October 6, 2021

Recognizing Sleep Issues in Childhood

In the 2013 Patient Odyssey Survey conducted by the RLS Foundation, nearly half (45%) of survey respondents reported the appearance of RLS symptoms before the age of 30. Recognizing sleep issues in childhood is important to prevent development of adverse mood, emotions, social skills, behavior and overall school performance in children and adolescents.

Restless sleep disorder (RSD) is a potential new sleep diagnosis for children and adolescents (ages 6 to 18). RSD represents a constellation of characteristics of disordered and disrupted sleep and often, impaired daytime function (tiredness, behavioral issues, poor school performance, etc.). Pediatric sleep researchers have developed eight criteria for a diagnosis of RSD:

1. Parent, caregiver, bed partner or patient gives accounts of “restless sleep.”
2. Movements of large muscle groups occur throughout the body and can include any combination of head and limb movements.
3. Movements take place during sleep or apparent sleep.
4. Five or more movements are observed during each hour of sleep.
5. Restless sleep is observed three or more times each week.
6. The patient exhibits restless sleep for a minimum of three months.
7. Restless sleep substantially impairs the patient’s life activities, including social, emotional, academic or occupational performance. Other effects include changes in emotional state, short attention span, tiredness, inattentiveness or lack of impulse control.
8. All behavioral, medical or sleep disorders have been eliminated as possible causes of the disrupted sleep, including a review of the patient’s current medications and dietary behaviors to determine whether the disrupted sleep may have another underlying cause.

All eight criteria must be present for a diagnosis of RSD. Restless sleep can co-occur with other disorders such as obstructive sleep apnea, asthma or eczema, so it is important to include screening for those disorders in the consideration of an RSD diagnosis.

Restless legs syndrome (RLS) shares similar features with RSD, such as difficulty falling asleep and staying asleep. Video polysomnography (videorecording of sleep studies) provides a visual picture that helps to differentiate RLS from RSD. In children with RLS, the primary visual feature is an increase in periodic leg movements; whereas in children with RSD, large body movements and repositioning that repeat throughout the night are highlighted on video. More importantly, in RLS, a verbalized “need to move” the legs while awake by the child or adolescent is the key diagnostic feature that is not characteristic of RSD.

In a 2018 study in the scientific journal Sleep, children with RSD were found to have low ferritin levels (lower than those found in pediatric RLS patients), and another study in 2021 showed RSD symptoms respond to oral or intravenous iron. Additional studies will further the understanding of this phenomenon and its possible relationship to the development of RLS.

Many adults with RLS report the emergence of RLS symptoms in their youth. RSD may account for some of these early symptoms that were part of their childhood and adolescence. If you suspect a child has a sleep disorder, a comprehensive medical evaluation by a pediatric sleep specialist will help to identify any potential sleep conditions that may be responsible for disrupting a restful night’s sleep.

References:

DelRosso LM, Bruni O, Ferri R. Restless sleep disorder in children: a pilot study on a tentative new diagnostic category. Sleep. 2018;41.

DelRosso LM, Ferri R, Allen RP, Bruni O, Garcia-Borreguero D, Kotagal S et al. Consensus diagnostic criteria for a newly defined pediatric sleep disorder: restless sleep disorder (RSD). Sleep Med. 2020;75:335-40.

DelRosso LM, Picchietti DL, Ferri R. Comparison between oral ferrous sulfate and intravenous ferric carboxymaltose in children with restless sleep disorder. Sleep. 2021;44.