms.

SIGNIFICANCE

Recent research has demonstrated that children with RSD have increased NREM instability and sympathetic activation during sleep. Analyzing sleep spindles in children with RSD in comparison with children with RLS and controls adds to our understanding of the pathophysiology or RSD and its effects on daytime impairment.

Overnight consolidation of speech sounds predicts decoding ability in skilled adult readers

PURPOSE

Phonological representations are important for reading. In the current work, we examine the relationship between speech-perceptual memory encoding and consolidation to reading ability in skilled adult readers.

METHOD

Seventy-three young adults (age 18-24) were first tested in their word and nonword reading ability, and then trained in the late evening to identify an unfamiliar speech sound contrast (Hindi retroflex-dental). Participants were assessed in their ability to perceive the target contrast immediately before training, after training, and 12 hours later.

RESULTS

While perceptual performance on the target at any time point was unassociated with reading ability, overnight changes to the post-training perceptual ability over the 12-hour delay was significantly associated with nonword reading (i.e. decoding) ability, but not real-word reading.

CONCLUSION

These results provide preliminary support for the hypothesis that individual differences in memory processes that update phonological representations following acoustic-phonetic exposure relate to decoding performance, including in adulthood.

The relation between sleep and neurocognitive development in infancy and early childhood: A neuroscience perspective

Sleep is essential for human life. It has different characteristics in the early stages of life compared to later periods: during development, qualitative and quantitative changes in sleep features occur such as the onset of REM/NREM sleep at 3 months, the progressive increase of night sleep duration, and the reduction of total sleep time. Sleep seems to be essential in the cognitive functions' development, especially in the first period of life. Indeed, higher rates of night sleep at the age of 12 and 18 months are associated with higher executive functions' performance. Furthermore, memory consolidation occurs during sleep and sleep contributes to children's learning not only in retaining information but also in organizing memories most efficiently. Therefore, sleep problems could cause negative effects on some features of cognitive development like memory, executive functions, and learning process. There is also an intimate relationship between sleep and regulation of emotional brain functions, with a link between sleep disturbance and behavioral problems.

Sleep-Related Declarative Memory Consolidation in Children and Adolescents with Developmental Dyslexia

Sleep has a crucial role in memory processes, and maturational changes in sleep electrophysiology are involved in cognitive development. Albeit both sleep and memory alterations have been observed in Developmental Dyslexia (DD), their relation in this population has been scarcely investigated, particularly concerning topographical aspects. The study aimed to compare sleep topography and associated sleep-related declarative memory consolidation in participants with DD and normal readers (NR). Eleven participants with DD and 18 NR (9-14 years old) underwent a whole-night polysomnography. They were administered a word pair task before and after sleep to assess for declarative memory consolidation. Memory performance and sleep features (macro and microstructural) were compared between the groups, and the intercorrelations between consolidation rate and sleep measures were assessed. DD showed a deeper worsening in memory after sleep compared to NR and reduced slow spindles in occipito-parietal and left fronto-central areas. Our results suggest specific alterations in local sleep EEG (i.e., sleep spindles) and in sleep-dependent memory consolidation processes in DD. We highlight the importance of a topographical approach, which might shed light on potential alteration in regional cortical oscillation dynamics in DD. The latter might represent a target for therapeutic interventions aimed at enhancing cognitive functioning in DD.

Learning and Consolidation of Declarative Memory in Good and Poor Readers of English as a Second Language

Declarative memory abilities may be important for children who are learning to read in a second language. In the present study, we investigated declarative memory in a recognition memory task in 7-to-13-year-old, Kannada native-speaking, good (n = 22) and poor (n = 22) readers of English, in Karnataka, India. Recognition memory was tested shortly (∼10 min) after encoding (day 1) and again on the next (day 2). Analyses revealed that the two groups did not differ in recognition memory performance on day 1. On day 2, the good readers improved from day 1, whereas poor readers did not. A partial correlation analysis suggests that consolidation - the change in performance in recognition memory between the 2 days - is associated with reading skills in good readers, but not in poor readers. Taken together, these results suggest that children who struggle to read in a second language may have deficits in declarative memory consolidation.

Association of sleep spindle activity and sleepiness in children with sleep-disordered breathing

STUDY OBJECTIVES

The association of snoring and sleep-disordered breathing (SDB) with daytime sleepiness is well documented; however, the exact mechanisms, and especially the role of sleep microstructure that may account for this association remain incompletely understood. In a cohort of children with SDB, we aimed to compare sleep spindle activity between children with daytime sleepiness versus those without daytime sleepiness.

METHODS

Children with SDB who reported daytime sleepiness were recruited and compared with age- and sex-matched SDB controls. Polysomnographic recordings were analyzed evaluating sleep spindle activity. A statistical comparison was carried out in both groups to assess the association between sleepiness and sleep spindle activity.

RESULTS

Thirty-three children with SDB (mean age: 7.5 ± 1.7 years) were included, 10 with and 23 without daytime sleepiness. Spindle activity was lower in children with daytime sleepiness compared with those without; in stage N2, median (interquartile range) sleep spindle indexes were 77.5 (37.3) and 116.9 (71.2) (P = .015), respectively.

CONCLUSIONS

Spindles were significantly reduced in children with SDB and daytime sleepiness. The exact mechanisms of this association remain unknown and future research is needed in order to establish the exact role of sleep spindle activity on daytime symptoms in children with SDB.

Specific Learning Disability Unmasked by Psychophysiological Insomnia

Sleep is essential for good cognition and academic performance. Children with deficits in learning and cognition thus have various sleep disturbances. Learning disabilities in dyslexia are exaggerated with associated sleep problems which also impact the daily routine. Although it is essential to rule out organic etiologies in insomnia, it should also be borne in mind to probe the child's functional performance in school. Psychophysiological insomnia should be considered in perpetuating stressful conditions. Any scholastic difficulty in a child has to be seriously evaluated to estimate the underlying condition. We report a rare case of psychophysiological insomnia diagnosed in a child with specific learning disability. Awareness of the associated sleep difficulties in dyslexia helps in improved assessment and treatment of such children.

Sleep EEG oscillations in neurodevelopmental disorders without intellectual disabilities

Neurodevelopmental disorders (NDDs) are often characterised by sleep problems, and recent evidence indicates alterations of the sleep electroencephalographic (EEG) oscillations in these patients. Sleep microstructure plays a crucial role in cognitive functioning and brain maturation. In this view, modifications in sleep EEG oscillations in NDDs could further impair the cognitive maturation process in these patients. We provide an overview of sleep microstructure alterations observed in three NDDs without intellectual disabilities (attention-deficit/hyperactivity disorder, high-functioning autism/Asperger syndrome and developmental dyslexia) and their relationships with the disorders' phenomenology. For each NDD, we discuss empirical evidence of altered EEG oscillations, and we consider their interaction with patients' cognitive and behavioural functioning, with the aim to elucidate their functional meaning. We highlight the limits of the present literature and propose possible future directions while underlining the clinical relevance of the research in this field. Beyond confirming the importance of sleep management in atypically developing children, the review findings suggest that sleep EEG oscillations in NDDs could become a target for specific clinical intervention.

Sleep spindle density is associated with worry in children with generalized anxiety disorder and healthy controls

BACKGROUND

Childhood generalized anxiety disorder (GAD), characterized by uncontrollable worry, is associated with long-term psychopathology risk, yet understanding of developmental trajectories is limited. Despite common complaints about sleep, 'macro' sleep abnormalities have not been identified. Emerging findings suggest micro-architectural features of sleep, including sleep spindles, differentiate various psychiatric populations. The current study investigated sleep spindle density during non-rapid eye movement (NREM) sleep among youth with GAD and healthy controls, including relationships with anxiety, worry, global functioning, and subjective sleep quality.

METHODS

58 pre-pubertal children, n = 26 with GAD and n = 32 matched healthy controls, aged 7-11 years (M = 8.86, SD=1.47), completed diagnostic assessments and a week of actigraphy monitoring prior to a night of polysomnography (PSG) either at home or in a sleep laboratory. NREM spindle activity was detected in frontal and central regions.

RESULTS

Sleep spindle activity did not differ based on diagnostic group or sex. Sleep spindles were unassociated with anxiety and sleep quality but showed a significant positive association with worry in all youth. Among youth with GAD, global functioning was negatively associated with spindle density in frontal regions during NREM stage 3. Spindle density was significantly greater during in-lab compared to at-home PSG.

LIMITATIONS

The small sample size and reliance on only one night of PSG necessitate additional studies.

CONCLUSIONS

The identified link between spindle activity and worry in pre-pubertal children highlights a need for investigations on transdiagnostic features of child psychopathology rather than specific disorders. Longitudinal studies are needed to explore spindle characteristics and affective risk across development.

Reduced sleep spindle activity in children with primary snoring

BACKGROUND

Habitually snoring children are at risk of manifesting disease-related problems even if their sleep studies are overall within normal limits.

STUDY OBJECTIVES

To compare sleep spindle activity in children with primary snoring and healthy controls.

METHODS

Sleep spindle activity including analysis of fast and slow spindles (ie, >13 Hz and <13 Hz, respectively) was evaluated in polysomnographic (PSG) recordings of 20 randomly selected children with primary snoring (PS; normal PSG recordings except for objective presence of snoring; 12 boys, mean age 6.5 ± 2.1 years), and 20 age- and gender-matched PSG-confirmed non-snoring controls.

RESULTS

PS children showed significantly lower spindle indices in all non-rapid eye movement (NREM) sleep stages (p < 0.05). In contrast, fast spindles were found in 40% (n = 8) children with PS and in 25% (n = 5) controls. Sleep spindle activity was particularly higher in NREM sleep stage 2 in controls compared PS (76% versus 43% of all marked sleep spindles events in NREM sleep stage 2, p < 0.001).

CONCLUSIONS

Children with PS exhibit significantly reduced spindle activity when compared to matched controls. Reduced sleep spindle activity may be an indicator of sleep disruption and, therefore, could be involved in the development of disease-related consequences in snoring children.

Recognizing Psychiatric Comorbidity With Reading Disorders

Reading disorder (RD), a specific learning disorder (SLD) of reading that includes impairment in word reading, reading fluency, and/or reading comprehension, is common in the general population but often is not comprehensively understood or assessed in mental health settings. In education settings, comorbid mental and associated disorders may be inadequately integrated into intervention plans. Assessment and intervention for RD may be delayed or absent in children with frequently co-occurring mental disorders not fully responding to treatment in both school and mental health settings. To address this oversight, this review summarizes current knowledge regarding RDs and common comorbid or co-occurring disorders that are important for mental health and school settings. We chose to highlight RD because it is the most common SLD, and connections to other often comorbid disorders have been more thoroughly described in the literature. Much of the literature we describe is on decoding-based RD (or developmental dyslexia) as it is the most common form of RD. In addition to risk for academic struggle and social, emotional, and behavioral problems, those with RD often show early evidence of combined or intertwined Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition childhood disorders. These include attention deficit hyperactivity disorder, anxiety and depression, disruptive, impulse-control, and conduct disorders, autism spectrum disorders, and other SLDs. The present review highlights issues and areas of controversy within these comorbidities, as well as directions for future research. An interdisciplinary, integrated approach between mental health professionals and educators can lead to comprehensive and targeted treatments encompassing both academic and mental health interventions. Such targeted treatments may contribute to improved educational and health-related outcomes in vulnerable youth. While there is a growing research literature on this association, more studies are needed of when to intervene and of the early and long-term benefits of comprehensive intervention.

Consolidation of vocabulary is associated with sleep in typically developing children, but not in children with dyslexia

Sleep is known to play an active role in consolidating new vocabulary in adults; however, the mechanisms by which sleep promotes vocabulary consolidation in childhood are less well understood. Furthermore, there has been no investigation into whether previously reported differences in sleep architecture might account for variability in vocabulary consolidation in children with dyslexia. Twenty-three children with dyslexia and 29 age-matched typically developing peers were exposed to 16 novel spoken words. Typically developing children showed overnight improvements in novel word recall; the size of the improvement correlated positively with slow wave activity, similar to previous findings with adults. Children with dyslexia showed poorer recall of the novel words overall, but nevertheless showed overnight improvements similar to age-matched peers. However, comparisons with younger children matched on initial levels of novel word recall pointed to reduced consolidation in dyslexics after 1 week. Crucially, there were no significant correlations between overnight consolidation and sleep parameters in the dyslexic group. This suggests a reduced role of sleep in vocabulary consolidation in dyslexia, possibly as a consequence of lower levels of learning prior to sleep, and highlights how models of sleep-associated memory consolidation can be usefully informed by data from typical and atypical development.

Using Oscillating Sounds to Manipulate Sleep Spindles

Introduction

EEG oscillations known as sleep spindles have been linked with various aspects of cognition, but the specific functions they signal remain controversial. Two types of EEG sleep spindles have been distinguished: slow spindles at 11-13.5 Hz and fast spindles at 13.5-16 Hz. Slow spindles exhibit a frontal scalp topography, whereas fast spindles exhibit a posterior scalp topography and have been preferentially linked with memory consolidation during sleep. To advance understanding beyond that provided from correlative studies of spindles, we aimed to develop a new method to systematically manipulate spindles.

Aims and Methods

We presented repeating bursts of oscillating white noise to people during a 90-min afternoon nap. During stage 2 and slow-wave sleep, oscillations were embedded within contiguous 10-s stimulation intervals, each comprising 2 s of white noise amplitude modulated at 12 Hz (targeting slow spindles), 15 Hz (targeting fast spindles), or 50 Hz followed by 8 s of constant white noise.

Results

During oscillating stimulation compared to constant stimulation, parietal EEG recordings showed more slow spindles in the 12-Hz condition, more fast spindles in the 15-Hz condition, and no change in the 50-Hz control condition. These effects were topographically selective, and were absent in frontopolar EEG recordings, where slow spindle density was highest. Spindles during stimulation were similar to spontaneous spindles in standard physiological features, including duration and scalp distribution.

Conclusions

These results define a new method to selectively and noninvasively manipulate spindles through acoustic resonance, while also providing new evidence for functional distinctions between the 2 types of EEG spindles.

Effects of Sleep on Word Pair Memory in Children - Separating Item and Source Memory Aspects

Word paired-associate learning is a well-established task to demonstrate sleep-dependent memory consolidation in adults as well as children. Sleep has also been proposed to benefit episodic features of memory, i.e., a memory for an event (item) bound into the spatiotemporal context it has been experienced in (source). We aimed to explore if sleep enhances word pair memory in children by strengthening the episodic features of the memory, in particular. Sixty-one children (8-12 years) studied two lists of word pairs with 1 h in between. Retrieval testing comprised cued recall of the target word of each word pair (item memory) and recalling in which list the word pair had appeared in (source memory). Retrieval was tested either after 1 h (short retention interval) or after 11 h, with this long retention interval covering either nocturnal sleep or daytime wakefulness. Compared with the wake interval, sleep enhanced separate recall of both word pairs and the lists per se, while recall of the combination of the word pair and the list it had appeared in remained unaffected by sleep. An additional comparison with adult controls (n = 37) suggested that item-source bound memory (combined recall of word pair and list) is generally diminished in children. Our results argue against the view that the sleep-induced enhancement in paired-associate learning in children is a consequence of sleep specifically enhancing the episodic features of the memory representation. On the contrary, sleep in children might strengthen item and source representations in isolation, while leaving the episodic memory representations (item-source binding) unaffected.

Children with developmental dyslexia showed greater sleep disturbances than controls, including problems initiating and maintaining sleep

AIM

Although there have been frequent clinical reports about sleep disturbances in children with learning disabilities, no data are available about the prevalence of sleep disturbances in children with developmental dyslexia (DD). This study evaluated sleep disturbances in children with DD referred to a hospital clinic and compared their scores with healthy controls.

METHODS

We consecutively enrolled 147 children (66% male) aged 10.26 ± 2.63 years who were referred by clinical paediatricians to the Clinic for Child and Adolescent Neuropsychiatry at the Second University of Naples with DD and 766 children without DD (60% male) aged 10.49 ± 2.39 years recruited from schools in the same urban area. Sleep disturbances were assessed with the Sleep Disturbances Scale for Children (SDSC), which was filled out by the children's main carers.

RESULTS

Compared with the controls, the children with DD showed significantly higher rates of above threshold scores on the total SDSC score (p < 0.001) and on the subscales for disorders in initiating and maintaining sleep (p < 0.001), sleep breathing disorders (p < 0.001) and disorders of arousal (p < 0.001).

CONCLUSION

Sleep disorders were significantly more frequent in children with DD than in healthy controls. A possible relationship between dyslexia and sleep disorders may have relevant clinical implications.

Crossmodal synesthetic congruency improves visual timing in dyslexic children

Consistent with the temporal ventriloquism effect, synesthetic correspondence between the features of visual size and auditory pitch has been shown to modulate the performance of visual temporal order judgment (TOJ) in typical adults. Here in the two main experiments we recruited seventeen dyslexic children and twenty typically developing children to perform a visual TOJ task and measured their ability of synesthetic correspondence between visual size and auditory pitch. In Experiment 1, participants were shown two consecutively presented visual discs that were temporally flanked by two synesthetic congruent or incongruent auditory beeps. In Experiment 2, participants received a crossmodal matching test (visual-size vs. auditory pitch). The results showed that compared to the typically developing group, dyslexic children benefited more from cross-modal synesthetic correspondence to partially compensate for their deficiency in visual TOJ task. The multisensory facilitation for timing performance was correlated with reading ability (Exp.1). Moreover, dyslexic children formed intact "congruent" matching of visually larger shapes to lower auditory pitch, and visually smaller shapes to higher auditory pitch, as did their typically developing peers (Exp 2). The results of our present study suggested general deficits of temporal processing in dyslexic children, However, with relatively intact ability of auditory pitch-visual size matching, dyslexic children could separate visual events using auditory cues. The current study also indicates a feasible way to improve the reading ability by exploiting temporal ventriloquism effect, modulated by appropriate crossmodal synesthetic associations.

Sleep Spindle Characteristics in Children with Neurodevelopmental Disorders and Their Relation to Cognition

Empirical evidence indicates that sleep spindles facilitate neuroplasticity and “off-line” processing during sleep, which supports learning, memory consolidation, and intellectual performance. Children with neurodevelopmental disorders (NDDs) exhibit characteristics that may increase both the risk for and vulnerability to abnormal spindle generation. Despite the high prevalence of sleep problems and cognitive deficits in children with NDD, only a few studies have examined the putative association between spindle characteristics and cognitive function. This paper reviews the literature regarding sleep spindle characteristics in children with NDD and their relation to cognition in light of what is known in typically developing children and based on the available evidence regarding children with NDD. We integrate available data, identify gaps in understanding, and recommend future research directions. Collectively, studies are limited by small sample sizes, heterogeneous populations with multiple comorbidities, and nonstandardized methods for collecting and analyzing findings. These limitations notwithstanding, the evidence suggests that future studies should examine associations between sleep spindle characteristics and cognitive function in children with and without NDD, and preliminary findings raise the intriguing question of whether enhancement or manipulation of sleep spindles could improve sleep-dependent memory and other aspects of cognitive function in this population.

Sensory modulation and sleep quality among adults with learning disabilities: a quasi-experimental case-control design study

Purpose

Following the International Classification of Functioning, Disability and Health (ICF) concepts, this study examines body functions such as sensory modulation and sleep quality among adults with learning disabilities (LD).

Methods

One hundred and ten participants, 55 adults with LD and 55 matched controls (mean age 30 years) filled in a socio-demographic questionnaire, the Adults/Adolescents Sensory Profile (AASP), and the Mini Sleep Questionnaire (MSQ). Chi-tests, Mann-Whitney tests, and Kolmogorov-Smirnov tests were conducted to examine group differences related to socio-demographic characteristics and body functions. Correlation and regression analyses were conducted to examine relationships between body functions.

Results

Significant differences were found between the groups in: (a) unique socio-demographic variables: high-schools attended, family status and number of children; (b) body functions: low registration and sensory sensitivity (p < .001), sensory avoiding (p = .002), sensory seeking (p = .021) and sleep quality (p < .001). Significant correlations were found between AASP subscale scores and the MSQ final score in each group. Regression analysis revealed that for the entire sample (N = 108), low registration accounted for 10.2% of the variance of sleep quality above group membership (p < .001), while in a separate examination of adults with LD (n = 53), low registration accounted for 19.9% of the variance of sleep quality (p < .001).

Conclusions

Adults with LD need to be studied through a health-related perspective such as the ICF model to gain further understanding of their unique characteristics and daily needs. Sensory and sleep functions of adults with LD should be further studied in the context of health related quality of life.

Slow sleep spindle activity, declarative memory, and general cognitive abilities in children

STUDY OBJECTIVES

Functional interactions between sleep spindle activity, declarative memory consolidation, and general cognitive abilities in school-aged children.

DESIGN

Healthy, prepubertal children (n = 63; mean age 9.56 ± 0.76 y); ambulatory all-night polysomnography (2 nights); investigating the effect of prior learning (word pair association task; experimental night) versus nonlearning (baseline night) on sleep spindle activity; general cognitive abilities assessed using the Wechsler Intelligence Scale for Children-IV (WISC-IV).

MEASUREMENTS AND RESULTS

Analysis of spindle activity during nonrapid eye movement sleep (N2 and N3) evidenced predominant peaks in the slow (11-13 Hz) but not in the fast (13-15 Hz) sleep spindle frequency range (baseline and experimental night). Analyses were restricted to slow sleep spindles. Changes in spindle activity from the baseline to the experimental night were not associated with the overnight change in the number of recalled words reflecting declarative memory consolidation. Children with higher sleep spindle activity as measured at frontal, central, parietal, and occipital sites during both baseline and experimental nights exhibited higher general cognitive abilities (WISC-IV) and declarative learning efficiency (i.e., number of recalled words before and after sleep).

CONCLUSIONS

Slow sleep spindles (11-13 Hz) in children age 8-11 y are associated with inter-individual differences in general cognitive abilities and learning efficiency.

Such stuff as dreams are made on? Elaborative encoding, the ancient art of memory, and the hippocampus

This article argues that rapid eye movement (REM) dreaming is elaborative encoding for episodic memories. Elaborative encoding in REM can, at least partially, be understood through ancient art of memory (AAOM) principles: visualization, bizarre association, organization, narration, embodiment, and location. These principles render recent memories more distinctive through novel and meaningful association with emotionally salient, remote memories. The AAOM optimizes memory performance, suggesting that its principles may predict aspects of how episodic memory is configured in the brain. Integration and segregation are fundamental organizing principles in the cerebral cortex. Episodic memory networks interconnect profusely within the cortex, creating omnidirectional “landmark” junctions. Memories may be integrated at junctions but segregated along connecting network paths that meet at junctions. Episodic junctions may be instantiated during non–rapid eye movement (NREM) sleep after hippocampal associational function during REM dreams. Hippocampal association involves relating, binding, and integrating episodic memories into a mnemonic compositional whole. This often bizarre, composite image has not been present to the senses; it is not “real” because it hyperassociates several memories. During REM sleep, on the phenomenological level, this composite image is experienced as a dream scene. A dream scene may be instantiated as omnidirectional neocortical junction and retained by the hippocampus as an index. On episodic memory retrieval, an external stimulus (or an internal representation) is matched by the hippocampus against its indices. One or more indices then reference the relevant neocortical junctions from which episodic memories can be retrieved. Episodic junctions reach a processing (rather than conscious) level during normal wake to enable retrieval. If this hypothesis is correct, the stuff of dreams is the stuff of memory.

About sleep's role in memory

Over more than a century of research has established the fact that sleep benefits the retention of memory. In this review we aim to comprehensively cover the field of "sleep and memory" research by providing a historical perspective on concepts and a discussion of more recent key findings. Whereas initial theories posed a passive role for sleep enhancing memories by protecting them from interfering stimuli, current theories highlight an active role for sleep in which memories undergo a process of system consolidation during sleep. Whereas older research concentrated on the role of rapid-eye-movement (REM) sleep, recent work has revealed the importance of slow-wave sleep (SWS) for memory consolidation and also enlightened some of the underlying electrophysiological, neurochemical, and genetic mechanisms, as well as developmental aspects in these processes. Specifically, newer findings characterize sleep as a brain state optimizing memory consolidation, in opposition to the waking brain being optimized for encoding of memories. Consolidation originates from reactivation of recently encoded neuronal memory representations, which occur during SWS and transform respective representations for integration into long-term memory. Ensuing REM sleep may stabilize transformed memories. While elaborated with respect to hippocampus-dependent memories, the concept of an active redistribution of memory representations from networks serving as temporary store into long-term stores might hold also for non-hippocampus-dependent memory, and even for nonneuronal, i.e., immunological memories, giving rise to the idea that the offline consolidation of memory during sleep represents a principle of long-term memory formation established in quite different physiological systems.

Sleep EEG fingerprints reveal accelerated thalamocortical oscillatory dynamics in Williams syndrome

Sleep EEG alterations are emerging features of several developmental disabilities, but detailed quantitative EEG data on the sleep phenotype of patients with Williams syndrome (WS, 7q11.23 microdeletion) is still lacking. Based on laboratory (Study I) and home sleep records (Study II) here we report WS-related features of the patterns of antero-posterior 8-16 Hz non-rapid-eye-movement (NREM) sleep EEG power distributions. Participants in Study I were 9 WS and 9 typically developing (TD) controls matched for age (14-29 years) and sex, and sleeping for two consecutive nights in the laboratory. WS participants were characterized by region-independent decreases in 10.50-12.50 Hz and central increases in 14.75-15.75 Hz EEG power. Region-independent decreases and increases in z-scores of the spectra were observed in the 10.25-12.25 Hz and 14-16 Hz ranges, respectively. Moreover, in the EEG spectra of participants with WS a lower probability for the emergence of a frontally dominant peak was observed. Parietal fast sigma peaks and the antero-posterior shifts in power distributions were of higher frequencies in WS (~1 Hz difference). A 1 year follow-up of 9 WS and 3 TD participants, as well as their inclusion into larger samples (20 WS and 20 TD, age: 6-29 years) of a two-night ambulatory home polysomnography study confirmed the WS-specific decrease in alpha/low sigma power (8-11.75 Hz) and the pattern of z-score differences (decreases: 8.50-11.25 Hz; increases: 13.5-14 Hz), including the antero-posterior shifts in power distribution (0.5 Hz) and some features of the spectral peaks. Altogether these data suggest a decrease in alpha/low sigma power, as well as a redistribution of NREM sleep 8-16 Hz EEG power toward the higher frequencies and/or a higher frequency of NREM sleep thalamocortical oscillations in WS.

Sleep alterations and iron deficiency anemia in infancy

Iron deficiency anemia (IDA) continues to be the most common single nutrient deficiency in the world. An estimated 20-25% of the world's infants have IDA, with at least as many having iron deficiency without anemia. Infants are at particular risk due to rapid growth and limited dietary sources of iron. We found that infants with IDA showed different motor activity patterning in all sleep-waking states and several differences in sleep states organization. Sleep alterations were still apparent years after correction of anemia with iron treatment in the absence of subsequent IDA. We suggest that altered sleep patterns may represent an underlying mechanism that interferes with optimal brain functioning during sleep and wakefulness in former IDA children.

Borderline intellectual functioning and sleep: the role of cyclic alternating pattern

In the clinical literature there are few specific studies about the relationship between cognition processes and sleep during childhood. In addition, milder deficits in general intellectual capacity have received less attention relative to major cognitive dysfunctions (such as the genetic or environmental basis of mental retardation), especially concerning the low normal and borderline status. Sleep could play a key role in multiple intellectual abilities such as memory, executive functions, and school performances. Aim of our study is to assess the sleep macrostructure and NREM instability (cyclic alternating pattern) and their relationship with IQ in a sample of subjects with borderline intellectual functioning (BIF). The DSM-IV defines BIF as a total intelligence quotient (TIQ) ranging between 71 and 84. Intellective functioning was assessed using the Italian version of Wechsler Intelligence Scale for Children-Revised (WISC-R), a well validated test for the developmental age between 6 and 16. For this study, 12 BIF and 17 healthy children, matched for sex and age, underwent an overnight PSG recording. Macrostructural sleep and CAP analysis were also performed. To our knowledge, this study represents the first attempt to evaluate sleep architecture and NREM instability organization in children with BIF. Findings from this investigation evidence that BIF presents alterations in both macro- and microstructural sleep architecture, with an interesting statistical significant correlation with IQ.

The relationship between sleep and epilepsy: the effect on cognitive functioning in children

AIM

The purpose of this review was to examine the possible pathophysiological links between epilepsy, cognition, sleep macro- and microstructure, and sleep disorders to highlight the contributions and interactions of sleep and epilepsy on cognitive functioning in children with epilepsy.

METHOD

PubMed was used as the medical database source. No language restriction was placed on the literature searches, and citations of relevant studies in the paediatric age range (0-18 y) were checked. Studies including a mixed population but with a high percentage of children were also considered.

RESULTS

The searches identified 223 studies. One reviewer scanned these to eliminate obviously irrelevant studies. Three reviewers scanned the remaining 128 studies and their relevant citations. The review showed that several factors could account for the learning impairment in children with epilepsy: aetiology, electroencephalographic (EEG) discharges, and persistence and circadian distribution of seizures, etc. EEG discharges may affect cognition and sleep, even in the absence of clinical or subclinical seizures. The sleep deprivation and/or sleep disruption affect the neurophysiological and neurochemical mechanisms important for the memory-learning process, but also influence the expression of EEG discharges and seizures. Learning and memory consolidation can take place over extended periods, and sleep has been demonstrated to play a fundamental role in these processes through neuroplastic remodelling of neural networks. Epilepsy and EEG paroxysms may affect sleep structure, interfering with these physiological functions.

INTERPRETATION

Improvement in the long-term cognitive-behavioural prognosis of children with epilepsy requires both good sleep quality and good seizure control. The antiepileptic drug of choice should be the one that interferes least with sleep structure and has the best effect on sleep architecture--thus normalizing sleep instability, especially during non-rapid eye movement sleep.