ABSTRACT

Purpose : Iron deficiency anemia (IDA) and sleep problems are prevalent in infancy and early childhood and are more associated with poor cognitive, motor, and social-emotional development. The aim of this study was to access the relationship between IDA and sleep disorders in a population of Korean children <36 months. Methods : One hundred and ninety six children, who visited the outpatient clinic for a routine check-up were consecutively enrolled from March 2011 to March 2012. All parents answered a questionnaire about sleep patterns of their children using a modified expanded version of the Brief Infant Sleep Questionnaire. Among the subjects, 93 children with strong evidence of sleep disordered breathing were excluded. Hundred three children were then divided into the IDA group (n=23) and the control group (n=80). Sleep-wake parameters and prevalence of sleep disturbances were compared between the two groups. A multivariate analysis was performed to determine the independent risk factors for sleep disturbances in children. Results : Children with IDA had more frequent nocturnal waking, restless sleep, and inconsolable crying during sleep than those in the control. Children with IDA also had more inappropriate sleep onset associations. No difference in sleep-wake parameters was observed between the two groups. The presence of IDA in children and maternal anemia were significant independent risk factors for sleep disturbances in children <36 months. Conclusion : The results suggest that prevention, early detection, and treatment of IDA would be important for good sleep in young children <36 months.

KEYWORD

Iron deficiency anemia, Infant, Sleep, Inappropriate sleep onset association

REFERENCES(41)open

  1. [jounal] Stoltzfus RJ / 2001 / Iron-deficiency anemia: reexamining the nature and magnitude of the public health problem. Summary: implications for research and programs / J Nutr 131 : 697 ~ 700

  2. [jounal] Brotanek JM / 2005 / Iron deficiency, prolonged bottle-feeding, and racial/ethnic disparities in young children / Arch Pediatr Adolesc Med 159 : 1038 ~ 1042

  3. [jounal] Lozoff B / 2006 / Long-lasting neural and behavioral effects of iron deficiency in infancy / Nutr Rev 64 : 34 ~ 43

  4. [jounal] Carter RC / 2010 / Iron deficiency anemia and cognitive function in infancy / Pediatrics 126 : 427 ~ 434

  5. [jounal] Lozoff B. / 2007 / Iron deficiency and child development / Food Nutr Bull 28 : 560 ~ 571

  6. [jounal] McCann JC / 2007 / An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function / Am J Clin Nutr 85 : 931 ~ 945

  7. [jounal] O'Brien LM / 2004 / Neurocognitive dysfunction and sleep in children : from human to rodent / Pediatr Clin North Am 51 : 187 ~ 202

  8. [jounal] Peirano PD / 2010 / Sleep alterations and iron deficiency anemia in infancy / Sleep Med 11 : 637 ~ 642

  9. [jounal] Dahl RE / 1996 / The impact of inadequate sleep on children's daytime cognitive function / Semin Pediatr Neurol 3 : 44 ~ 50

  10. [jounal] Peirano PD / 2009 / Sleep and neurofunctions throughout child development: lasting effects of early iron deficiency / J Pediatr Gastroenterol Nutr 48 (Suppl 1) : 8 ~ 15

  11. [jounal] Peirano PD / 2007 / Iron deficiency anemia in infancy is associated with altered temporal organization of sleep states in childhood / Pediatr Res 62 : 715 ~ 719

  12. [jounal] Mindell JA / 2006 / American Academy of Sleep M. Behavioral treatment of bedtime problems and night wakings in infants and young children / Sleep 29 : 1263 ~ 1276

  13. [jounal] Bayer JK / 2007 / Sleep problems in young infants and maternal mental and physical health / J Paediatr Child Health 43 : 66 ~ 73

  14. [jounal] Kordas K / 2008 / Maternal reports of sleep in 6-18 month-old infants from Nepal and Zanzibar : association with iron deficiency anemia and stunting / Early Hum Dev 84 : 389 ~ 398

  15. [jounal] Morris S / 2001 / Economic evaluation of strategies for managing crying and sleeping problems / Arch Dis Child 84 : 15 ~ 19

  16. [jounal] 윤정원 / 2012 / Prevalence and risk factors for vitamin D deficiency in children with iron deficiency anemia / Korean Journal of Pediatrics 55 (6) : 206 ~ 211

  17. [jounal] Hiscock H / 2007 / Adverse associations of sleep problems in Australian preschoolers : national population study / Pediatrics 119 : 86 ~ 93

  18. [jounal] Quach J / 2009 / Outcomes of child sleep problems over the school-transition period : Australian population longitudinal study / Pediatrics 123 : 1287 ~ 1292

  19. [jounal] Meijer AM / 2000 / Time in bed, quality of sleep and school functioning of children / J Sleep Res 9 : 145 ~ 153

  20. [jounal] Sadeh A / 2003 / The effects of sleep restriction and extension on school-age children : what a difference an hour makes / Child Dev 74 : 444 ~ 455

  21. [book] Mindell JA / 2010 / A clinical guide to pediatric sleep : diagnosis and management of sleep problems / Wolters Kluwer Health/Lippincott Williams & Wilkins

  22. [jounal] Armstrong KL / 1998 / Sleep deprivation or postnatal depression in later infancy : separating the chicken from the egg / J Paediatr Child Health 34 : 260 ~ 262

  23. [other] World Health Organization. Dept. of Nutrition for Health and Development / 2001 / Iron deficiency anaemia : assessment, prevention and control : a guide for programme managers / World Health Organization

  24. [jounal] Lozoff B / 2006 / Iron deficiency and brain development / Semin Pediatr Neurol 13 : 158 ~ 165

  25. [jounal] Angulo-Kinzler RM / 2002 / Spontaneous motor activity in human infants with iron-deficiency anemia / Early Hum Dev 66 : 67 ~ 79

  26. [jounal] Algarin C / 2003 / Iron deficiency anemia in infancy : long-lasting effects on auditory and visual system functioning / Pediatr Res 53 : 217 ~ 223

  27. [jounal] Peirano P / 2007 / Iron-deficiency anemia is associated with altered characteristics of sleep spindles in NREM sleep in infancy / Neurochem Res 32 : 1665 ~ 1672

  28. [jounal] Sun ER / 1998 / Iron and the restless legs syndrome / Sleep 21 : 371 ~ 377

  29. [jounal] Simakajornboon N / 2003 / Periodic limb movements in sleep and iron status in children / Sleep 26 : 735 ~ 738

  30. [jounal] Dzirasa K / 2006 / Dopaminergic control of sleep-wake states / J Neurosci 26 : 10577 ~ 10589

  31. [jounal] Fuller PM / 2006 / Neurobiology of the sleep-wake cycle: sleep architecture, circadian regulation, and regulatory feedback / J Biol Rhythms 21 : 482 ~ 493

  32. [book] Mindell JA / 2003 / A clinical guide to pediatric sleep : diagnosis and management of sleep problems / Lippincott Williams & Wilkins

  33. [jounal] Beard JL / 1994 / Altered monamine metabolism in caudate-putamen of iron-deficient rats / Pharmacol Biochem Behav 48 : 621 ~ 624

  34. [jounal] Angulo-Kinzler RM / 2002 / Twenty-four-hour motor activity in human infants with and without iron deficiency anemia / Hum Dev 70 : 85 ~ 101

  35. [jounal] Sadeh A / 2009 / Sleep and sleep ecology in the first 3 years : a web-based study / J Sleep Res 18 : 60 ~ 73

  36. [jounal] Benhamou I / 2000 / Sleep disorders of early childhood : a review / J Psychiatry Relat Sci 37 : 190 ~ 196

  37. [jounal] Viteri FE / 2005 / Importance of pre-pregnancy and pregnancy iron status: can long-term weekly preventive iron and folic acid supplementation achieve desirable and safe status? / Nutr Rev 63 : 65 ~ 76

  38. [jounal] Idjradinata P / 1993 / Reversal of developmental delays in iron-deficient anaemic infants treated with iron / Lancet 341 : 1 ~ 4

  39. [jounal] Lozoff B / 2003 / Behavioral and developmental effects of preventing iron-deficiency anemia in healthy full-term infants / Pediatrics 112 : 846 ~ 854

  40. [jounal] Sadeh A. / 2004 / A brief screening questionnaire for infant sleep problems: validation and findings for an Internet sample / Pediatrics 113 : 570 ~ 577

  41. [jounal] Mindell JA / 2011 / Efficacy of an internetbased intervention for infant and toddler sleep disturbances / Sleep 34 : 451 ~ 458