A group of children with “restless sleep” who do not fit the criteria for any other sleep disorder but with daytime impairment are studied to identify restless sleep disorder (RSD) clinically and polysomnographically and to differentiate it from other sleep disorders of childhood. A pilot study of 15 school aged children with restless sleep and 15 sex and age matched children with restless leg syndrome (RLS) and 37 normal controls were included. Data obtained included nocturnal and diurnal parental concerns, iron and ferritin levels and polysomnography (PSG). 15 children with RLS (12 males; 3 females), with a mean age of 11.9 (standard deviation 3.52), 15 subjects with RSD (11 males, 4 females) with a mean age of 9.5 (standard deviation 3.18), the control subjects were 30 males and 7 females; mean age was 10.6 with a standard deviation of 3.8. Age and sex did not differ between groups. Parental concerns in RSD included frequent nocturnal large body movements involving limbs, head and trunk, and restless sleep and perception of sleep disruption without nocturnal awakening. Daytime impairment included daytime sleepiness. All children with RSD had low ferritin levels (mean 20, SD 8.87). PSG data showed decreased sleep efficiency similar to RLS group but not prolonged sleep latency. We have characterized clinically and polysomnographically children with RSD and attempted a new diagnostic category. We also have identified an association between RDS and iron deficiency. Future larger studies are needed to confirm these findings and evaluate the natural progression of restless sleepers

This systematic review assessed the prevalence of restless sleep in children, documented the association of restless sleep with other conditions, and summarized the existing evidence regarding whether restless sleep should be considered a distinct sleep disorder. A comprehensive search of electronic databases was performed using the broad search term "restless sleep" in all fields. Of the 266 articles retrieved, 107 were retained for inclusion in this review. The majority (n = 93) were observational studies. The studies were grouped under several pathologic/condition categories: sleep-disordered breathing (n = 19); adenotonsillectomy (n = 7); respiratory disorders, otitis media, and smoke exposure (n = 12); sleep-related movement disorders and restless sleep disorder (n = 11); neurologic or psychiatric disorders (n = 7); Down syndrome/other neurodevelopmental disorders (n = 10); sleep-related bruxism and other sleep disorders (n = 7); and restless sleep in the general population/mixed clinical samples (n = 18). A high prevalence of restless sleep was found in children with many of these underlying conditions, likely related to associated inherent sleep disruption and frequent awakenings (e.g., apnea and periodic limb movements), pain, sleep instability, and caregiver perception. The majority of studies identified restless sleep as reported by the caregiver, only 34 studies attempted to define restless sleep further. Four studies provided supportive evidence for designating restless sleep as an independent sleep disorder, restless sleep disorder (RSD). This review highlights the fact that the prevalence, etiology and sequelae (including daytime impairments) of restless sleep in children are important topics deserving of further research and that clinical definitions based on empirical evidence need to be developed. The designation of "primary" versus "secondary" restless sleep may be a useful construct, especially with regard to developing clinical trials and treatment algorithms.