铁缺乏与睡眠 - 范围综述。

Iron deficiency and sleep - A scoping review.

机构信息

H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children's Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, Canada.

H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children's Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, Canada; Division of Biochemical Genetics, BC Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, Canada.

出版信息

Sleep Med Rev. 2020 Jun;51:101274. doi: 10.1016/j.smrv.2020.101274. Epub 2020 Feb 8.

DOI:10.1016/j.smrv.2020.101274

PMID:32224451

Abstract

Iron deficiency (ID) is associated with sleep disorders, but standardized assessment of iron status in the diagnostic work-up and iron supplementation as treatment have not been considered in clinical practice. We investigated associations of ID with type and severity of sleep disorders and whether iron supplementation improves sleep-related symptoms. In 2017, we conducted a scoping review for the period 1972-2016 using the terms "iron deficiency anemia" and "sleep" on biomedical database search engines, and in 2019, we updated our review with an ad-hoc search. Among the 93 articles meeting our inclusion criteria, 74/93 studies investigated restless legs syndrome (RLS), 8/93 periodic limb movements in sleep (PLMs), 3/93 sleep disordered breathing (SDB), 6/93 general sleep disturbances (GSD), and 2/93 attention-deficit/ hyperactivity disorder related sleep disorders (ADHD-SDs). A statistically supported positive association with ID was found in 22/42 RLS, 3/8 PLMs, 1/2 SDB, 3/4 GSD, and 1/2 ADHD-SDs association studies. The ad-hoc literature search revealed eight additional association studies with a statistically supported positive association in 2/5 RLS, 1/1 SDB, 1/1 ADHD-SDs, and 1/1 restless sleep disorder (RSD) studies. Iron supplementation was beneficial in 29/30 RLS (including five randomized controlled trials [RCTs]), 1/1 SDB, and 2/2 GSD treatment studies. Iron supplementation was also beneficial in 2/2 RLS (including two RCTs), 1/1 GSD (RCT), and 1/1 RSD studies identified in the ad-hoc search. In pediatric populations, 1/1 RLS, 1/1 SDB, 2/5 PLMs, 2/3 GSD and 1/2 ADHD-SDs studies found positive associations, and 6/6 RLS and 2/2 GSD studies demonstrated a benefit with iron supplementation. In conclusion, iron investigation and supplementation should be considered in patients presenting with sleep disorders. To investigate the role of ID in sleep in the future, a harmonization of study designs, including outcome measures and standardized iron and inflammation status is necessary.

摘要

缺铁（ID）与睡眠障碍有关，但在临床实践中，并未考虑在诊断中对铁状态进行标准化评估以及用铁补充剂进行治疗。我们研究了 ID 与睡眠障碍的类型和严重程度之间的关系，以及铁补充剂是否能改善与睡眠相关的症状。2017 年，我们使用“缺铁性贫血”和“睡眠”这两个术语，在生物医学数据库搜索引擎上进行了 1972 年至 2016 年期间的范围综述，2019 年，我们又进行了一次特别搜索，对综述进行了更新。在符合纳入标准的 93 篇文章中，74/93 篇研究调查了不宁腿综合征（RLS），8/93 篇研究调查了周期性肢体运动障碍（PLMs）在睡眠中的作用，3/93 篇研究调查了睡眠呼吸障碍（SDB），6/93 篇研究调查了一般睡眠障碍（GSD），2/93 篇研究调查了注意缺陷多动障碍相关的睡眠障碍（ADHD-SDs）。在 42 项 RLS 关联研究、8 项 PLMs 关联研究、2 项 SDB 关联研究、4 项 GSD 关联研究和 2 项 ADHD-SDs 关联研究中，发现与 ID 呈统计学意义上的正相关。特别搜索文献还发现了另外 8 项关联研究，其中在 5 项 RLS 关联研究、1 项 SDB 关联研究、1 项 ADHD-SDs 关联研究和 1 项不安腿睡眠障碍（RSD）关联研究中，发现了与 ID 呈统计学意义上的正相关。铁补充剂对 30/30 项 RLS（包括 5 项随机对照试验[RCT]）、1 项 SDB 和 2/2 GSD 治疗研究有益。在特别搜索中发现的另外 2 项 RLS（包括两项 RCT）、1 项 GSD（RCT）和 1 项 RSD 研究中，铁补充剂也有获益。在儿科人群中，1/1 RLS、1/1 SDB、1/5 PLMs、2/3 GSD 和 1/2 ADHD-SDs 研究发现了阳性关联，6/6 RLS 和 2/2 GSD 研究表明铁补充剂有益。总之，对于出现睡眠障碍的患者，应考虑进行铁检测和补充。为了在未来研究 ID 对睡眠的作用，有必要协调研究设计，包括结局指标和标准化铁和炎症状态。