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Sleep. 2019 Sep 29. pii: zsz234. doi: 10.1093/sleep/zsz234. [Epub ahead of print]

Determinants of ferritin response to oral iron supplementation in children with sleep movement disorders.

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Seattle Children's Hospital, Seattle, Washington, USA.
University of Washington, Seattle, Washington, USA.
Oasi Research Institute - IRCCS, Troina, Italy.



To identify children who respond to oral iron supplementation as evidenced by increased ferritin levels and to identify factors that correlate with improvement in ferritin levels in those who respond.


A retrospective chart review of the PLMS/RLS/RSD database at Seattle Children's Hospital was carried out. Data collected included nocturnal polysomnography parameters, age, sex, initial and follow-up ferritin level and date of collection, and presence of RLS, PLMS/PLMD, RSD, obstructive sleep apnea (OSA), neurologic, psychiatric, neurodevelopmental, or medical comorbidity. Oral iron therapy was evaluated by side effects (none; constipation; bad taste/nausea), subjective outcome in symptoms (resolved, improved, no change), and adherence to therapy (poor, fair, good).


Seventy-seven children were included in this study of whom 42 were classified as responders (increase in ferritin of ≥10 µg/L) and 35 were non-responders. Age and sex were not different between groups. Adherence was the only significant predictor of an increase in ferritin of ≥10 µg/L. Constipation was seen in 7.1% of responders vs. 45.8% of non-responders. No change in symptoms was reported in 26.2% of responders vs. 71.4% in non-responders. A significant correlation was found between treatment duration and ferritin level change in responders but not in non-responders.


Side effects hinders adherence to oral iron supplementation in children. Responders to oral iron show improvement in ferritin levels and symptoms, while non-responders show no improvement in ferritin levels despite a long-lasting treatment, at least in part of them.


Ferritin; Oral Iron supplementation; Periodic limb movement disorder; Periodic limb movements of sleep; Restless legs syndrome; Restless sleep disorder


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