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Sleep disturbances in children and adolescents with iron deficiency: Questionnaire-based and actigraphic findings

Maria Ausilia Musumeci1, Valentina Baglioni1, Michela Ribersani2

  • 1Department of Human Neuroscience, Sapienza University, Rome, Italy.

Sleep Medicine
|July 15, 2026
PubMed

Insights

Children with iron deficiency (ID) and iron deficiency anemia (IDA) experience significant sleep disturbances, including restless and fragmented sleep. Iron supplementation may improve reported symptoms but shows only partial normalization on objective measures.

Area of Science:

  • Pediatric Sleep Medicine
  • Nutritional Neurology

Background:

  • Iron deficiency (ID) and iron deficiency anemia (IDA) are increasingly recognized in children.
  • Sleep disturbances, including restless sleep and movement disorders, are frequently reported in pediatric ID/IDA.
  • Objective correlates and actigraphic data for sleep disturbances in pediatric ID/IDA are not well-defined.

Purpose of the Study:

  • To characterize caregiver-reported sleep disturbances and restless legs syndrome (RLS)-related symptoms in children with ID/IDA.
  • To objectively assess sleep patterns using actigraphy in pediatric ID/IDA.
  • To compare sleep findings in ID/IDA with healthy controls and evaluate short-term changes after iron supplementation.

Main Methods:

  • A single-center pilot observational study involving 31 children with ID/IDA.
  • Caregiver-reported sleep evaluation using the Sleep Disturbance Scale for Children (SDSC) and RLS-oriented items.
  • Home actigraphy was performed on 16 children, with follow-up after iron treatment in 8 participants.

Main Results:

  • Children with ID/IDA exhibited significantly higher SDSC scores compared to healthy controls, particularly in difficulty initiating/maintaining sleep, sleep-wake transition disorders, and sleep hyperhidrosis.
  • Approximately 32% of children with ID/IDA reported clinically plausible RLS-related symptoms.
  • Actigraphy revealed shorter sleep duration, reduced sleep efficiency, and increased sleep fragmentation in the ID/IDA cohort.
  • Iron supplementation led to improved caregiver-reported restlessness but only partial normalization of actigraphic sleep parameters.

Conclusions:

  • Pediatric ID/IDA is strongly associated with both subjective and objective sleep disruptions, manifesting as restless and fragmented sleep.
  • Systematic sleep assessment should be considered in children with low iron stores.
  • Iron status evaluation is crucial in the work-up for children presenting with restless or nonrestorative sleep.
Abstract

Keywords:
ActigraphyIron deficiencyIron deficiency anemiaPediatric restless legs syndromeRestless sleepSleep disturbance

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