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SSRIs, limb movements of sleep linked in kids.


Children who are treated with selective serotonin reuptake inhibitors have fivefold greater odds of experiencing periodic limb movements of sleep than do those who are not treated with SSRIs, according to findings from a retrospective study of polysomnography data.

Nearly a third (31.7%) of 41 children who received SSRIs at the time of the study experienced periodic limb movements of sleep, vs. only 7.8% of 982 children not receiving SSRIs (odds ratio, 5.45), reported Dr, Martina Vendrame of Boston University, and her colleagues.

Furthermore, the median periodic limb movement index in those receiving SSRIs was significantly higher than the index in those not receiving SSRIs (11.2 vs. 6.5), the investigators said (Pediatr. Neurol 2011;45:175-7).

Although periodic limb movements of sleep have been reported in adults taking serotonergic antidepressants - with one study showing that 44% of adults receiving fluoxetine experienced the symptoms, and others showing that restless legs syndrome (RLS) is exacerbated in up to 10% of adult patients on SSRIs - the current study is one of the few that provide information about periodic limb movements of sleep in children and adolescents.

The study subjects were all children who underwent overdiagnostic polysomphy between January 2009 and April 2010 at a single center.

The studies were conducted for various sleep disturbances such as snoring, pauses in breathing, daytime sleepiness, and gasping or snorting in sleep; none was conducted for reports of RLS or periodic limb movements of sleep.

The patients who received SSRIs included 31 girls and 10 boys who had a median age of 15.4 years. The SSRIs were prescribed for depression and included citalopram or escitalopram in 15 patients, fluoxetine in 14 patients, and sertraline in 12 patients.

"The mechanism by which SSRIs may cause periodic limb movements of sleep is not clear, but serotonin-mediated dopaminergic inhibition may represent the underlying mechanism," the investigators noted.

Although no significant differences in mean periodic limb movements of sleep indexes were seen between different SSRIs in this study, it is possible that different doses and timing of administration could result in better control of limb movements, the investigators said.

They added that when periodic limb movements of sleep are found, a careful history should be taken to assess whether they are causing sleep disturbance, and whether the child is experiencing RLS.

Although limited by the use of single night polysomnography, a small study population, and possibly by referral bias to a tertiary center, the findings suggest that periodic limb movements of sleep might be an important side effect of SSRIs that is frequently overlooked in children.

The investigators advised that appropriate clinical judgment and medical management might lead to better control of periodic limb movements and an improved quality of life in these young patients.
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Author:Worcester, Sharon
Publication:Clinical Psychiatry News
Date:Nov 1, 2011
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