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Severe Sleep Abnormalities Found In Children And Adolescents With Chronic Anaemia

Children and adolescents with B-thalassaemia or congenital dyserythropoietic anaemia type 1 (CDA-1) exhibit severe sleep abnormalities due to periodic limb movements (PLM) during nightly sleep.

Although PLM syndrome and sleep disruption are known to occur in adults with iron-deficiency anaemia, this is one of the first studies to examine sleep patterns in children and adolescents with chronic anaemia.

Ariel Tarasiuk, PhD, and colleagues from Ben-Gurion University of the Negev, Beer-Sheav, Israel, studied 10 patients with B-thalassaemia (mean age 10.4 years) and 10 patients with CDA-1 (mean age of 13.5 years) to evaluate sleep fragmentation, objective daytime sleepiness, and presence of obstructive sleep apnoea. Of the 10 patients in each group, 7 were male and 3 female. A group of 13 healthy children were used as a control group to compare outcomes.

Based on nocturnal polysomnographic studies to test sleep patterns, the study found that severe sleep fragmentation was the most striking sleep abnormality in patients with B-thalassaemia and CDA-1. Compared to the control group, the B-thalassaemia and CDA-1 patients had significantly more sleep arousals and awakenings (27.8 and 23.8, versus 12.1 events per hour, respectively; p<0.002). In addition, the index of arousals and awakenings exceeded 20 events/hour for 80 and 50% of the B-thalassaemia and CDA-1 patients, respectively, compared to 15% of the control group.

Arousals induced by PML during sleep accounted for 38 and 25% of arousals in patients with B-thalassaemia and CDA-1, respectively, whereas 98% of the arousals in the control group were unrelated to any particular event.

Excessive daytime sleepiness was also noted in both types of anaemia patients as indicated by the multiple sleep latency test score that averaged 7.8 minutes for 6 of the patients with B-thalassaemia, and 10.7 minutes for 8 patients with CDA-1. No signs of obstructive sleep apnoea were noted in any of the patients.

Repeat polysomnographic study of 9 patients (5 B-thalassaemia and 4 CDA-1) did not show a change in the total number or index of arousals and awakenings compared to the first polysomnographic tests.

The authors conclude that children and adolescents with chronic anaemia have a 2-fold increase in the number of arousals and awakenings compared to healthy patients.
Archives of Pediatrics and Adolescent Medicine, Vol. 157 No. 5, May 2003. "Sleep Disruption and Objective Sleepiness in Children With beta-Thalassemia and Congenital Dyserythropoietic Anemia"

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