CHEST Guidelines-A-15-Year-Old-Girl-With-Sleep-Onset-Insomnia-and-P

A-15-Year-Old-Girl-With-Sleep-Onset-Insomnia-and-P

Pdf Summary

A 15-year-old girl experiencing sleep-onset insomnia and poor sleep quality due to restless legs syndrome (RLS) presented with a history of difficulty falling asleep, nocturnal awakenings, and an urge to move her legs alleviated by movement. These symptoms, which worsened over the past six months, disrupted her sleep, resulting in excessive daytime sleepiness and the need for daytime naps. The patient's medical history includes beta-thalassemia trait, and initial evaluations, including iron studies and a sleep study, were conducted. <br /><br />The sleep study ruled out obstructive sleep apnea, but indicated poor sleep efficiency due to multiple awakenings and frequent leg movements. Despite low ferritin and transferrin saturation levels, iron supplementation was deemed unsuitable due to potential side effects and the presence of thalassemia. The diagnosis of RLS was discussed with the family, who chose to initiate gabapentin over iron supplementation due to the child's condition.<br /><br />Gabapentin, an alpha-2-delta voltage-gated calcium channel ligand, inhibits the presynaptic release of excitatory neurotransmitters and resembles gamma aminobutyric acid in function. Its use in children with RLS is less common, but in this case, low-dose gabapentin noticeably improved the child's sleep efficiency from 50.6% to 86.7% without affecting sleep latency, as demonstrated by a second polysomnography (PSG). <br /><br />Gabapentin is not FDA-approved for RLS treatment in children, but the case indicates potential benefits in managing RLS symptoms and improving sleep in pediatric patients, even though gabapentin enacarbil, often used in adults, has not been studied in children. Pediatric management guidelines stress evaluating iron status and considering gabapentin when iron supplementation is not viable.

Keywords

restless legs syndrome

sleep-onset insomnia

gabapentin

pediatric RLS

sleep quality

beta-thalassemia trait

iron supplementation

polysomnography

daytime sleepiness

sleep efficiency