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Sleep disturbances and serum ferritin levels in children with attention-deficit/hyperactivity disorder

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Abstract

Background

A subset of children with attention-deficit/hyperactivity disorder (ADHD) may present with impairing sleep disturbances. While preliminary evidence suggests that iron deficiency might be involved into the pathophysiology of daytime ADHD symptoms, no research has been conducted to explore the relationship between iron deficiency and sleep disturbances in patients with ADHD. The aim of this study was to assess the association between serum ferritin levels and parent reports of sleep disturbances in a sample of children with ADHD.

Methods

Subjects: Sixty-eight consecutively referred children (6–14 years) with ADHD diagnosed according to DSM-IV criteria using the semi-structured interview Kiddie-SADS-PL. Measures: parents filled out the Sleep Disturbance Scale for Children (SDSC) and the Conners Parent Rating Scale (CPRS). Serum ferritin levels were determined using the Tinaquant method.

Results

Compared to children with serum ferritin levels ≥45 µg/l, those with serum ferritin levels <45 µg/l had significantly higher scores on the SDSC subscale “Sleep wake transition disorders” (SWTD) (P = 0.042), which includes items on abnormal movements in sleep, as well as significantly higher scores on the CPRS–ADHD index (P = 0.034). The mean scores on the other SDSC subscales did not significantly differ between children with serum ferritin ≥45 and <45 µg/l. Serum ferritin levels were inversely correlated to SWTD scores (P = 0.043).

Conclusion

Serum ferritin levels <45 µg/l might indicate a risk for sleep wake transition disorders, including abnormal sleep movements, in children with ADHD. Our results based on questionnaires set the basis for further actigraphic and polysomnographic studies on nighttime activity and iron deficiency in ADHD. Research in this field may suggest future trials of iron supplementation (possibly in association with ADHD medications) for abnormal sleep motor activity in children with ADHD.

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Authors and Affiliations

  1. AP-HP, Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France

    Samuele Cortese MD, Eric Konofal MD, PhD, Marie-Christine Mouren MD & Michel Lecendreux MD

  2. Department of Mother-Child and Biology-Genetics, Child Neuropsychiatry Unit, G.B. Rossi Hospital, Verona University, Verona, Italy

    Samuele Cortese MD & Bernardo Dalla Bernardina MD

  3. Pediatric Sleep Disorders Center, Robert Debré Hospital, Paris, France

    Eric Konofal MD, PhD & Michel Lecendreux MD

  4. Sleep Disorders Center, Pitié-Salpêtrière Hospital, Paris, France

    Eric Konofal MD, PhD

  5. Service de Psychopathologie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019, Paris, France

    Samuele Cortese MD

Authors
  1. Samuele Cortese MD
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  2. Eric Konofal MD, PhD
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  3. Bernardo Dalla Bernardina MD
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  4. Marie-Christine Mouren MD
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  5. Michel Lecendreux MD
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Correspondence to Samuele Cortese MD.

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Cortese, S., Konofal, E., Bernardina, B.D. et al. Sleep disturbances and serum ferritin levels in children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 18, 393–399 (2009). https://doi.org/10.1007/s00787-009-0746-8

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  • DOI: https://doi.org/10.1007/s00787-009-0746-8

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