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McWilliams S, Hill O, Ipsiroglu OS, Clemens S, Weber AM, Chen M, Connor J, Felt BT, Manconi M, Mattman A, Silvestri R, Simakajornboon N, Smith SM, Stockler S. Iron Deficiency and Sleep/Wake Behaviors: A Scoping Review of Clinical Practice Guidelines-How to Overcome the Current Conundrum? Nutrients 2024; 16:2559. [PMID: 39125438 PMCID: PMC11314179 DOI: 10.3390/nu16152559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Current evidence suggests that iron deficiency (ID) plays a key role in the pathogenesis of conditions presenting with restlessness such as attention deficit hyperactivity disorder (ADHD) and restless legs syndrome (RLS). In clinical practice, ID and iron supplementation are not routinely considered in the diagnostic work-up and/or as a treatment option in such conditions. Therefore, we conducted a scoping literature review of ID guidelines. Of the 58 guidelines included, only 9 included RLS, and 3 included ADHD. Ferritin was the most frequently cited biomarker, though cutoff values varied between guidelines and depending on additional factors such as age, sex, and comorbidities. Recommendations surrounding measurable iron biomarkers and cutoff values varied between guidelines; moreover, despite capturing the role of inflammation as a concept, most guidelines often did not include recommendations for how to assess this. This lack of harmonization on the interpretation of iron and inflammation biomarkers raises questions about the applicability of current guidelines in clinical practice. Further, the majority of ID guidelines in this review did not include the ID-associated disorders, ADHD and RLS. As ID can be associated with altered movement patterns, a novel consensus is needed for investigating and interpreting iron status in the context of different clinical phenotypes.
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Affiliation(s)
- Scout McWilliams
- H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children’s Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada; (S.M.); (O.H.); (S.S.)
| | - Olivia Hill
- H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children’s Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada; (S.M.); (O.H.); (S.S.)
| | - Osman S. Ipsiroglu
- H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children’s Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada; (S.M.); (O.H.); (S.S.)
- Divisions of Developmental Pediatrics, Child and Adolescent Psychiatry and Respirology, BC Children’s Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Stefan Clemens
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA;
| | - Alexander Mark Weber
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Michael Chen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (M.C.); (A.M.)
| | - James Connor
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA 17033, USA;
| | - Barbara T. Felt
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Department of Neurology, University of Bern, 3012 Bern, Switzerland
| | - Andre Mattman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (M.C.); (A.M.)
| | - Rosalia Silvestri
- Department of Clinical and Experimental Medicine, Sleep Medicine Center, University of Messina, Azienda Ospedaliera Universitaria “Gaetano Martino”, 98122 Messina, Italy;
| | - Narong Simakajornboon
- Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Susan M. Smith
- Department of Nutrition, UNC-Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA;
| | - Sylvia Stockler
- H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children’s Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada; (S.M.); (O.H.); (S.S.)
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Division of Biochemical Diseases, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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Li Y, Zhang W, Wang H, Zhang W. Case report: A new treatment for restless leg syndrome: three cases. Front Neurosci 2024; 18:1333188. [PMID: 38312929 PMCID: PMC10834780 DOI: 10.3389/fnins.2024.1333188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Restless legs syndrome is a movement disorder that seriously affects the quality of life of patients. It is characterized by marked discomfort mainly occurring in the deep tissues of the lower extremities, including deep muscle or bone chafing, as well as crawling sensations or pulling sensations. These sensations often cause patients to awaken after falling asleep and to feel the urge to walk around, which seriously affects their sleep quality. Patients with restless leg syndrome exhibit significantly enhanced sympathetic nerve activity and immune disorders, while stellate ganglion blockage can block sympathetic nerves and regulate immune cells and cytokines to maintain immune system homeostasis. We report three patients with restless legs syndrome complicated with severe nephrotic syndrome. After treatment with stellate ganglion block, the symptoms in the restless legs were relieved within 1 month, and the quality of sleep was significantly improved. Our findings suggest that stellate ganglion block has broad promise in the management of restless legs syndrome patients with severe comorbidities.
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Affiliation(s)
| | | | | | - Weiwei Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
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