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Aini N, Marta OFD, Mashfufa EW, Setyowati L. Association between Chronic kidney disease and restless leg syndrome (RLS): a systematic review and meta-analysis. Sleep Biol Rhythms 2024; 22:227-237. [PMID: 38524160 PMCID: PMC10959887 DOI: 10.1007/s41105-024-00513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 01/23/2024] [Indexed: 03/26/2024]
Abstract
Restless leg syndrome (RLS) is characterized by unpleasant nocturnal sensations in the lower limbs, and it has emerged as the fourth leading cause of insomnia and is often an underdiagnosed medical condition among sleep disorders. The symptoms of RLS are more common in chronic kidney disease patients than in the general population. Therefore, we performed the first meta-analysis to estimate the risk of RLS among chronic kidney disease patients. We conducted a comprehensive search in Embase, Ovid-MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. Data were analyzed with the random-effects model using Comprehensive Meta-Analysis (CMA) software to find the odds ratio (OR). The heterogeneity was checked with the I2 test and Cochran's Q-statistic, and we performed the moderator analysis to find potential sources of heterogeneity. The study quality was assessed using the Newcastle-Ottawa Scale. Of 1175 studies, we found nine studies, with a total of 18,983 participants. The pooled OR of RLS among chronic kidney disease was 5.64 (95%CI 2.70-11.78). Regarding moderator analysis results, it was observed that higher body mass index and abnormal laboratory results would increase the risk of RLS; however, the statistical test was not significant in the current study. The findings reveal a substantial sixfold increase in the likelihood of RLS when compared to the general population. Therefore, health professionals should encourage patients to adhere to the treatment and practice a healthy lifestyle to manage their condition and reduce the risk of RLS. Moreover, future research can develop an intervention to reduce RLS symptoms. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-024-00513-4.
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Affiliation(s)
- Nur Aini
- Nursing Department, Faculty of Health Sciences, University of Muhammadiyah Malang, Bendungan Sutami Street, 188 A, Malang, East Java Indonesia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Ollyvia Freeska Dwi Marta
- Nursing Department, Faculty of Health Sciences, University of Muhammadiyah Malang, Bendungan Sutami Street, 188 A, Malang, East Java Indonesia
| | - Erma Wahyu Mashfufa
- Nursing Department, Faculty of Health Sciences, University of Muhammadiyah Malang, Bendungan Sutami Street, 188 A, Malang, East Java Indonesia
| | - Lilis Setyowati
- Nursing Department, Faculty of Health Sciences, University of Muhammadiyah Malang, Bendungan Sutami Street, 188 A, Malang, East Java Indonesia
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Walters AS, Li Y, Koo BB, Ondo WG, Weinstock LB, Champion D, Afrin LB, Karroum EG, Bagai K, Spruyt K. Review of the role of the endogenous opioid and melanocortin systems in the restless legs syndrome. Brain 2024; 147:26-38. [PMID: 37633259 PMCID: PMC10796165 DOI: 10.1093/brain/awad283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023] Open
Abstract
Restless legs syndrome (RLS) is responsive to opioid, dopaminergic and iron-based treatments. Receptor blocker studies in RLS patients suggest that the therapeutic efficacy of opioids is specific to the opioid receptor and mediated indirectly through the dopaminergic system. An RLS autopsy study reveals decreases in endogenous opioids, β-endorphin and perhaps Met-enkephalin in the thalamus of RLS patients. A total opioid receptor knock-out (mu, delta and kappa) and a mu-opioid receptor knock-out mouse model of RLS show circadian motor changes akin to RLS and, although both models show sensory changes, the mu-opioid receptor knock mouse shows circadian sensory changes closest to those seen in idiopathic RLS. Both models show changes in striatal dopamine, anaemia and low serum iron. However, only in the total receptor knock-out mouse do we see the decreases in serum ferritin that are normally found in RLS. There are also decreases in serum iron when wild-type mice are administered a mu-opioid receptor blocker. In addition, the mu-opioid receptor knock-out mouse also shows increases in striatal zinc paralleling similar changes in RLS. Adrenocorticotropic hormone and α-melanocyte stimulating hormone are derived from pro-opiomelanocortin as is β-endorphin. However, they cause RLS-like symptoms and periodic limb movements when injected intraventricularly into rats. These results collectively suggest that an endogenous opioid deficiency is pathogenetic to RLS and that an altered melanocortin system may be causal to RLS as well.
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Affiliation(s)
- Arthur S Walters
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Yuqing Li
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Brian B Koo
- Sleep Medicine Laboratory, VA Connecticut Health Care System, West Haven, CT 06516, USA
- Yale Center for Restless Legs Syndrome, Yale School of Medicine, New Haven, CT 06520, USA
| | - William G Ondo
- Department of Neurology, Methodist Hospital, Weill Cornell Medical School, Houston, TX 77030, USA
| | - Leonard B Weinstock
- Department of Internal Medicine, Washington University School of Medicine, St.Louis, MO 63130, USA
| | - David Champion
- Sydney Children's Hospital, Department of Pain Medicine, Randwick, NSW 2031, Australia
| | - Lawrence B Afrin
- Hematology/Oncology, AIM Center for Personalized Medicine, Purchase, NY 10577, USA
| | - Elias G Karroum
- Department of Neurology and Rehabilitation Medicine, The George Washington University School of Medicine and Health Sciences, George Washington University, Washington, D.C. 20052, USA
| | - Kanika Bagai
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot Inserm, Paris 75019, France
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van Tonder CB, Joubert G, Moodley A. Restless legs syndrome in chronic renal failure patients on dialysis. Afr Health Sci 2023; 23:764-777. [PMID: 38357105 PMCID: PMC10862641 DOI: 10.4314/ahs.v23i3.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background Restless legs syndrome (RLS) occurs in patients with chronic renal failure (CRF). Objectives To determine the prevalence and morbidity of RLS in CRF patients on dialysis. Methods This cross-sectional questionnaire-based study included 100 dialysis patients (50 on haemodialysis [HD]; 50 on peritoneal dialysis [PD]). A focused lower limb examination was done. Patients were classified with RLS when reporting uncomfortable feelings in their legs that improved with movement and worsened when resting and at night. Results Gender distribution was equal. The median age was 43 (19-67) years. Six patients (HD and PD n=3 each) had international criteria-confirmed RLS. Twenty-four patients reported symptoms suggestive of RLS. Fourteen and 16 patients with RLS symptoms were on HD and PD, respectively. Sleep disturbances occurred in 43.3% (n=13) of patients with RLS symptoms, compared to 20.0% (n=20) of the large cohort. Sleep disturbances, peripheral sensory loss, chronic disease-related anaemia, increased urea and decreased albumin levels were more common among patients with RLS symptoms. Conclusion RLS symptoms occurred in 30.0% of the entire cohort, although only 6.0% met the international criteria. The type of dialysis had no impact on the incidence of symptoms. Identifying RLS in patients with CRF on dialysis will allow for early intervention.
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Affiliation(s)
- Carin Behrens van Tonder
- Department of Neurology, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Anand Moodley
- Department of Neurology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Hernandez-Con P, Shults J, Willis AW, Yang YX. Dopamine agonists and risk of lung cancer in patients with restless legs syndrome. Pharmacoepidemiol Drug Saf 2023; 32:726-734. [PMID: 36760024 PMCID: PMC10766437 DOI: 10.1002/pds.5596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To examine the association between long-term use of dopamine agonists (DAs) and the risk of lung cancer in patients with restless legs syndrome (RLS). METHODS We conducted a retrospective cohort study using Optum Clinformatics® database. We included adults ≥40 years diagnosed with RLS during the study period (1/2006-12/2016). Follow-up started with the first RLS diagnosis and ended on the earliest of: incident diagnosis of lung cancer, end of enrollment in the database or end of the study period. The exposure of interest was cumulative duration of DAs use, measured in a time-varying manner. We constructed a multivariable Cox regression model to estimate HRs and 95% CIs for the association between lung cancer and cumulative durations of DA use, adjusting for potential confounding variables. RESULTS We identified 295 042 patients with a diagnosis of RLS. The mean age of the cohort was 62.9; 66.6% were women and 82.3% were white. The prevalence of any DA exposure was 40.3%. Compared to the reference group (no use and ≤1 year), the crude HRs for lung cancer were 1.16 (95% CI 0.99-1.36) and 1.14 (95% CI 0.86-1.51) for 1-3 years and >3 years of cumulative DA use, respectively. The adjusted HR for lung cancer was 1.05 (95% CI 0.88-1.25) for 1-3 years and 1.02 (95% CI 0.76-1.37) for >3 years of cumulative DA use, respectively. CONCLUSIONS At typical doses for the clinical management of RLS, long-term DA use was not associated with risk of lung cancer.
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Affiliation(s)
- Pilar Hernandez-Con
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Justine Shults
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Allison W Willis
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yu-Xiao Yang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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McNamara S, Hon B, Kirshblum S. Restless leg syndrome in spinal cord injury: case report. Spinal Cord Ser Cases 2023; 9:19. [PMID: 37137889 PMCID: PMC10156660 DOI: 10.1038/s41394-023-00576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023] Open
Abstract
CASE DESCRIPTION Restless leg syndrome (RLS) is a condition infrequently reported in spinal cord injury that causes an uncomfortable sensation in the legs and an urge to move them. We report a case involving a 63-year-old man with incomplete paraplegia with an onset of RLS four years post injury. FINDINGS Based upon history, pramipexole was prescribed for the presumptive diagnosis of RLS, with good effect. Initial workup revealed an anemia (hemoglobin of 9.3 gram/deciliter (g/dl)) and iron deficiency (ferritin of 10 microgram/liter (μg/L)), necessitating further evaluation. CONCLUSION Due to the complexities in diagnosing RLS in patients with SCI, it is important to be cognizant of symptoms and to consider this diagnosis to initiate the appropriate work-up for an etiology, of which iron deficiency anemia is common.
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Affiliation(s)
- Shane McNamara
- Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, NJ, USA.
| | - Beverly Hon
- Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, NJ, USA
- Spinal Cord Injury & Disorders Department, Veteran Administration New Jersey Healthcare System, East Orange, NJ, USA
| | - Steven Kirshblum
- Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, NJ, USA
- Kessler Institute for Rehabilitation, West Orange, New Jersey. Kessler Foundation, West Orange, NJ, USA
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Preiss A, Baumgartner P, Edlund MJ, Bobashev GV. Using Named Entity Recognition to Identify Substances Used in the Self-medication of Opioid Withdrawal: Natural Language Processing Study of Reddit Data. JMIR Form Res 2022; 6:e33919. [PMID: 35353047 PMCID: PMC9008522 DOI: 10.2196/33919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/28/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The cessation of opioid use can cause withdrawal symptoms. People often continue opioid misuse to avoid these symptoms. Many people who use opioids self-treat withdrawal symptoms with a range of substances. Little is known about the substances that people use or their effects. OBJECTIVE The aim of this study is to validate a methodology for identifying the substances used to treat symptoms of opioid withdrawal by a community of people who use opioids on the social media site Reddit. METHODS We developed a named entity recognition model to extract substances and effects from nearly 4 million comments from the r/opiates and r/OpiatesRecovery subreddits. To identify effects that are symptoms of opioid withdrawal and substances that are potential remedies for these symptoms, we deduplicated substances and effects by using clustering and manual review, then built a network of substance and effect co-occurrence. For each of the 16 effects identified as symptoms of opioid withdrawal in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, we identified the 10 most strongly associated substances. We classified these pairs as follows: substance is a Food and Drug Administration-approved or commonly used treatment for the symptom, substance is not often used to treat the symptom but could be potentially useful given its pharmacological profile, substance is a home or natural remedy for the symptom, substance can cause the symptom, or other or unclear. We developed the Withdrawal Remedy Explorer application to facilitate the further exploration of the data. RESULTS Our named entity recognition model achieved F1 scores of 92.1 (substances) and 81.7 (effects) on hold-out data. We identified 458 unique substances and 235 unique effects. Of the 130 potential remedies strongly associated with withdrawal symptoms, 54 (41.5%) were Food and Drug Administration-approved or commonly used treatments for the symptom, 17 (13.1%) were not often used to treat the symptom but could be potentially useful given their pharmacological profile, 13 (10%) were natural or home remedies, 7 (5.4%) were causes of the symptom, and 39 (30%) were other or unclear. We identified both potentially promising remedies (eg, gabapentin for body aches) and potentially common but harmful remedies (eg, antihistamines for restless leg syndrome). CONCLUSIONS Many of the withdrawal remedies discussed by Reddit users are either clinically proven or potentially useful. These results suggest that this methodology is a valid way to study the self-treatment behavior of a web-based community of people who use opioids. Our Withdrawal Remedy Explorer application provides a platform for using these data for pharmacovigilance, the identification of new treatments, and the better understanding of the needs of people undergoing opioid withdrawal. Furthermore, this approach could be applied to many other disease states for which people self-manage their symptoms and discuss their experiences on the web.
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Affiliation(s)
- Alexander Preiss
- Center for Data Science, RTI International, Durham, NC, United States
| | - Peter Baumgartner
- Center for Data Science, RTI International, Durham, NC, United States
- ExplosionAI GmbH, Berlin, Germany
| | - Mark J Edlund
- Community Health Research Division, RTI International, Durham, NC, United States
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Nsa EI, Uzomba CI, Etuk IS, Anah MU. Prevalence of Renal Disease in Human Immunodeficiency Virus-Infected Children in Calabar, Nigeria. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:S30-S38. [PMID: 37102522 DOI: 10.4103/1319-2442.374380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Renal disease is increasingly being reported in human immunodeficiency virus (HIV)-infected children with or without antiretroviral drugs. This study was aimed at determining the prevalence of renal disease in HIV-infected children with or without treatment in Calabar, Nigeria. A descriptive cross-sectional study of 146 consecutive HIV-infected children seen at the pediatric HIV clinic of General Hospital Calabar and University of Calabar Teaching Hospital, aged six weeks to 15 years, was carried out from February 1 to September 30, 2015. Demographic and clinical data were obtained by interviewing parents and from medical records of each subject. Clinical examination, anthropometry (weight and height), and blood pressure were done on each child. Each child's urine was tested for persistent proteinuria using combi-10-urinalysis strips. All negative urine samples had urine albumin and urine creatinine determined using immunoturbidimetric assay and Jaffe kinetic reaction, respectively; hence, the urine albumin and urine creatinine ratio was calculated. The serum creatinine of each subject was estimated and used to calculate estimated glomerular filtration rate (eGFR) using Schwartz formula. Renal disease was defined by persistent proteinuria >+1 on dipstick or urine protein-creatinine ratio >0.2, decreased eGFR <60 mL/min/1.73 m2, and presence of microalbuminuria (urine albumin/creatinine ratio >30-300 mg/g). Data were analyzed using IBM SSPS Statistics version 20.0, and P ≤0.05 was statistically significant. A total of 146 children were recruited. Eighty-five (58.2%) were male and 61 (41.8%) were female giving a male:female ratio of 1:0.7. Fifty-three (36.3%) had renal disease, 48 (32.9%) had microalbuminuria, and five (3.4%) had persistent proteinuria. There was no significant association between renal disease and severe HIV disease (P >0.05), highly active antiretroviral therapy treatment (P >0.05), and duration of treatment (P >0.05). Renal disease is common in HIV-infected children with or without medication. Hence, they should be screened for renal disease at diagnosis and periodically.
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Affiliation(s)
- Ekaette Itam Nsa
- Department of Pediatrics, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Chigozie Ikechukwu Uzomba
- Department of Pediatrics, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Imaobong Saturday Etuk
- Department of Pediatrics, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Maxwell Udoh Anah
- Department of Pediatrics, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Richards K, Britt KC, Cuellar N, Wang Y, Morrison J. Clinical Decision-Making: Restless Legs Syndrome and Dementia in Older Adults. Nurs Clin North Am 2021; 56:265-274. [PMID: 34023120 DOI: 10.1016/j.cnur.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Restless legs syndrome (RLS), one of the more prevalent sleep disturbances among older adults, impacts quality of life. Patients with dementia are at high risk for developing RLS and may be unable to describe their symptoms. Often underdiagnosed, RLS can contribute to discomfort, pain, nighttime agitation, disturbed sleep, and falls. Clinical assessment is crucial and should include a thorough evaluation with input from the patient and family, deprescribing medication if possible, and consideration of common sleep-disturbing factors. Evidence-based treatment in this population is limited; overall focus should center on relieving discomfort while identifying and treating bothersome sleep symptoms.
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Affiliation(s)
- Kathy Richards
- The University of Texas at Austin, School of Nursing, 1710 Red River Street, Austin, TX 78712, USA. https://twitter.com/kathyrichards2
| | - Katherine Carroll Britt
- The University of Texas at Austin, School of Nursing, 1712 Red River Street, Austin, TX 78712, USA. https://twitter.com/KatherineCBritt1
| | - Norma Cuellar
- The University of Alabama, University Boulevard, 650 University Boulevard East, Tuscaloosa, AL 35401, USA.
| | - Yanyan Wang
- The University of Texas at Austin, School of Nursing, 1712 Red River Street, Austin, TX 78712, USA. https://twitter.com/yanw06689982
| | - Janet Morrison
- The University of Texas at Austin, School of Nursing, 1712 Red River Street, Austin, TX 78712, USA. https://twitter.com/phdb4ss
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So S, Brennan FP, Brown MA. Cognitive Biases in Medicine: The Potential Impact on the Diagnosis of Restless Legs Syndrome in Chronic Kidney Disease. J Pain Symptom Manage 2021; 61:870-877. [PMID: 33035652 DOI: 10.1016/j.jpainsymman.2020.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Sarah So
- Department of Palliative Care, St George Hospital, Kogarah, Sydney, Australia; St George & Sutherland Clinical Schools, University of NSW, Sydney, New South Wales, Australia.
| | - Frank P Brennan
- Department of Palliative Care, St George Hospital, Kogarah, Sydney, Australia; Department of Renal Medicine, St George Hospital, Kogarah, Sydney, Australia; St George & Sutherland Clinical Schools, University of NSW, Sydney, New South Wales, Australia
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital, Kogarah, Sydney, Australia; St George & Sutherland Clinical Schools, University of NSW, Sydney, New South Wales, Australia
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Richards KC, Allen RP, Morrison J, Fry L, Kovach CR, Rangel A, Loera A, Wang Y, Hanlon AL, Lozano AJ, Bliwise DL. Nighttime Agitation in Persons with Dementia as a Manifestation of Restless Legs Syndrome. J Am Med Dir Assoc 2020; 22:1410-1414. [PMID: 33347845 DOI: 10.1016/j.jamda.2020.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Nighttime agitation or "sundowning" is challenging for clinicians and caregivers to manage in older adults in the dementia stage of Alzheimer's disease (AD-D). Our research previously revealed that nighttime agitation might be a manifestation of restless legs syndrome (RLS). The current study aims to describe the characteristics of older adults with AD-D, nighttime agitation, and RLS, and to evaluate sleep disturbance and iron status in relation to nighttime agitation severity. DESIGN An observational study with baseline descriptive and correlational data from a clinical trial. SETTING AND PARTICIPANTS Long-term care (n = 69) and independent living (n = 7); age 82.91 ± 9.46 years, with AD-D, nighttime agitation, and RLS. MEASUREMENTS Trained observers counted nighttime agitation behaviors. Independent variables were age; cognition measured by the Mini-Mental State Examination; minutes slept from actigraphy; transferrin saturation percentage (TS%) and transferrin from fasting blood samples; and illness severity using the Cumulative Illness Rating Scale for Geriatrics. Bivariate and multivariable linear regression models were generated. RESULTS In the multivariable model, sleep minutes (P = .002) and TS% (P = .003) were negatively associated with frequency of nighttime agitation behaviors, and they explained 20% of the variance. Seventy-nine percent received 1 or more medications that worsen RLS symptoms, such as antihistamines and serotonin reuptake inhibitors. CONCLUSIONS AND IMPLICATIONS We encourage clinicians to consider nighttime agitation as a manifestation of RLS. Treatment of iron deficiency indicated by low TS% and deprescribing medications that exacerbate RLS may decrease nighttime agitation, improve sleep, and enhance quality of life in older adults with AD-D.
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Affiliation(s)
- Kathy C Richards
- School of Nursing, University of Texas at Austin, Austin, TX, USA.
| | - Richard P Allen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janet Morrison
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Liam Fry
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Christine R Kovach
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Angelica Rangel
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Ana Loera
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Yanyan Wang
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Alexandra L Hanlon
- Center for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, USA
| | - Alicia J Lozano
- Center for Biostatistics and Health Data Science, Virginia Tech, Blacksburg, VA, USA
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Berteotti C, Lo Martire V, Alvente S, Bastianini S, Matteoli G, Ohtsu H, Lin JS, Silvani A, Zoccoli G. Tibialis anterior electromyographic bursts during sleep in histamine-deficient mice. J Sleep Res 2020; 30:e13255. [PMID: 33314463 DOI: 10.1111/jsr.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/02/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
Antihistamine medications have been suggested to elicit clinical features of restless legs syndrome. The available data are limited, particularly concerning periodic leg movements during sleep, which are common in restless legs syndrome and involve bursts of tibialis anterior electromyogram. Here, we tested whether the occurrence of tibialis anterior electromyogram bursts during non-rapid eye movement sleep is altered in histidine decarboxylase knockout mice with congenital histamine deficiency compared with that in wild-type control mice. We implanted six histidine decarboxylase knockout and nine wild-type mice to record neck muscle electromyogram, bilateral tibialis anterior electromyogram, and electroencephalogram during the rest (light) period. The histidine decarboxylase knockout and wild-type mice did not differ significantly in terms of sleep architecture. In both histidine decarboxylase knockout and wild-type mice, the distribution of intervals between tibialis anterior electromyogram bursts had a single peak for intervals < 10 s. The total occurrence rate of tibialis anterior electromyogram bursts during non-rapid eye movement sleep and the occurrence rate of the tibialis anterior electromyogram bursts separated by intervals < 10 s were significantly lower in histidine decarboxylase knockout than in wild-type mice. These data do not support the hypothesis that preventing brain histamine signalling may promote restless legs syndrome. Rather, the data suggest that limb movements during sleep, including those separated by short intervals, are a manifestation of subcortical arousal requiring the integrity of brain histamine signalling.
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Affiliation(s)
- Chiara Berteotti
- PRISM Lab, Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Viviana Lo Martire
- PRISM Lab, Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Sara Alvente
- PRISM Lab, Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Stefano Bastianini
- PRISM Lab, Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Gabriele Matteoli
- PRISM Lab, Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | | | - Jian-Sheng Lin
- Physiologie intégrée du système d'éveil, Centre de recherche en neurosciences de Lyon, INSERM U1028-CNRS UMR 5292 Faculté de Médecine, Université Claude Bernard, Lyon, France
| | - Alessandro Silvani
- PRISM Lab, Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Giovanna Zoccoli
- PRISM Lab, Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
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12
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Abstract
Restless legs syndrome (RLS), with a lifetime prevalence of up to 10%, is a frequent neurological disease and the most common movement disorder in sleep. A compulsive urge to move the legs with sensory symptoms and sleep disturbances can significantly impair the quality of life. Furthermore, RLS frequently occurs as a comorbidity to various internal and neurological diseases. It is diagnosed clinically based on the five essential diagnostic criteria. For treatment, an iron deficiency should first be excluded. Drugs approved for the treatment of RLS include dopaminergics (L-DOPA/benserazide) and dopamine agonists as well as oxycodone/naloxone, as a second-line treatment in severe cases. Augmentation as a deterioration of symptoms is a clinically defined complication of high-dose dopaminergic treatment, requiring special management strategies. Due to its high prevalence of up to 25%, RLS plays also an important role in the care of pregnant women.
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13
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Restless-legs-Syndrom: ein Update. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Nishioka H, Kanzawa Y. Restless legs syndrome induced by fexofenadine/pseudoephedrine. J Gen Fam Med 2020; 21:256-257. [PMID: 33304720 PMCID: PMC7689230 DOI: 10.1002/jgf2.338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
Antihistamines are known risk factors for restless legs syndrome (RLS). However, reports on RLS associated with fexofenadine or its combinations are rare. Here, we report a 30-year-old woman with RLS that was induced by fexofenadine/pseudoephedrine. She had been taking fexofenadine/pseudoephedrine for three months and felt a strong urge to move her legs at night, which was relieved by movement. Her condition improved by taking pramipexole, which she discontinued subsequently because of dizziness. One month later, she quitted taking fexofenadine/pseudoephedrine, after which her symptoms disappeared a week later. This case study demonstrates that RLS can be induced by fexofenadine/pseudoephedrine and we should always consider the possibility of drug-induced RLS.
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Affiliation(s)
- Hiroaki Nishioka
- Department of General Internal MedicineKobe City Medical Center General HospitalKobeJapan
| | - Yohei Kanzawa
- Department of General Internal MedicineAkashi Medical CenterAkashiJapan
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15
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Didato G, Di Giacomo R, Rosa GJ, Dominese A, de Curtis M, Lanteri P. Restless Legs Syndrome across the Lifespan: Symptoms, Pathophysiology, Management and Daily Life Impact of the Different Patterns of Disease Presentation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3658. [PMID: 32456058 PMCID: PMC7277795 DOI: 10.3390/ijerph17103658] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
Restless legs syndrome is a common but still underdiagnosed neurologic disorder, characterized by peculiar symptoms typically occurring in the evening and at night, and resulting in sleep disruption and daily functioning impairment. This disease can affect subjects of all age ranges and of both sexes, manifesting itself with a broad spectrum of severity and deserving special attention in certain patient categories, in order to achieve a correct diagnosis and an effective treatment. The diagnosis of restless legs syndrome can be challenging in some patients, especially children and elderly people, and an effective treatment might be far from being easy to achieve after some years of drug therapy, notably when dopaminergic agents are used. Moreover, the pathophysiology of this disorder offers an interesting example of interaction between genetics and the environment, considering strong iron metabolism involvement and its interaction with recognized individual genetic factors. Therefore, this syndrome allows clinicians to verify how lifespan and time can modify diagnosis and treatment of a neurological disorder.
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Affiliation(s)
- Giuseppe Didato
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
| | - Roberta Di Giacomo
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
| | - Giuseppa Jolanda Rosa
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
- Neurology Unit, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Ambra Dominese
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
| | - Marco de Curtis
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
| | - Paola Lanteri
- Neurophysiopathology Unit, Foundation IRCCS Carlo Besta Neurological Institute, 20133 Milan, Italy;
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16
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Ocak D, Kotan VO, Paltun SC, Aydemir MÇ. Is restless legs syndrome related with depression/anxiety disorders or medications used in these disorders? A cross-sectional, clinic-based study. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1673943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Davut Ocak
- Department of Psychiatry, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Vahap Ozan Kotan
- Department of Psychiatry, Başkent University Medical Faculty, Ankara, Turkey
| | - Salih Cihat Paltun
- Department of Psychiatry, Ankara Numune Training and Research Hospital, Ankara, Turkey
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17
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Abstract
Pain is one of the most common symptoms among patients with end-stage renal disease (ESRD), and is often under recognized and not adequately managed in hemodialysis (HD) patients. Barriers to adequate pain management include poor awareness of the problem, insufficient medical education, fears of possible drug-related side effects, and common misconceptions about the inevitability of pain in elderly and HD patients. Caregivers working in HD should be aware of the possible consequences of inadequate pain assessment and management. Common pain syndromes in HD patients include musculoskeletal diseases and metabolic neuropathies, associated with typical intradialytic pain. Evaluating the etiology, nature, and intensity of pain is crucial for choosing the correct analgesic. A mechanism-based approach to pain management may result in a better outcome. Pharmacokinetic considerations on clearance alterations and possible toxicity in patients with ESRD should drive the right analgesic prescription. Comorbidities and polymedications may increase the risk of drug-drug interactions, therefore drug metabolism should be taken into account when selecting analgesic drugs. Automedication is common among HD patients but should be avoided to reduce the risk of hazardous drug administration. Further research is warranted to define the efficacy and safety of analgesic drugs and techniques in the context of patients with ESRD as generalizing information from studies conducted in the general population could be inappropriate and potentially dangerous. A multidisciplinary approach is recommended for the management of complex pain syndromes in frail patients, such as those suffering from ESRD.
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Affiliation(s)
- Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
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18
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Abstract
Neuropathic pain is associated with sleep disturbances, and in turn poor sleep quality leads to increased pain sensitivity, so it is essential to assess sleep alongside neuropathic pain. Responses to drugs are inconsistent and identifying the best treatment option that will reduce pain and improve sleep quality remains challenging for clinicians. Anticonvulsants such as pregabalin and gabapentin improve neuropathic pain and have a positive effect on comorbid sleep disturbances. Opioids and antidepressants are effective in reducing pain but can exacerbate sleep disturbances. FUNDING Pfizer, Italy.
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19
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Cho CH, Kim L, Lee HJ. Individuals with Restless Legs Syndrome Tend to have Severe Depressive Symptoms: Findings from a Community-Based Cohort Study. Psychiatry Investig 2017; 14:887-893. [PMID: 29209397 PMCID: PMC5714735 DOI: 10.4306/pi.2017.14.6.887] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/06/2017] [Accepted: 04/09/2017] [Indexed: 11/21/2022] Open
Abstract
Restless legs syndrome (RLS) is a sensorimotor neurological disturbance causing physical and psychological distress. Here, we investigated the severity and effect of depressive symptoms in RLS among a Korean cohort population. Depressive symptoms were more prevalent in the RLS group than in the non-RLS group [≥mild depression: odds ratio (OR)=1.95, p<0.001; ≥ moderate depression: OR=6.15, p<0.001; and ≥severe depression: OR=56.54, p<0.001], with a predominant proportion of severe depression (97%) in the RLS group. We found that difficulty falling asleep (OR=8.16, p<0.001), broken sleep (OR=11.66, p=0.001), early morning awakening (OR=8.5, p<0.001), and excessive daytime sleepiness (OR=3.04, p=0.031) were significantly frequent in individuals with severe depression in the RLS group. Red blood cell count was significantly low in individuals with severe depression in the RLS group (p=0.041). We found that severe depression was associated with RLS, suggesting the evaluation and management of mood symptoms and sleep-related and hematological features when treating RLS.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
- Sleep-Wake Disorders Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Leen Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
- Sleep-Wake Disorders Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
- Sleep-Wake Disorders Center, Korea University Anam Hospital, Seoul, Republic of Korea
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20
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Angriman M, Cortese S, Bruni O. Somatic and neuropsychiatric comorbidities in pediatric restless legs syndrome: A systematic review of the literature. Sleep Med Rev 2017; 34:34-45. [DOI: 10.1016/j.smrv.2016.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/18/2016] [Accepted: 06/22/2016] [Indexed: 11/26/2022]
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21
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DeFerio JJ, Govindarajulu U, Brar A, Cukor D, Lee KG, Salifu MO. Association of restless legs syndrome and mortality in end-stage renal disease: an analysis of the United States Renal Data System (USRDS). BMC Nephrol 2017; 18:258. [PMID: 28764654 PMCID: PMC5540277 DOI: 10.1186/s12882-017-0660-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Objective of the study is to assess prevalence and survival among end stage renal disease patients with restless legs syndrome (RLS) within a national database (USRDS). Methods A case-control, retrospective analysis was performed. Differences in characteristics between the groups, RLS and those with no sleep disorder (NSD), were determined using χ2 tests. Cox proportional hazard regression was used to assess survival between those with RLS and propensity score matched controls. Results Cases of restless legs syndrome were defined as patients that had received an ICD-9 code of 333.94 at any point during their treatment (n = 372). RLS group demonstrated a significantly higher proportion of patients with major depressive disorder, dysthymic disorder, anxiety, depression, minor depressive disorder, and psychological disorder. The difference between the survival was not statistically significant in those without sleep disorder as compared to those with RLS (HR =1.16±0.14, p = 0.3). Conclusions True prevalence of RLS in dialysis patients can only be estimated if knowledge gap for care providers in diagnosis of RLS is addressed. RLS patients also have increased incidence of certain psychological disorders which needs to be addressed. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0660-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joseph J DeFerio
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Usha Govindarajulu
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Amarpali Brar
- Division of Nephrology, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 52, Brooklyn, NY, 11203, USA
| | - Daniel Cukor
- Department of Psychiatry and Behavioral Science, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Kathleen G Lee
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Moro O Salifu
- Division of Nephrology, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 52, Brooklyn, NY, 11203, USA.
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22
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Abstract
Neurological symptoms commonly occur in chronic kidney disease and may result from its treatments and complications. Impaired renal function also influences treatments for other neurological conditions, requiring various cautions, dose adjustments and timing considerations, particularly in the context of renal replacement therapy. In this review, we present six illustrative clinical vignettes to highlight these challenges.
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Affiliation(s)
- Dearbhla M Kelly
- Department of Neurology, Cork University Hospital, Cork, Ireland.,Department of Renal Medicine, Cork University Hospital, Cork, Ireland
| | | | - Simon Cronin
- Department of Neurology, Cork University Hospital, Cork, Ireland .,Department of Clinical Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland
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23
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Thr105Ile (rs11558538) polymorphism in the histamine-1-methyl-transferase (HNMT) gene and risk for restless legs syndrome. J Neural Transm (Vienna) 2016; 124:285-291. [DOI: 10.1007/s00702-016-1645-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/03/2016] [Indexed: 12/11/2022]
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24
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Allen JM, Graef DM, Ehrentraut JH, Tynes BL, Crabtree VM. Sleep and Pain in Pediatric Illness: A Conceptual Review. CNS Neurosci Ther 2016; 22:880-893. [PMID: 27421251 PMCID: PMC6492850 DOI: 10.1111/cns.12583] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep disruption is a common comorbidity of pediatric pain. Consequences of pain and disrupted sleep, evidence for the pain-sleep relation, and how aspects of illness, treatment, and pharmacological pain management may contribute to or exacerbate these issues are presented. AIMS This conceptual review explored the relation between pain and sleep in children diagnosed with chronic medical or developmental conditions. The goal of this review is to expand upon the literature by examining common themes in sleep disturbances associated with painful conditions across multiple pediatric illnesses. Populations reviewed include youth with intellectual and developmental disabilities (IDD), migraines, cystic fibrosis (CF), sickle cell disease (SCD), cancer, juvenile idiopathic arthritis (JIA), juvenile fibromyalgia (JFM), and functional gastrointestinal disorders (FGIDs). RESULTS Consistent evidence demonstrates that children with medical or developmental conditions are more vulnerable to experiencing pain and subjective sleep complaints than healthy peers. Objective sleep concerns are common but often under-studied. Evidence of the pain-sleep relationship exists, particularly in pediatric SCD, IDD, and JIA, with a dearth of studies directly examining this relation in pediatric cancer, JFM, CF, and FGIDs. Findings suggest that assessing and treating pain and sleep disruption is important when optimizing functional outcomes. CONCLUSION It is essential that research further examine objective sleep, elucidate the pain-sleep relationship, consider physiological and psychosocial mechanisms of this relationship, and investigate nonpharmacological interventions aimed at improving pain and sleep in vulnerable pediatric populations.
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Affiliation(s)
- Jennifer M Allen
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Danielle M Graef
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Brooklee L Tynes
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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25
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Akhlaghi H, Ghorbani M, Lahoori NA, Shams A, Seyedin O. Preconcentration and determination of naproxen in water samples by functionalized multi-walled carbon nanotubes hollow fiber solid phase microextraction—HPLC. JOURNAL OF ANALYTICAL CHEMISTRY 2016. [DOI: 10.1134/s1061934816070091] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Braley TJ, Chervin RD. A practical approach to the diagnosis and management of sleep disorders in patients with multiple sclerosis. Ther Adv Neurol Disord 2015; 8:294-310. [PMID: 26600873 DOI: 10.1177/1756285615605698] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Patients with multiple sclerosis (MS) are at increased risk for comorbid sleep disturbances, which can profoundly contribute to poor functional status and fatigue. Insomnia, sleep-disordered breathing, and restless legs syndrome are among the most common sleep disorders experienced by patients with MS. Despite their impact, these underlying sleep disorders may escape routine clinical evaluations in persons with MS, thereby leading to missed opportunities to optimize functional status and quality of life in patients with MS. A practical, systematic approach to the evaluation and treatment of sleep disorders in MS, in the context of MS-specific variables that may influence risk for these conditions or response to therapy, is recommended to facilitate early diagnosis and successful treatment. This review summarizes the most common sleep disorders experienced by persons with MS, and offers a practical approach to diagnosis and management of these conditions.
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Affiliation(s)
- Tiffany J Braley
- Assistant Professor, Department of Neurology, Multiple Sclerosis and Sleep Disorders Centers, University of Michigan, C728 Med-Inn Building, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Ronald D Chervin
- Michael S. Aldrich Professor of Sleep Medicine and Professor of Neurology, Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA
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27
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Yang FC, Lin TY, Chen HJ, Lee JT, Lin CC, Kao CH. Risk of Restless Legs Syndrome Following Tension-Type Headache: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e2109. [PMID: 26579827 PMCID: PMC4652836 DOI: 10.1097/md.0000000000002109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Migraine and restless legs syndrome (RLS) appear to be associated, but the relationship between tension-type headache (TTH) and RLS is unknown. This nationwide, population-based, retrospective cohort study explored the potential association between TTH and RLS.We identified 15,504 patients with newly diagnosed TTH from 2000 to 2007 and 62,016 individuals without TTH who were selected by frequency matched based on sex, age, and the index year. The study participants were followed until diagnosed with RLS, withdrawal from the NHI program, or the end of 2011. Cox proportional hazard models were used to identify risk factors for RLS in TTH patients.After adjusting for sex, age, comorbidity, and medications, TTH was significantly associated with an increased risk of RLS (hazard ratio [HR] = 1.57, 95% confidence interval [CI] = 1.22-2.02). The risk was most prominent in patients aged 20 to 39 years in the TTH group, which exhibited a 2.60-fold higher risk (95% confidence interval = 1.53-4.42) of RLS compared with the non-TTH group. The TTH group had a higher risk of RLS than that of the non-TTH group regardless of sex.Tension-type headache appears to be associated with an increased risk of developing RLS. This similarity to migraines may indicate that headache and RLS have a coincident pathophysiological mechanism, a possibility requiring further study. Clinicians should be more attentive to RLS as a possible comorbidity in patients with TTH.
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Affiliation(s)
- Fu-Chi Yang
- Form the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (F-CY, J-TL, C-CL); Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (T-YL); Management Office for Health Data, China Medical University Hospital (H-JC); College of Medicine, China Medical University (H-JC); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University (C-HK); Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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28
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Freudenreich O, Huffman JC, Sharpe M, Beach SR, Celano CM, Chwastiak LA, Cohen MA, Dickerman A, Fitz-Gerald MJ, Kontos N, Mittal L, Nejad SH, Niazi S, Novak M, Philbrick K, Rasimas JJ, Shim J, Simpson SA, Walker A, Walker J, Wichman CL, Zimbrean P, Söllner W, Stern TA. Updates in Psychosomatic Medicine: 2014. PSYCHOSOMATICS 2015; 56:445-59. [DOI: 10.1016/j.psym.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 01/21/2023]
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30
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Sharon D. Nonpharmacologic Management of Restless Legs Syndrome (Willis-Ekbom Disease). Sleep Med Clin 2015; 10:263-78, xiii. [DOI: 10.1016/j.jsmc.2015.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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