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March 21, 2026Open Access

Prevalence of Obstructive Sleep Apnea in Children with Cerebral Palsy with and without Epilepsy: A Systematic Review and Meta-analysis

SDShivani DhondeBharati Vidyapeeth Deemed University AJAshwin M JawdekarBharati Vidyapeeth Deemed University MSMrunmayee SomanBharati Vidyapeeth Deemed University

Key Points

This research aims to estimate the prevalence of obstructive sleep apnea in children with cerebral palsy, focusing on the impact of epilepsy.
Conducted a systematic search in multiple databases including PubMed and Cochrane Library.
Included observational studies reporting obstructive sleep apnea prevalence in children under 18 with cerebral palsy.
Assessed risk of bias using the Joanna Briggs Institute checklist.
Performed meta-analysis using a random-effects model.
Included twelve studies representing 1,417 children with cerebral palsy.
Identified high variability in obstructive sleep apnea prevalence influenced by cerebral palsy subtype and presence of epilepsy.
Noted that questionnaire evaluations were more common than objective measures like polysomnography.
The spastic subtype was consistently linked to higher obstructive sleep apnea prevalence.

Abstract

Background: Cerebral palsy (CP) is a common neuromuscular condition that affects posture and muscle coordination, often leading to compromised airway stability during sleep.Children with CP are at a higher risk of developing obstructive sleep apnea (OSA), especially when accompanied by comorbid conditions like epilepsy.However, determining the exact prevalence of OSA in this group is challenging because of the inconsistencies in study designs and differences in the diagnostic criteria.Aims and objectives: To estimate the pooled prevalence of OSA in children with CP, with and without epilepsy, and assess the diagnostic approaches used across studies.Methods: A systematic search was conducted across PubMed, Web of Science, Cochrane Library, and Google Scholar.Observational studies involving children under 18 years with CP, with or without epilepsy, and reporting OSA prevalence were included.Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist.Meta-analysis was performed using a random-effects model.Results: Twelve studies were included, having a total of 1,417 children with CP.A high variability in OSA prevalence was observed, which was influenced by CP subtype, presence of epilepsy, and the diagnostic tools.Questionnaire-based evaluations were more common than objective measures like polysomnography (PSG).The spastic subtype was consistently associated with higher OSA prevalence.Conclusion: Children with CP, especially those with the spastic subtype, are at a high risk for developing OSA.This risk may be further impacted by the presence of epilepsy.Standardized diagnostic protocols and further research are needed to improve early identification and management in this vulnerable population.

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