Abstract
Objective
Recent data suggest that both disordered sleep and low serum iron occur more frequently
in children with autism compared with children with typical development. Iron deficiency
has been linked to specific sleep disorders. The goal of the current study was to
evaluate periodic limb movements in sleep and iron status in a group of children with
autism compared with typically developing children and children with nonautism developmental
delay to determine if iron status correlated with polysomnographic measures of latency
and continuity and periodic limb movements in sleep.
Methods
A total of 102 children (68 with autism, 18 typically developing, 16 with developmental
delay) aged 2 to 7 years underwent a one-night modified polysomnography study and
phlebotomy at the National Institutes of Health to measure serum markers of iron status
(ferritin, iron, transferrin, percent transferrin saturation).
Results
No serum iron marker was associated with periodic limb movements of sleep or any other
sleep parameter; this did not differ among the diagnostic groups. No significant differences
among groups were observed on serum iron markers or most polysomnogram parameters:
periodic limb movements in sleep, periodic limb movements index, wake after sleep
onset, or sleep efficiency. Children in the autism group had significantly less total
sleep time. Serum ferritin was uniformly low across groups.
Conclusions
This study found no evidence that serum ferritin is associated with polysomnogram
measures of latency or sleep continuity or that young children with autism are at
increased risk for higher periodic limb movements index compared with typically developing
and developmental delay peers.
Keywords
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References
- Ferritin and iron levels in children with autistic disorder.Eur J Pediatr. 2012; 171: 143-146
- Iron deficiency and the measurement of iron status.Nutr Res Rev. 1992; 5: 198-202
Iron deficiency anemia. World Health Organization Web Site. Available at: http://www.who.int/nutrition/topics/ida/en/. Accessed February 10, 2015.
- Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study.BMC Psychiatry. 2013; 13: 161
- Ferritin as an indicator of suspected iron deficiency in children with autism spectrum disorder: prevalence of low serum ferritin concentration.Dev Med Child Neurol. 2006; 48: 1008-1009
- Iron deficiency in autism and Asperger syndrome.Autism. 2002; 6: 103-114
- Iron deficiency in preschool children with autistic spectrum disorders.Res Autism Spect Dis. 2010; 4: 639-644
- Iron deficiency – United States, 1999–2000.MMWR Morb Mortal Wkly Rep. 2002; 51: 897-899
- Dietary adequacy of children with autism compared with controls and the impact of restricted diet.J Dev Behav Pediatr. 2013; 34: 449-459
- Relationship of serum ferritin levels to sleep fragmentation and periodic limb movements of sleep on polysomnography in autism spectrum disorders.Pediatr Neurol. 2013; 49: 274-278
- Sleep in children with autism spectrum disorder.Pediatr Neurol. 2012; 47: 242-251
- Sleep disturbances in children with psychiatric disorders.Semin Pediatr Neurol. 2008; 15: 70-78
- A laboratory study of sleep in Asperger's syndrome.Neuroreport. 2000; 11: 127-130
- Atypical sleep architecture and the autism phenotype.Brain. 2005; 128: 1049-1061
- Lower limb motor restlessness in Asperger's disorder, measured using actometry.Psychiatry Res. 2004; 128: 63-70
- Sleep problems in children with autism, attention-deficit hyperactivity disorder, and epilepsy.Res Autism Spect Dis. 2012; 6: 413-421
- Children with autism: effect of iron supplementation on sleep and ferritin.Pediatr Neurol. 2007; 36: 152-158
- The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism.J Autism Dev Disord. 2000; 30: 205-223
- Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders.J Autism Dev Disord. 1994; 24: 659-685
- Validation of the social communication questionnaire in a population cohort of children with autism spectrum disorders.J Am Acad Child Psychiatry. 2007; 46: 1324-1332
- Rapid eye movement sleep percentage in children with autism compared with children with developmental delay and typical development.Arch Pediatr Adolesc Med. 2010; 164: 1032-1037
- The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications.American Academy of Sleep Medicine, Westchester, IL2007
WHO. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations: Vitamin and Mineral Nutrition Information System. Available at: http://www.who.int/vmnis/indicators/serum_ferritin.pdf. Published 2011. Accessed January 2015.
- Assessment of iron deficiency in US preschool children and nonpregnant females of childbearing age: National Health and Nutrition Examination Survey 2003-2006.Am J Clin Nutr. 2009; 89: 1334-1342
- Periodic limb movements in children: prevalence in a referred population.Sleep. 2004; 27: 313-315
- Periodic limb movement disorder of sleep in children.J Sleep Res. 2003; 12: 73-81
- Iron deficiency decreases dopamine D 1 and D 2 receptors in rat brain.Pharmacol Biochem Behav. 2001; 69: 409-418
- Iron deficiency alters dopamine transporter functioning in rat striatum.J Nutr. 2000; 130: 2831-2837
- In vivo dopamine metabolism is altered in iron-deficient anemic rats.J Nutr. 1997; 127: 2282-2288
- Insight into the pathophysiology of restless legs syndrome.J Neurosci Res. 2000; 62: 623-628
- Dopamine and iron in the pathophysiology of restless legs syndrome (RLS).Sleep Med. 2004; 5: 385-391
- A double-blind, placebo-controlled study of the treatment of periodic limb movements in sleep using carbidopa/levodopa and propoxyphene.Sleep. 1993; 16: 717-723
- Periodic leg movements in sleep and periodic limb movement disorder: prevalence, clinical significance and treatment.Sleep Med Rev. 2006; 10: 169-177
- Restless legs syndrome.Neurology. 1960; 10: 868-873
- The role of iron in restless legs syndrome.Mov Disord. 2007; 22: S440-S448
- Abnormalities in CSF concentrations of ferritin and transferrin in restless legs syndrome.Neurology. 2000; 54: 1698-1700
- A genetic risk factor for periodic limb movements in sleep.N Engl J Med. 2007; 357: 639-647
- Correlates of periodic limb movements of sleep in the pediatric population.Pediatr Neurol. 2008; 39: 33-39
- Periodic limb movements in sleep and iron status in children.Sleep. 2003; 26: 735-738
- Low body stores of iron and restless legs syndrome: a correctable cause of insomnia in adolescents and teenagers.Sleep Med. 2002; 3: 127-132
- Motor activity and intra-individual variability according to sleep-wake states in preschool-aged children with iron-deficiency anemia in infancy.Early Hum Dev. 2013; 89: 1025-1031
- Capturing PLMS and their variability in children with sickle cell disease: does ankle activity monitoring measure up to polysomnography?.Sleep Med. 2012; 13: 1013-1020
- Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: a report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health.Sleep Med. 2003; 4: 101-119
- CSF iron, ferritin and transferrin levels in restless legs syndrome.J Sleep Res. 2005; 14: 43-47
- Iron deficiency anemia in infancy exerts long-term effects on the tibialis anterior motor activity during sleep in childhood.Sleep Med. 2012; 13: 1006-1012
- Children Show Individual Night-to-Night Variability of Periodic Limb Movements in Sleep.Sleep. 2009; 32: 530-535
- Polysomnographic characteristics in normal preschool and early school-aged children.Pediatrics. 2006; 117: 741-753
- Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine.J Clin Sleep Med. 2012; 8: 597-619
Article info
Publication history
Published online: June 26, 2015
Accepted:
June 19,
2015
Received:
April 13,
2015
Footnotes
Clinical Trials Registration: Clinical and Immunological Investigations of Subtypes of Autism, NCT00298246: http://www.clinicaltrials.gov/show/NCT00298246. Minocycline to Treat Childhood Regressive Autism, NCT00409747: http://clinicaltrials.gov/show/NCT00409747.
Identification
Copyright
Published by Elsevier Inc.
