Iron Deficiency and Restless Sleep/Wake Behaviors in Neurodevelopmental Disorders and Mental Health Conditions

Abstract

Iron deficiency (ID) and restlessness are associated with sleep/wake-disorders (e.g., restless legs syndrome (RLS)) and neurodevelopmental disorders (attention deficit/hyperactivity and autism spectrum disorders (ADHD; ASD)). However, a standardized approach to assessing ID and restlessness is missing. We reviewed iron status and family sleep/ID history data collected at a sleep/wake behavior clinic under a quality improvement/quality assurance project. Restlessness was explored through patient and parental narratives and a 'suggested clinical immobilization test'. Of 199 patients, 94% had ID, with 43% having a family history of ID. ADHD (46%) and ASD (45%) were common conditions, along with chronic insomnia (61%), sleep-disordered breathing (50%), and parasomnias (22%). In unadjusted analysis, a family history of ID increased the odds (95% CI) of familial RLS (OR: 5.98, p = 0.0002, [2.35-15.2]), insomnia/DIMS (OR: 3.44, p = 0.0084, [1.37-8.64]), and RLS (OR: 7.00, p = 0.01, [1.49-32.93]) in patients with ADHD, and of insomnia/DIMS (OR: 4.77, p = 0.0014, [1.82-12.5]), RLS/PLMS (OR: 5.83, p = 0.009, [1.54-22.1]), RLS (OR: 4.05, p = 0.01, [1.33-12.3]), and familial RLS (OR: 2.82, p = 0.02, [1.17-6.81]) in patients with ASD. ID and restlessness were characteristics of ADHD and ASD, and a family history of ID increased the risk of sleep/wake-disorders. These findings highlight the need to integrate comprehensive blood work and family history to capture ID in children and adolescents with restless behaviors.

Keywords: attention deficit/hyperactivity disorder; autism spectrum disorder; circadian rhythm sleep disorders; fetal alcohol spectrum disorder; hematologic indices; insomnia; iron deficiency; prenatal alcohol exposure; restless leg syndrome; restless sleep disorder; sleep-disordered breathing.

Figure 1

(a) Formal SCIT, visual depiction of the steps (①–⑦) as described in Table 1, which is used to capture descriptions of sensations from the affected individual in combination with observations from the assessing professional in a structured manner for exploring individual RLS symptoms (courtesy of kleanthes Publishers, Dresden [25,37,44]). (b) Informal SCIT, visual depiction of the play situations as described in Table 1, which is used in children and individuals who cannot participate in a formal SCIT. Here we explore the balance between movements and resting from an RLS perspective together with the caregivers based solely on observations (courtesy of kleanthes Publishers, Dresden [25,37,44]).