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G332(P) Excessive daytime sleepiness in teenagers – could it be due to iron deficiency?
  1. C Kallappa,
  2. T Ninan
  1. Paediatric, Heart of England NHS Hospitals Foundation Trust, Birmingham, UK

Abstract

Introduction Research has shown that restless leg syndrome, restless sleep or insomnia among paediatric population is often related to low iron stores. Dopamine plays a role in neuronal networks including sleep activity. Iron is vital to the brain’s dopamine system and therefore iron deficiency is a contributing factor to sleep disorders. 1.9% of children and 2% of adolescents are affected with restless leg syndrome.1 A 2002 study showed that abnormal iron stores or metabolism may result in restless leg syndrome causing insomnia in teenagers.2

Back ground To assess teenagers presenting with recent onset sleep problems with respect to presenting complaints, RLS (restless leg syndrome) questionnaire, investigations and measuring outcomes using Modified Paediatric Epworth Sleepiness Scale (Ages 6–16), pre and post treatment.

Patients and methods 5 teenagers aged between 14 and 15 years, presenting with excessive day time sleepiness and tiredness referred to sleep clinic in the last 12 months were analysed. They were sent sleep questionnaire prior to clinic visit. They completed the RLS questionnaire in the clinic and the modified paediatric Epworth sleepiness scale. Those found to have Ferritin <50microgram/lt were treated with iron supplements for 3 months along with sleep hygiene and dietary advice.

Results 3/5 teenagers had nocturnal leg pains with multiple arousals. The RLS questionnaire was positive for all 5 questions. Epworth sleepiness score was >10. Iron studies showed a mean of 9 mmols/lt (10.7–28.6) and ferritin of 9.7 ng/ml (5–204) respectively. Post iron treatment, clinical symptoms and Epworth scoring improved (0–2).

Conclusion Sleep related symptoms in these patients were due to the restless legs. This supports the hypothesis that low iron levels may result in RLS causing sleep disturbances in teenagers. Iron studies including ferritin levels in teenagers is indicated with insomnia, excessive daytime sleepiness of unexplained origin even when anaemia is mild or absent.

We recommend commencing iron supplementation for patients with ferritin of <50 ng/lt along with sleep hygiene and dietary advice.

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