TOPLINE:

For children with epilepsy, also having sleep apnea significantly increased their risk for sudden cardiac arrest 5-10 years later. The long-term use of continuous positive airway pressure therapy was associated with an increased risk for sudden cardiac arrest and arrhythmias, whereas adenotonsillectomy was linked to reduced risk.

METHODOLOGY:

• Researchers used data from the TriNetX global research network spanning more than 18 countries to assess the effect of sleep apnea on the incidence of sudden cardiac arrest in children with epilepsy.
• Data was pulled from a 25-year period starting in 2000, with sleep apnea identified using diagnostic codes and polysomnography records.
• Of the pediatric patients with epilepsy, 10,120 had sleep apnea and 165,789 did not.
• Patients with or without sleep apnea were matched using propensity scores to control for confounding factors (n = 8679 each).
• The annual incidence of sudden cardiac arrest from 2012 to 2023 was calculated, and risks for sudden cardiac arrest and any arrhythmias were assessed over 5- and 10-year follow-up periods.

TAKEAWAY:

• Children with epilepsy and sleep apnea had a significantly higher average incidence of sudden cardiac arrest, at 50.5 per 10,000 person-years from 2012 to 2023, than those with only epilepsy or sleep apnea (20.0 and 9.0 per 10,000 person-years, respectively).
• The risk for sudden cardiac arrest in children with epilepsy and sleep apnea increased at 5 years (hazard ratio [HR], 1.99; P < .001) and remained elevated at 10 years (HR, 1.74; P < .001).
• The risk for any cardiac arrhythmias was also elevated in patients with both conditions (HR, 2.06; P < .001 for both 5- and 10-year periods), and those with ventricular tachycardia had the highest 10-year risk (HR, 1.88; P < .001).
• Refractory epilepsy (odds ratio [OR], 1.74; 95% CI, 1.25-2.42) and long-term continuous positive airway pressure therapy (OR, 3.41; 95% CI, 2.27-5.11) were associated with an increased risk for sudden cardiac arrest, whereas adenotonsillectomy was linked to a reduced risk (OR, 0.40; 95% CI, 0.27-0.60). Similar findings were noted for any cardiac arrhythmias.

IN PRACTICE:

“[The study] findings highlight the importance of individualized treatment strategies in pediatric patients with epilepsy and comorbid sleep apnea to reduce the risk of sudden cardiac arrest,” the authors wrote.

SOURCE:

The study was led by Po-Ming Wu, MD, MS, of the Institute of Clinical Medicine in the College of Medicine at the National Cheng Kung University in Tainan City, Taiwan. It was published online on August 19, 2025, in Pediatrics.

LIMITATIONS:

The reliance on electronic health records may have led to incomplete data and lack of information on socioeconomic status and lifestyle. 

DISCLOSURES:

The study was supported by grants from National Cheng Kung University Hospital and the National Science and Technology Council of Taiwan. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.