Recently, I was a member of a group of international sleep researchers who developed consensus diagnostic criteria detailing a new sleep disorder in children called Restless Sleep Disorder or RSD. With this new discovery, we intend to improve clinical practice and promote further research.
For years, sleep experts have identified ‘restless sleep’ as part of other sleep conditions that can cause sleep disruption or nocturnal awakenings like obstructive sleep apnea or restless legs syndrome. However, recent research in children has shown that restless sleep can also be a primary disorder, not always associated with another condition.
Adequate sleep is important for growth, memory, mental and physical health, social interactions, safe alertness during the day and many other functions. We, as sleep physicians, recommend and have guidelines on how much sleep should someone get. But we do not only need an adequate amount of sleep. We also need good quality of sleep. This is the main significance of RSD. It identifies children with poor sleep quality, frequent movements during sleep and daytime symptoms as a consequence of this poor sleep. Restless legs syndrome (RLS) for instance, manifests at bedtime with symptoms of leg discomfort, but children with RSD go to sleep well, without any problems. It’s just that once they are asleep, they move more than children without RSD and these movements interfere with sleep quality and contribute to daytime symptoms.
RSD has been studied in comparison with other sleep disorders showing individual and particular characteristics. Initially, research on children with RSD was started due to the need to better understand how these children slept. Dr. Judith Owens, an author on the journal article, as well as the current President of the International Pediatric Sleep Association (IPSA) explains, “Parents were concerned that children did not get enough sleep at night because they were “moving all night,” “trashing the bed,” or “sleeping like a helicopter”—various terms used by parents to characterize the sleep patterns of their children. Parents also noticed undereye dark circles, next-day fatigue, inability to concentrate and sleepiness. We identified that there was no other explanation for the symptoms.”
Using sleep studies and other advanced technology, we on the research team were able to understand that children with RSD were moving a lot more than their counterparts. The movements occurred through the night, and were associated with other findings of sleep disruption. Prior to this team discovery, the International Restless Legs Syndrome Study Group assigned nine experts in sleep medicine to develop a pediatric consensus. The taskforce was chaired by Drs. Dan Picchietti and myself. Later, the taskforce invited another expert for a consensus of ten sleep physicians form various parts of the world. The current “consensus criteria for the diagnosis” was completed in June 2020. It published in Sleep Medicine journal on August 17, 2020. The world had a name for this sleep disorder in children.
Current treatment for RSD is iron supplementation—both oral or IV—as we identified that iron supplementation improves sleep quality in children with RSD during our research. More studies continue to be done on children with RSD to help understand the syndrome better.
COMMON SYMPTOMS OF RSD IN CHILDREN (AGED 6-18)
• Ability to fall asleep is not usually compromised
• During sleep, frequent movements can be observed
• Frequent movements during sleep include repositioning of arms, legs or full body
• Next day indications of lack of healthy sleep such as sleepiness, undereye dark circles, fatigue, inability to concentrate
If you suspect that your child has RSD, please consult your physician or request a referral to a sleep expert.
Dr. DelRosso is an Associate Professor of Pediatrics and Associate Sleep Medicine Fellowship director at the University of Washington. She co-chairs the 2021 World Sleep Day.