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Sleep Disruption and Objective Sleepiness in Children With  -Thalassemia and Congenital Dyserythropoietic Anemia
Ariel Tarasiuk, PhD;
Abdul-Hai Ali, PhD;
Asher Moser, MD;
Bruria Freidman, REEGT;
Asher Tal, MD;
Josef Kapelushnik, MD
Arch Pediatr Adolesc Med. 2003;157:463-468.
Background Sleep fragmentation and periodic leg movement syndrome (PLMS) have been reported in adults with iron deficiency anemia. Little is known about sleep function and daytime sleepiness in children with chronic anemia such as  -thalassemia or congenital dyserythropoietic anemia type 1 (CDA-1).
Objectives To investigate if children and adolescents who have -thalassemia (major or intermedia) or CDA-1 experience sleep fragmentation and objective daytime sleepiness and also to investigate if children and adolescents with -thalassemia have obstructive sleep apnea.
Methods Ten patients (7 males and 3 females) with -thalassemia (mean [SD] age, 10.4 [7.3] years), 10 patients (7 males and 3 females) with CDA-1 (mean [SD] age, 13.5 [5.1] years), and 13 healthy volunteer control children(7 males and 6 females) (mean [SD] age, 10 [4] years) underwent nocturnal polysomnographic studies. A multiple sleep latency test was performed for 6 patients who had -thalassemia and 8 patients who had CDA-1.
Results Both patient groups, that is, those who had -thalassemia and those who had CDA-1, had multiple arousals during sleep (mean [SD], 27.8 [11.4] events per hour and 23.8 [11.8] events per hour, respectively) compared with the control subjects (12.1 [6.6] events per hour) (P<.002). Thirty-eight percent (10.6 events per hour) of the arousals in patients with -thalassemia and 25% (6.0 events per hour) of the arousals in patients with CDA-1 were induced by periodic limb movements during sleep. In the control group, most (98%) arousals were spontaneous and unrelated to any definable event. The multiple sleep latency test average was 7.8 minutes for patients with -thalassemia (n = 6) and 10.7 minutes for patients with CDA-1 (n = 8). Five patients with -thalassemia and 4 patients with CDA-1 underwent a second polysomnographic study on the next night to confirm reproducibility. There was no significant change in the total number or index of arousals and no difference in the severity of the periodic limb movements during sleep compared with the results of the first polysomnographic study.
Conclusion Children and adolescents with -thalassemia or CDA-1 have evidence of impaired sleep function that is partially due to periodic limb movements during sleep and arousals that result in objective diurnal sleepiness.
From the Sleep-Wake Disorders Unit (Drs Tarasiuk, Ali, and Tal and Ms Freidman) and the Departments of Pediatric Hemato-Oncology (Drs Moser and Kapelushnik), Pediatrics–B (Dr Tal), and Physiology (Dr Tarasiuk), Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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