A new study published in Nutrients has established a connection between iron deficiency (ID) and sleep disorders in children diagnosed with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). This research emphasizes the critical role that iron plays in sleep regulation.
Iron is a vital trace element found in various brain cells, including neurons, astrocytes, oligodendrocytes, and microglia. It is essential for the synthesis of neurotransmitters that control the sleep-wake cycle and is integral to the dopamine production pathway. Despite its importance, iron levels are often overlooked in the clinical management of sleep disorders.
Common causes of sleep disorders include hyper-arousability, restless leg syndrome (RLS), hyper-motor restlessness, restless sleep disorder (RSD), and periodic limb movements in sleep (PLMS).
The study collected prospective data from clinical assessments and structured intake forms between 2021 and 2023, followed by a retrospective analysis. Researchers recorded the most recent iron status, parental history of ID, and various covariates such as comorbidities, demographics, and medications. Children with hematologic comorbidities were excluded from the study, which had a mean participant age of approximately 11 years.
Among 250 patients referred to the Sleep/Wake-Behavior clinic in Vancouver, British Columbia, 80% met the inclusion criteria. Of these, 188 were identified as having either non-anemic or anemic ID, with many participants reporting a family history of ID, particularly among mothers during their teenage years or pregnancy.
Notably, about half of the cohort exhibited disruptive behaviors, with ADHD being the most prevalent diagnosis. Among the 84 participants with internalizing disorders, anxiety was the most frequently reported. Other common neurodevelopmental conditions included ASD, global developmental delay/intellectual disability, and various genetic disorders.
The study revealed that 74% of patients experienced RLS, with 52% reporting a family history of the condition. Additionally, 30% of participants exhibited PLMS or restless sleep. Among the 92 patients diagnosed with ADHD, those with a family history of ID had a significantly increased risk of RLS, insomnia, and other sleep disturbances. Conversely, no increased risk of painful RLS was found.
A family history of ID was linked to a four-fold increase in the likelihood of experiencing RLS or PLMS, as well as insomnia and familial RLS among children with ASD. Interestingly, while ADHD patients were nearly twice as likely to develop RLS compared to those without ADHD, no significant association was observed between RLS and ASD or issues related to bedtime resistance.
These findings underscore the importance of comprehensive blood work and family history assessments to identify iron deficiency in children and adolescents exhibiting restless behaviors. The study’s strengths include the high prevalence of ID and its potential link to self-injurious behaviors. However, it also acknowledges limitations, such as the lack of detailed information on the causes of ID and the retrospective nature of the analysis.
Conclusion
Future research is necessary to explore the mechanisms underlying iron deficiency, as this nutrient deficit may arise from various factors, including inflammation and inadequate nutrition. Additionally, the study’s retrospective design limited the categorization of certain data, such as distinguishing between anemic and non-anemic ID, which could affect the findings’ robustness.
In summary, the study highlights the critical need for awareness and further investigation into the role of iron in sleep disorders among children with ADHD and autism, paving the way for improved management strategies in clinical settings.
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