By: DEBRA L. BECK, Family Practice News Digital Network
AT SLEEP 2014
VITALSKey clinical point:
For children with restless sleep, consider iron supplementation at a serum ferritin level of 20 mcg/L.Major finding:
A serum ferritin threshold of 20 mcg/L is a better predictor of sleep restlessness in children than is the adult threshold of 50 mcg/L.
Data source: Review of 537 children (1-18 yrs) referred to the University of Michigan pediatric sleep clinic.
Disclosures: The study was supported by a grant from the Charles Woodson Fund for Clinical Research.
MINNEAPOLIS – Using the adult treatment threshold for serum ferritin to guide treatment in children with restless sleep may lead to inappropriate iron supplementation.
In both adults and children, iron deficiency has been linked to the presence and severity of restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS). For adults, a serum ferritin less than 50 mcg/L is the threshold commonly used to guide iron supplementation for patients with RLS or PLMS.
A report in the New England Journal of Medicine confirms previous studies suggesting that long-term treatment with the type of drugs commonly prescribed to treat restless leg syndrome (RLS) can cause a serious worsening of the condition in some patients. The year-long study from a multi-institutional research team found that pregabalin – which is FDA-approved to treat nerve pain, seizures, and other conditions – was effective in reducing RLS symptoms and was much less likely to cause symptom worsening thanpramipexole, one of several drugs that activate the dopamine neurotransmission system and are FDA approved for treatment of RLS.
“Our key finding is that dopaminergic drugs, while very effective for many people with RLS, can worsen symptoms in some patients over time, while non-dopaminergic pregabalin is not associated with this disturbing side effect,” says John Winkelman, MD, PhD, of the Massachusetts General Hospital Department of Psychiatry, senior author of the study.