Emory School of Medicine and Children's Healthcare of Atlanta-Egleston Campus, Atlanta, Georgia.
Nox Health, Atlanta, Georgia.
J Clin Sleep Med. 2020 Dec 15;16(12):2029-2035. doi: 10.5664/jcsm.8756.
In this study we investigated the clinical correlates of restless legs syndrome in children with autism and report on our experiences with response to treatment.
A retrospective chart review of children seen in our sleep center from 2016-2019 was performed to identify children with autism and chronic insomnia. Patients underwent clinical assessments for restless legs symptomatology. Overnight polysomnogram, serum ferritin testing, and response to clinical treatment data were collected.
A total of 103 children with autism and chronic insomnia were identified (age range 2-19 years). Of these, 41 children (39%) were diagnosed with restless legs syndrome. The diagnosis of restless legs syndrome was associated with significantly lower serum ferritin levels (mean 29 ± 18.62 ng/mL vs non-restless legs syndrome 56.7 ± 17.59, P < .001) and higher periodic limb movements of sleep on polysomnogram (8.12 ± 6.6 vs non-restless legs syndrome 0.06 ± 0.17). The presence of leg kicking, body rocking, or any symptoms involving the legs was highly correlated with the diagnosis of restless legs syndrome. Positive treatment response was noted in nearly all treated patients, including those treated with oral iron supplementation alone (25 children, 23 responders), gabapentin alone (12 children, all responders), and combination therapy (3 children, all responders).
Our findings suggest restless legs syndrome may represent an under-recognized cause of insomnia in children with autism. Initial assessment should include a thorough query of behaviors related to nocturnal motor complaints, because restless legs syndrome may be a treatable cause of sleep disruption.
本研究旨在调查自闭症儿童中不宁腿综合征的临床相关性，并报告我们对治疗反应的经验。
对 2016 年至 2019 年在我们睡眠中心就诊的自闭症和慢性失眠儿童进行回顾性图表审查。患者接受不宁腿症状的临床评估。收集夜间多导睡眠图、血清铁蛋白检测和对临床治疗的反应数据。
共确定 103 例自闭症和慢性失眠儿童（年龄 2-19 岁）。其中 41 例（39%）被诊断为不宁腿综合征。不宁腿综合征的诊断与血清铁蛋白水平显著降低（均值 29±18.62ng/ml 与非不宁腿综合征 56.7±17.59ng/ml，P<.001）和睡眠多导图上的周期性肢体运动增加（8.12±6.6 与非不宁腿综合征 0.06±0.17）相关。腿部踢动、身体摇晃或任何涉及腿部的症状与不宁腿综合征的诊断高度相关。几乎所有接受治疗的患者都有阳性治疗反应，包括单独接受口服铁补充治疗的患者（25 例，23 例有反应）、加巴喷丁单独治疗的患者（12 例，均有反应）和联合治疗的患者（3 例，均有反应）。
我们的发现表明，不宁腿综合征可能是自闭症儿童失眠的一个未被充分认识的原因。初步评估应包括对夜间运动相关投诉行为的彻底询问，因为不宁腿综合征可能是一种可治疗的睡眠障碍原因。
