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Intravenous iron therapy in the pediatric sleep clinic: a single institution experience
David G Ingram1, Baha Al-Shawwa1, Lourdes M DelRosso2
1Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, Missouri.
Insights
Intravenous iron infusions show promise for children with restless sleep disorders, with 73% experiencing symptom improvement. This study supports IV iron's effectiveness and safety in pediatric sleep clinics.
Area of Science:
- Pediatric Sleep Medicine
- Iron Metabolism and Deficiency
- Neurology
Background:
- Restless legs syndrome (RLS), periodic limb movement disorder (PLMD), and restless sleep disorder (RSD) can significantly impact children's quality of life.
- Oral iron supplementation is often the first line of treatment, but some children do not respond adequately.
- Intravenous (IV) iron administration has emerged as a potential therapeutic option for these conditions.
Purpose of the Study:
- To evaluate the clinical response and safety of IV iron supplementation in children diagnosed with RLS, PLMD, or RSD.
- To assess changes in ferritin levels following IV iron infusion in a pediatric sleep clinic population.
- To provide further evidence supporting the use of IV iron for pediatric sleep disorders refractory to oral iron.
Main Methods:
- A retrospective chart review was conducted on pediatric patients treated at a single sleep clinic.
- Data on sleep symptoms and serum ferritin levels were collected before and after IV iron infusion.
- Patients received IV iron, primarily ferric carboxymaltose, for RLS, PLMD, or RSD.
Main Results:
- Out of 59 patients with follow-up, 73% reported improvement in at least one sleep-related symptom after IV iron infusion.
- Average ferritin levels significantly increased from 21.7 μg/L to 147.9 μg/L post-infusion (P < .001).
- No significant differences in ferritin level changes, sex, or age were found between patients who improved and those who did not. Mild adverse reactions, such as behavioral changes, occurred in 11% of patients.
Conclusions:
- IV iron supplementation is an effective and safe treatment option for pediatric patients with RLS, PLMD, and RSD who are unresponsive to oral iron.
- The study supports the use of IV iron to improve sleep symptoms in children with these specific sleep disorders.
- Further research can explore optimal dosing and long-term outcomes of IV iron therapy in pediatric sleep medicine.
Study Objectives:
Initial reports of intravenous (IV) iron administration have been promising for children with restless legs syndrome, periodic limb movement disorder, and restless sleep disorder. The aim of the current study was to evaluate further the clinical response to IV iron supplementation in children seen in a pediatric sleep clinic.
Methods:
We performed a retrospective chart review of children cared for in a single pediatric sleep clinic who also underwent IV iron infusion. Pre and post IV data regarding their sleep symptoms and ferritin levels were abstracted.
Results:
Overall, 63 pediatric sleep patients underwent IV iron infusion, mostly with ferric carboxymaltose (n = 60), for restless legs syndrome (n = 30), periodic limb movement disorder (n = 22), and restless sleep disorder (n = 17). Of the 59 patients with clinical follow-up, 39 (73%) noted improvement in at least 1 symptom, and 14 (26%) did not notice improvement or noticed worsening symptoms. Of the 59 patients with preinfusion and postinfusion labs, the average ferritin level increased from 21.7 (13.3) to 147.9 (120.9) μg/L, P < .001. Comparing patients who experienced clinical improvement vs those who did not, there were no statistically significant differences in change in ferritin levels (P = .278), sex (P = .452), or age (P = .391). Ferritin change with infusion according to diagnostic subgroups (restless legs syndrome/periodic limb movement disorder/restless sleep disorder) was examined, and no significant differences were noted (F(2,56) = 0.852, P = .432). In terms of immediate adverse reactions to the IV infusion, 7 (11%) experienced at least 1 side effect, with the most common being behavior change (n = 6) or gastrointestinal discomfort (n = 4); no episodes of anaphylaxis or extravasation were noted.
Conclusions:
These data provide additional support for the efficacy and safety of IV iron for pediatric restless legs syndrome, periodic limb movement disorder, and restless sleep disorder recalcitrant to oral iron.
Citation:
Ingram DG, Al-Shawwa B, DelRosso LM, Sharma M. Intravenous iron therapy in the pediatric sleep clinic: a single institution experience. J Clin Sleep Med. 2022;18(11):2545-2551.
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