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  • Updated 12.18.2021
  • Expires For CME 12.18.2024

Restless sleep disorder in children

Introduction

Overview

Restless sleep disorder is a new pediatric sleep disorder characterized by frequent body movements during sleep and daytime impairment. Since its characterization, potential pathophysiologic mechanisms have been identified, particularly the association with iron deficiency. Alteration in cyclic alternating pattern and heart rate variability brings to light some of the possible contributing mechanisms. Treatment with oral or intravenous iron supplementation has been highly effective. Comorbid parasomnias or other disorders can further contribute to sleep disruption and daytime symptoms.

Key points

• Large muscle group movements during sleep characterize restless sleep disorder.

• Restless sleep disorder presents with significant daytime symptoms, such as sleepiness, hyperactivity, and cognitive deficits.

• Children with restless sleep disorder have low ferritin levels.

• Iron supplementation improves sleep in children with restless sleep disorder.

Historical note and terminology

Sleep medicine is a medical specialty dedicated to identifying, diagnosing, and treating sleep disorders (34). It is well established that sleep is essential for healthy development, growth, cognition, and emotional regulation, among other important areas of health in children and adults (22). Decades of research have demonstrated the importance of an appropriate amount of sleep. In fact, the American Academy of Sleep Medicine has published an expert consensus position statement that details the number of hours that children of various ages should sleep to avoid consequences of sleep deprivation, which include excessive daytime sleepiness, hyperactivity, and attention deficit (31; 29). Although the recommended total amount of sleep has been determined, assessment of sleep quality has not been equally studied. Sleep interruption can potentially affect sleep quality in a similar manner as sleep deprivation.

According to symptoms, pathophysiology, and presentation, sleep disorders are divided into six main groups: circadian rhythm disorders, insomnia, hypersomnia, sleep-related breathing disorders, parasomnias, and sleep-related movement disorders (32). A large body of literature proves the consequences of sleep disorders in adults, including cardiovascular and neurologic consequences (16; 25; 38), but studies in children are sparse, in particular studies that assess the consequences of sleep-related movement disorders in children (28; 27). Sleep-related movement disorders include restless legs syndrome, periodic limb movements of sleep, rhythmic movement disorders, bruxism, and the recently identified restless sleep disorder (11). Although restless sleep disorder has been identified and characterized in the past couple of years, restless sleep has been described since the early 1980s. In fact, the very first International Classification Of Sleep Disorders published in 1979 defined restless sleep as repetitive and persistent movements during sleep (03). This definition was later removed, but restless sleep has continued to be studied in the setting of poor sleep quality in various medical and sleep disorders (24).

A systematic review of the literature performed by the International Restless Legs Study Group demonstrated that there were several medical and sleep disorders reported in the literature that presented with restless sleep in children (13). Obstructive sleep apnea, restless legs syndrome, eczema, pain, and headaches, among others, were some of the most common conditions associated with restless sleep (26; 39; 20). Besides presenting as a symptom of another disorder, the systematic review also demonstrated that restless sleep could be a primary sleep disorder. The International Restless Legs Study Group task force then established consensus diagnostic criteria for restless sleep disorder.

Since then, advances in the literature have demonstrated the presence of restless sleep disorder in other groups, including children with attention deficit hyperactivity disorder (23) and children with parasomnia (33).

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