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Rethinking bedtime resistance in children with autism: is restless legs syndrome to blame?

Michelle L Kanney1, Jeffrey S Durmer2, Lynn Marie Trotti3

  • 1Emory School of Medicine and Children's Healthcare of Atlanta-Egleston Campus, Atlanta, Georgia.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|August 18, 2020
PubMed

Insights

Restless legs syndrome is common in children with autism and insomnia, often linked to low ferritin. Treatment, including iron, effectively resolves symptoms, improving sleep quality.

Area of Science:

  • Neurology
  • Pediatrics
  • Sleep Medicine

Background:

  • Autism Spectrum Disorder (ASD) is frequently associated with sleep disturbances, including chronic insomnia.
  • Restless Legs Syndrome (RLS) is a potential contributor to insomnia, but its prevalence and clinical correlates in children with ASD are not well-established.

Purpose of the Study:

  • To investigate the clinical characteristics of Restless Legs Syndrome (RLS) in children diagnosed with Autism Spectrum Disorder (ASD).
  • To evaluate the effectiveness of treatments for RLS in this pediatric population.

Main Methods:

  • Retrospective chart review of 103 children with ASD and chronic insomnia (ages 2-19) from a sleep center (2016-2019).
  • Clinical assessments for RLS symptomatology, overnight polysomnography, serum ferritin levels, and treatment response data were collected.

Main Results:

  • 41% of children with ASD and insomnia were diagnosed with RLS.
  • RLS diagnosis correlated with significantly lower serum ferritin levels and higher periodic limb movements during sleep.
  • Leg kicking and body rocking were highly indicative of RLS.

Conclusions:

  • RLS is an under-recognized cause of insomnia in children with ASD.
  • Thorough assessment of nocturnal motor complaints is crucial for identifying treatable RLS.
  • Treatment, including iron supplementation and gabapentin, showed high response rates.
Abstract

Keywords:
autismferritininsomniairon deficiencymotor restlessnessnocturnal leg kickingpediatricperiodic leg movementsrestless legs syndrome

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