Sleep Pattern In Infants With Iron Deficiency At 12 Months Of Age: A One Year Cross Sectional Study At Tertiary Hospital

Anemia, defined as a hemoglobin concentration lower than the normal range for a child’s age and is a significant global health issue. Anemia was defined as a hemoglobin level below 11 g/dl(1). Anemia commonly affects children aged 6 to 59 months, with an estimated global prevalence of 39.8%, translating to approximately 269 million children(2). This condition is particularly prevalent in early infancy and childhood, where rapid growth increases iron requirements.

According to the national family health survey (NFHS-5), the prevalence of anemia among Indian children has risen from 58.6% (NFHS-4) to 67.1% nationally, with 53.5% in rural Karnataka and 66.3% in Belagavi district(3).

Iron deficiency, which accounts for approximately 50% of all anemia cases in children(2), is known to adversely affect growth, cognitive development, immunity, and overall well-being. A growing body of evidence suggests that Iron Deficiency may also negatively impact sleep quality and sleep architecture in infants, although this area remains under-explored(2).

Iron Deficiency in early life can impair brain development, delay neural maturation, and affect neurotransmitter metabolism, all of which may influence sleep regulation. Additionally, Iron plays a key role in the synthesis of dopamine and melatonin—neurochemicals integral to the regulation of sleep-wake cycles,(4) Iron deficiency, even in the absence of anemia, may cause sleep disturbances such as increased night waking, restlessness, and reduced sleep duration. These disruptions may further impair the neurodevelopmental trajectory of affected infants. Anemia had significantly shorter sleep duration compared to their non-anemic peers. The presence of anemia increased the odds of being a short sleeper by over four times.

Infants diagnosed with iron deficiency anemia (ida) have been observed to experience changes in sleep structure, more frequent night awakenings, and decreased quiet sleep compared to those without anemia. Recent studies highlight that these sleep disruptions—such as reduced total sleep time, increased night time waking, and altered sleep architecture—can affect not just the infant’s immediate well-being but also their long-term neurological development. Nonetheless, these studies come with several limitations, including small sample sizes, reliance on sleep data reported by caregivers, absence of extended follow-up, and a focus on non-indian populations, which limits the applicability of findings to the indian setting.

In the Indian context, despite the high prevalence of Iron Deficiency among young children, there is a noticeable lack of research examining how iron deficiency affects infant sleep—particularly around 11 to 13 months of age, a crucial period for both brain development and the establishment of regular sleep patterns. This study aims to bridge that gap by investigating the impact of Iron Deficiency on sleep among Indian infants. The scarcity of region-specific data reinforces the importance of this research. The first year of life is a key stage for brain development, and many indian infants are affected by Iron Deficiency during this time. Disrupted sleep in infancy could have lasting consequences for behavior and cognitive development. Addressing Iron Deficiency early through iron supplementation might help enhance both sleep quality and overall developmental progress. Additionally, it is important to raise awareness among healthcare providers regarding the potential sleep-related issues linked to ida, which are often overlooked. This research seeks to deepen the understanding of how iron deficiency may contribute to sleep disturbances in infants and to support the development of timely interventions.