Leg movements during sleep in children treated with serotonergic antidepressants

Abstract

Study objectives To evaluate leg movements during sleep (LMS) in children taking serotonergic antidepressants, compared to those of children with restless legs syndrome (RLS) and controls, and to assess the time structure of intermovement intervals (IMI). Methods Twenty-three children (12 girls, mean age 14.1 years) on antidepressants and with a total LMS index ≥15/hour, 21 drug-naïve RLS children (11 girls, mean age 13.6 years) also with total LMS index ≥15/hour, and 35 control children (17 girls, mean age 14.3 years) were recruited. LMS were scored and a series of parameters was calculated, along with the analysis of their time structure. Results Children taking antidepressants showed higher total and periodic LMS (PLMS) indexes than both controls and RLS children, as well as higher short-interval and isolated LMS indexes than controls. LMS periodicity was highest in children on antidepressants. In children taking antidepressants, a well-defined PLMS IMI peak corresponding to ~10-60 s, with a maximum at ~20 s was present, which was much less evident in RLS patients and absent in controls. A progressive decrease of PLMS during the night and more frequent arousals were found in children on antidepressants and with RLS. Conclusions Children taking serotonergic antidepressants show higher periodicity LMS than children with RLS or controls and have a higher number of PLMS through the night. Antidepressant-associated PLMS in children seem to have features similar to PLMS of adults with RLS. Whether this is a marker of an increased risk to develop RLS later in life needs to be determined.

An approach to common sleep presentations in infants and toddlers

“…34 Children who take selective serotonin reuptake inhibitors seem more affected. 35 In most cases, children presenting with PLMS have only occasional such movements, typically around sleep onset, without significantly affecting overall sleep time and maintenance; these children require no specific treatment. However, if the movements are atypical, frequent and disrupt sleep, consider performing iron studies (targeting serum ferritin >50 μg/L).…”

Restless legs syndrome: Over 50 years of European contribution

“…PLMS have been reported to be increased in both adults (Yang, White, & Winkelman, 2005) and children (Ferri et al, 2022; Vendrame, Zarowski, Loddenkemper, Steinborn, & Kothare, 2011) taking selective serotonin reuptake inhibitors (SSRIs) and serotonin‐norepinephrine reuptake inhibitors (SNRIs) antidepressants, but not the dopamine reuptake inhibitor bupropion (Kolla, Mansukhani, & Bostwick, 2018). SSRIs and SNRIs increase serotonin levels, and serotonergic projections from the raphe nuclei influence dopaminergic neurons in the substantia nigra, ventral tegmental area, nigro‐striatal pathway and mesolimbic dopaminergic system (Digiovanni, Dimatteo, Pierucci, & Esposito, 2008).…”

Behavioral sleep medicine—The need for harmonization of clinical best practice outcome measures in children and adolescents with intellectual or developmental disabilities and restless sleep

“…Interestingly, recent data on the effect of antidepressants on sleep in children ( 19 ) showed an increase of total and PLMs compared to controls and to drug-naïve RLS children, with features akin to adult RLS, including an inter-movement interval peak between 10 and 60 s, progressively declining throughout the night.…”