Traumatic brain injury (TBI) is commonplace among pediatric patients and has a complex, but intimate relationship with psychiatric disease and disordered sleep. Understanding the factors that influence the risk for the development of TBI in pediatrics is a critical component of beginning to address the consequences of TBI. Features that may increase risk for experiencing TBI sometimes overlap with factors that influence the development of post-concussive syndrome (PCS) and recovery course. Post-concussive syndrome includes physical, psychological, cognitive and sleep–wake dysfunction. The comorbid presence of sleep–wake dysfunction and psychiatric symptoms can lead to a more protracted recovery and deleterious outcomes. Therefore, a multidisciplinary evaluation following TBI is necessary. Treatment is generally symptom specific and mainly based on adult studies. Further research is necessary to enhance diagnostic and therapeutic approaches, as well as improve the understanding of contributing pathophysiology for the shared development of psychiatric disease and sleep–wake dysfunction following TBI.

Restless sleep disorder (RSD) is a newly defined sleep related movement disorder characterized by large muscle movements (LMM) in sleep. We examined the sleep study, clinical characteristics, and daytime functioning in children with RSD and compared them to children with Periodic Limb Movement Disorder (PLMD) or Restless Legs Syndrome (RLS). Video polysomnography from 47 children with restless sleep was retrospectively reviewed for LMM and age- and sex- matched to 34 children with PLMD and 12 children with RLS. Data examined included PSG characteristics, ferritin, Pediatric Quality of Life (PedsQL), and Epworth Sleepiness Scores (ESS). Fourteen children met the clinical criteria for RSD with a LMM index of 5 or more per hour of sleep . Mean ESS was elevated in RSD patients compared to either the PLMD or RLS groups though the result did not reach statistical significance (RSD = 10.20 ± 6.81, PLMD = 6.19 ± 4.14, RLS = 6.25 ± 4.90). The PedsQL score was significantly decreased in the RLS group compared to RSD and was reduced overall in all three groups (PedsQL Total RSD= 70.76 ± 18.05, PLMD = 57.05 ± 20.33, RLS = 53.24 ± 16.97). Serum ferritin values were similar in all three groups (RSD= 26.89 ± 10.29, PLMD = 33.91 ± 20.31, RLS = 23.69 ± 12.94 ng/mL, P= NS). Children with RSD demonstrate increased daytime sleepiness compared to PLMD or RLS and all three disease groups decreased quality of life. Further studies are needed to examine long term consequences of RSD.

Introduction Restless sleep disorder (RSD) is a recently described disorder of children and adolescents with complaints of restless sleep and is characterized by large body movements which interfere with nocturnal sleep, are associated with daytime dysfunction, and are not better explained by another disorder (1, 2). Polysomnography criteria for RSD includes the scoring of large body movements (LBMI) and identified an LBMI ≥ 5 as sensitive and specific for RSD. As data is currently limited to two pediatric centers, our study aims to identify RSD cases at our institution, characterize their PSG, and determine their effect on daytime dysfunction and quality of life. Methods This single center retrospective study included 41 children with complaints of restless sleep and 35 sex- and age-matched children with RLS/PLMD collected from February 2018 to November 2020. The video PSGs were re-scored utilizing the previously published criteria (1,3). We used two LBMI thresholds, LBMI ≥ 5 and an exploratory LBMI ≥ 4. We then compared Epworth Sleepiness Scores (ESS), Pediatric Quality of Life measures (PedsQL), PSG characteristics, LBM associated awakenings and ferritin level between groups. Results Twenty-one children (mean age=8.3 ± 3.13 SD) met the LBMI>=4 criteria, of which 11 (age=8.4±3.81 SD) met the LBMI>=5 criteria. All three groups reported decreased quality of life (PedsQL total LBMI>=4=66.21±20.28, LBMI>=5=72.39±18.24, RLS/PLMD=55.54±19.86), low mean ferritin values (LBMI>=4=33.18 ± 20.11, LBMI>=5 =28.38 ± 12.68, RLS/PLMD = 36.57±25.46), and increased wake after sleep onset (WASO) (LBMI>=4 = 42.82 ± 34.26, LBMI>=5=44.38 ± 38.4, RLS/PLMD = 52.34 ± 42.03), with no significant differences between groups. Both LBMI>=4 and LBMI>=5 groups exhibited higher ESS compared to the RLS/PLMD group (LBMI>=4=10.36±7.13; LBMI>=5=11.13±5.19; RLS/PLMD=6.17±4.04; LBMI>=4 vs RLS/PLMD, P=0.05; LBMI>=5 vs RLS/PLMD, P = 0.032). Both awakenings and WASO associated with LBM were high in LBMI>=4 and LBMI>=5 (Awakenings: LBMI>=4=8.43±9.96, LBMI>=5 =8.00±12.19, WASOassociatedLBM: LBMI>=4=23.60±44.64 LBMI>=5=29.46±57.57) Conclusion One quarter of children with complaints of restless sleep met the standard criteria for RSD. Both children with RSD (including the exploratory LBMI≥ 4 group) and RLS/PLMD had increased WASO, low ferritin and decreased quality of life, but the RSD group had more daytime sleepiness compared to RLS/PLMD. Support (if any):