Large Body Movements on Video-Polysomnography are Associated with Daytime Dysfunction in Children with Restless Sleep Disorder

Restless sleep disorder (RSD) is a newly defined sleep related movement disorder characterized by large muscle movements (LMM) in sleep. We examined the sleep study, clinical characteristics, and daytime functioning in children with RSD and compared them to children with Periodic Limb Movement Disorder (PLMD) or Restless Legs Syndrome (RLS). Video polysomnography from 47 children with restless sleep was retrospectively reviewed for LMM and age- and sex- matched to 34 children with PLMD and 12 children with RLS. Data examined included PSG characteristics, ferritin, Pediatric Quality of Life (PedsQL), and Epworth Sleepiness Scores (ESS). Fourteen children met the clinical criteria for RSD with a LMM index of 5 or more per hour of sleep . Mean ESS was elevated in RSD patients compared to either the PLMD or RLS groups though the result did not reach statistical significance (RSD = 10.20 ± 6.81, PLMD = 6.19 ± 4.14, RLS = 6.25 ± 4.90). The PedsQL score was significantly decreased in the RLS group compared to RSD and was reduced overall in all three groups (PedsQL Total RSD= 70.76 ± 18.05, PLMD = 57.05 ± 20.33, RLS = 53.24 ± 16.97). Serum ferritin values were similar in all three groups (RSD= 26.89 ± 10.29, PLMD = 33.91 ± 20.31, RLS = 23.69 ± 12.94 ng/mL, P= NS). Children with RSD demonstrate increased daytime sleepiness compared to PLMD or RLS and all three disease groups decreased quality of life. Further studies are needed to examine long term consequences of RSD.

The incidence of sleep disturbances among medical students

Sleep disturbance is a common health problem that can influence the quality of life. There are several types of sleep disorders, such as obstructive sleep apnea, insomnia, narcolepsy, periodic limb movement disorder, and circadian dysregulation. Medical students are probably more prone to sleep disturbances due to their extreme academic stress. In this research, the incidence of sleep disturbance among medical students was examined, and the concomitant risk factors were determined. That was one-time research. A questioning was used to collect social, demographic and sleeping data. 678 1st, 2nd and 3rd year medical students were surveyed. 29% complained of at least one sleep disturbance. The most widely spread sleep disturbance observed among 51.8% medical students included insomnia (initial insomnia and sleep maintenance). 4th year students and those who spend much time on smartphones were more prone to sleep disturbances. Sleep disturbances are common among medical students. They need to be discovered and paid attention to before the situation gets worse.

611 Sleep Disorders in a Longitudinal Community Cohort of Children with Down Syndrome

Introduction Obstructive sleep apnea (OSA) affects 50–79% of children with Down Syndrome (CDS) prompting the development of guidelines to increase early detection of OSA. Cross-sectional survey based data shows that CDS have higher rates of bedtime resistance, sleep anxiety, night waking and parasomnias, which are also under-recognized. However, due to increased survival of CDS it may be that OSA treated in childhood returns or worsens, or that CDS may develop other sleep disorders as their life experience and exposure to comorbidities expands. Little is known about sleep disorders across the life span of CDS and screening guidelines leave a gap beyond early childhood. We determined to enhance understanding of respiratory and non-respiratory sleep disorders in a community population of CDS. Methods A retrospective population based observational study of CDS born between 1995–2011 was performed using the Rochester Epidemiology Project database. Medical records from all encounters through July 2020 were reviewed to identify sleep disorders. Sleep diagnoses, sleep test results, and treatments aimed at sleep disorders were recorded. Results 94 CDS were identified with 85 providing consent for research. 54 out of 85 individuals were diagnosed with OSA with 26 diagnosed prior to age 4 and 25 undergoing polysomnography prior to treatment. 26 individuals underwent polysomnography following surgery of which 16 continued to have clinically significant OSA requiring further treatment with secondary surgery, CPAP or anti-inflammatory therapy. Other sleep disorders observed included insomnia (n=16), restless leg syndrome (n=7), periodic limb movement disorder (n=10), idiopathic hypersomnia (n=1), nightmares (n=1), nocturnal enuresis (n=1), bruxism (n=1) and delayed sleep phase disorder (n=1). Most non-OSA sleep disorders were diagnosed during OSA evaluation by sleep medicine providers. However, many children were on melatonin without a formal sleep disorder diagnosis. Conclusion Both OSA and other sleep disorders remain under-diagnosed in CDS. This may be due to lack of validated screening tools that can be administered at the primary care level. Screening recommendations should consider the longitudinal nature of OSA in CDS and the presence of non-respiratory sleep disorders. Adenotonsillectomy is not as effective in CDS and postsurgical polysomnography is warranted along with long term follow-up to assess for further treatment needs. Support (if any):

584 Response to Intravenous Ferric Carboxymaltose in the Treatment of Childhood Restless Legs Syndrome/Periodic Limb Movement Disorder

Introduction Pediatric Restless Legs Syndrome (RLS)/Periodic Limb Movement Disorder (PLMD) are treatable disorders affecting quality of life. The first line therapy is oral iron, which may have gastrointestinal side effects or suboptimal absorption. Consequently, parenteral iron preparations are needed, but have been insufficiently studied in children. This study evaluates the response to intravenous ferric carboxymaltose (FCM) in pediatric RLS/PLMD. Methods We performed a retrospective chart review of children who received FCM between May 2018 and January 2019 for treating RLS/PLMD. Serum ferritin before and after the infusion were compared. Where possible, the Clinical Global Impressions of Improvement (CGI-I) was evaluated. Side effects documented in the charts were extracted. The median administered dose of FCM was 10.1 mg/kg (range 9.6–20.8) over 0.6 to2 hours. Results There were 27 patients, with mean age of 10.0 +/-4.2 years. 52% were female. 24 had RLS and 3 had PLMD. 20/27 (69.7%) had prior oral iron therapy; 4/20 (26.0%) experienced side effects. Adverse events from FCM infusion included procedure-related anxiety in 4/27, nausea in 1/27, infusion site pain in 2/27, and tachycardia in 1/27. One patient developed subcutaneous extravasation of iron with brownish skin discoloration and a resulting adjustment disorder. Three patients had phosphorus checked following infusion; all were normal. Serum ferritin was available both before and after the infusion for 17 patients. Mean serum ferritin prior to infusion was 27.2 +/-15.7 µg/L (range 6–58) and after the infusion it was 109.8 +/-49.34 µg/L (range 27–192). Mean ferritin increase was 82.6 +/-41.5 µg/L (range 14–160; p=0.0001). Post-infusion ferritin was over 50 µg/L for all but 2 of the subjects, with follow up ranging from 31–266 days (mean 120 days). A larger increase was seen at higher doses (p=0.01). Ferritin increase was not impacted by age, gender, symptom severity, PLMI or prior ferritin level. CGI-I was applied to 15 patients with sufficient follow-up documentation and showed improvement in 86%, with 79% much or very much improved. Conclusion The administration of FCM in children with RLS/PLMD is associated with a satisfactory rise in serum ferritin and modest symptomatic improvement. Support (if any):

Prevalence of sleep disorders among medical students of Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia

Background: Sleep disorders are a common medical problem and can affect health and quality of life. There are multiple types of sleep disorders such as obstructive sleep apnea, insomnia, narcolepsy, restless legs/periodic limb movement disorder, circadian rhythm disorders, sleepwalking and nightmares. Medical students appear to be more liable to develop sleep disorders due to their high academic load.Design and Methods: This study seeks to estimate the prevalence of sleep disorders among Umm Al-Qura University medical students and associated risk factors. This cross-sectional study was conducted at the Faculty of Medicine of Umm Al-Qura University in Makkah, Saudi Arabia. A self administrated questionnaire was used to collect the data including socio-demographic data and sleep-50 questionnaire. Four hundred and thirty-eight (438) medical students from the second year to the sixth year were recruited to the study.Results: Three hundred and twenty-three participants (73.8%) complained of at least one sleep disorder. The most prevalent sleep disorder among students was narcolepsy at 226 (51.6%). Female students, second year students and students spending significant time watching television or on smartphones were more affected than others with p values of 0.001, 0.005, and 0.004, respectively.Conclusions: Sleep disorders are common among medical students. It is essential to detect and address them before their condition deteriorates.

Sleep Health and Sleep Disorders

This chapter reviews the architecture and functions of sleep, how to interview patients on their sleep histories, how to evaluate for sleep disorders, commonly encountered sleep disorders and their pathophysiology, and the conventional and integrative therapies for each. The evaluation process includes a conventional sleep study as well as addressing vitamin D, B, and magnesium status. Sleep disorders discussed in this chapter are obstructive sleep apnea, insomnia, restless legs syndrome, periodic limb movement disorder, rapid-eye-movement behavior disorder, circadian rhythm disorders, and narcolepsy and other central hypersomnias. The role of conventional tools and times when alternative and complementary therapies may be considered are discussed in detail. Treatment covered include continuous positive airway pressure, oral appliance, myofunctional therapy, cognitive-behavioral therapy for insomnia, physical modalities, acupuncture, light therapy, melatonin, nutraceuticals, and other supplements that aid with sleep and daytime symptoms.