Advances in pediatric restless legs syndrome: Iron, genetics, diagnosis and treatment

Objective: Clinical reports in children implicate restless legs syndrome (RLS) with sleep and behavior problems. However, population-based studies on this association in adolescents and young adults are limited. Furthermore, few studies have evaluated the association between symptoms consistent with RLS and quality of life (QoL). Study Design: This cross-sectional study included 214 Caucasian and Hispanic adolescents and young adults aged 12-20 years. Symptoms consistent with RLS were based on four essential criteria and if the symptoms occurred ≥ 5 days/ month. Trouble falling asleep was present if reported "yes, still have the problem." Quality of life (QoL) was assessed using the Pediatric QoL Inventory. Three summary QoL scores ranging from 0-100 were evaluated; higher scores indicated better QoL. Results: Participants were 50% male and 68.1% Caucasian. Prevalence of RLS was 8.4% (n = 18). RLS was associated with trouble falling asleep (OR = 3.1, p = 0.049), and trouble falling asleep was associated with worse Psychosocial Health scores (Coeff. −5.6, p = 0.004) and Total Scale scores for quality of life (Coeff. −4.6, p = 0.007). Conclusions:The prevalence of symptoms consistent with RLS in this community-based sample of adolescents and young adults, aged 12-20, is comparable to rates reported in older cohorts. Symptoms consistent with RLS may be associated with trouble falling asleep and psychosocial distress that may contribute to a lower health-related quality of life. S C I E N T I F I C I N V E S T I G A T I O N SR estless legs syndrome (RLS) is defi ned as a sensorimotor disorder that can have a pronounced disturbance on sleep with symptom severity ranging from mild and occasional to nightly and severe with complete disruption of sleep. Four essential criteria have been identifi ed and are required for the identifi cation of RLS.1 These are: (1) an urge to move the legs often accompanied by unpleasant sensations; (2) the urge is worsened during rest or inactivity; (3) the urge is improved with leg movement; and (4) the urge is worsened in the evening or night. The prevalence of RLS in adults is approximately 10% and has been associated with iron defi ciency, pregnancy, end-stage renal disease, and family history of RLS.2,3 RLS was fi rst described in children by Walters in 1994, 4 and the prevalence of RLS has been reported to be between 2% and 6%, 5,6 although relatively few studies of RLS have been conducted in the pediatric and adolescent populations. In adults, RLS has been associated with depression.7 However, little information is available on the impact of RLS on quality of life. In one study, RLS was found to have a signifi cant impact on health-related quality of life, measured using the SF-36 (Medical Outcomes Study 36-Item Short Form health survey), in 85 adult subjects with RLS as compared to 2,474 subjects from the general population.8 Subjects with RLS reported signifi cant defi cits in health-related quality of life when compared to subjects with hypertension, cardiovascular conditions...

Section: Discussionmentioning

confidence: 99%

Restless Legs Syndrome, Sleep, and Quality of Life among Adolescents and Young Adults

Silva

Goodwin

Vana

et al. 2014

“…It is also possible that the effects of perioperative management with narcotics and sedatives caused the decrease in periodic limb movement in our study, because these are often used to treat periodic limb movement disorder. 34 Previous studies have emphasized respiratory complications and bleeding as the most common adverse events after AT. 10,11,[35][36][37][38] Despite these risks, the duration of postoperative monitoring is highly variable in high-risk children.…”

Section: Discussionmentioning

confidence: 99%

Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea

Waltuch

Gonik

et al. 2017

Study Objectives: There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT. Methods: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. Results: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9%, and sleep fragmentationarousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). Conclusions: Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. Commentary: A commentary on this article appears in this issue on page 775.

“…32 Low serum ferritin plays an important role in RLS pathophysiology and may also contribute to the pathophysiology of some psychiatric disorders such as ADHD. 22,32 We were interested in determining if there was a difference in serum ferritin levels in RLS patients without psychiatric disorders compared to those with psychiatric disorders. In this study we found low mean serum ferritin levels (< 50 μg/L) among children and adolescents diagnosed with RLS across age, gender, and the presence/absence of a psychiatric disorder.…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Comorbidity in Children and Adolescents with Restless Legs Syndrome: A Retrospective Study

Pullen

Wall

Angstman

et al. 2011

Objective: Children and adolescents with restless legs syndrome (RLS) are commonly diagnosed with comorbid attention defi cit hyperactivity disorder and behavioral disturbances. Uncertainty exists over the signifi cance of other co-occurring psychiatric disorders and their pharmacologic management in children with RLS. The purpose of this study was to determine the prevalence and nature of psychiatric disorders in children with RLS and to describe the use of psychotropic medications in our study cohort. Methods:The electronic medical records of children younger than 18 years of age who had been diagnosed with RLS between January 1, 2003, and December 31, 2009, were reviewed. Only those patients whose fi ndings were consistent with the 2003 NIH workshop diagnostic criteria for probable or defi nite restless legs syndrome were included in this study. The medical records were cross-referenced for encounters with a child psychiatrist or psychologist. Likewise, only psychiatric diagnoses whose medical records explicitly refl ected DSM-IV diagnostic criteria for psychiatric disorder(s) were included. Demographic data, serum ferritin, psychotropic medications, and in some cases, the results of pharmacogenomic testing were included in the data analysis in an ad hoc fashion. Results: We found 374/922 patients who met diagnostic criteria for childhood onset RLS. The mean age of the subjects was 10.6 years (range 0 to 18) and the male to female ratio was approximately 1:1. Overall, 239/374 (64%) patients with RLS had one or more comorbid psychiatric disorders. Attention defi cit hyperactivity disorder was found in 94/374 (25%) patients, mood disturbances were found in 109/374 (29.1%) patients, anxiety disorders in 43/374 (11.5%) patients, and behavioral disturbances in 40/374 (10.9%) patients. Attention defi cit hyperactivity disorder and disruptive behavior disorders were more common in males (OR = 1.94 for both), whereas mood disturbances and anxiety disorders were more common in females (OR = 1.6 and 1.26, respectively). Mean serum ferritin levels derived from all patients without any psychiatric disorder were compared to all patients with one or more psychiatric disorder. No differences were found. The number of new psychotropic medication trials increased significantly with increase in patient age. Stimulants and antidepressant medications were the most commonly prescribed agents. As a part of clinical care, 15 of these patients underwent pharmacogenomic testing. Metabolic abnormalities were predicted by genotyping in 12/15 (80%) patients. Conclusion: Comorbid psychiatric conditions occurred in twothirds of children with RLS, underscoring the need for multidisciplinary management of this condition. An important relationship might exist between psychotropic medication, and possibly pharmacogenomic factors, in children and adolescents with symptoms of restless legs syndrome. These fi ndings are consistent and build on those reported in the adult literature. keywords: Childhood onset restless legs syndrome, attention def...