Diagnosis, comorbidities, and management of restless legs syndrome

The impact of neuropsychiatric burden on Restless Legs Syndrome (RLS) disease severity

OBJECTIVE

In patients with Restless Legs Syndrome (RLS), neuropsychiatric comorbidities like anxiety, depression, and somatization are common, yet the precise connection between somatization and RLS severity remains unclear. This study aims to elucidate the influence of neuropsychiatric comorbidities on RLS severity, focusing particularly on the role of somatization.

METHODS

This cross-sectional analytical study was conducted at a tertiary hospital. All 113 RLS patients who followed in neurology clinic for at least a year were invited, and 87 participated. Data collection included sociodemographic details, the International Restless Legs Syndrome Study Group rating scale (IRLS), the Beck Depression Inventory, Beck Anxiety Scale, and Somatization Scale. Elastic-net regularized path analysis was used as the statistical method.

RESULTS

Among the 87 participants (70.1 % female, mean age 52.5 ± 13.2 years), the mean duration of RLS diagnosis was 4.95 ± 4.53 years. Univariate statistics revealed positive correlations among RLS severity, anxiety, depression, and somatization. Path analysis showed that somatization was associated with RLS severity (p = 0.014). Anxiety had no direct effect on RLS severity but influenced it indirectly through its positive association with somatization (p < 0.001). Depression was found to have no effect on RLS severity, either directly or through somatization.

CONCLUSIONS

The relationship between anxiety and RLS severity is mediated by somatization. Furthermore, the association between RLS severity and somatization appears to be more significant than previously recognized, highlighting the importance of considering somatization in addressing the neuropsychiatric burden of RLS patients.

Effects of Dietary Supplementation in Patients with Restless Legs Syndrome: A Systematic Review

Restless legs syndrome (RLS) is a common neurological disorder. It disrupts sleep and well-being and is often associated with other conditions. This review examines the potential of dietary supplements to manage RLS symptoms and reduce reliance on medications. A total of 10 randomized clinical trials involving 482 participants were analyzed, focusing on the impact of various supplements on symptom severity, sleep quality, and daytime sleepiness. Findings suggest some supplements may have positive results. Magnesium oxide and vitamin B6 significantly improved sleep quality and RLS symptoms, with magnesium showing greater effectiveness. Vitamin D supplementation did not show significant benefits. Oral iron has promising results, indicating potential efficacy but issues related to compliance and absorption. Both vitamins C and E positively affect RLS symptoms, likely due to their antioxidant properties. Valerian improved RLS and sleep but did not show a statistically significant improvement. Despite these encouraging results, a high risk of bias was noted in half of the studies, emphasizing the need for more rigorous research. Overall, this review suggests that dietary supplements may be a promising approach to managing RLS. However, further investigation is required to confirm the efficacy and safety.

Examining the prevalence of sleep disturbances in patients seeking physical therapy services

OBJECTIVE

The purpose of this study was to assess the prevalence of sleep disturbances in adults seeking physical therapy services.

METHODS

Participants were issued an electronic survey to provide demographic information and the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Sleep Hygiene Index (SHI), Insomnia Severity Index (ISI), STOP-BANG (obstructive sleep apnea (OSA) risk), and restless leg syndrome (RLS) risk. Percentages were calculated to describe prevalence of sleep disturbances, and Spearman's correlations were used to identify associations between pain and sleep questionnaires.

RESULTS

Eighty-eight participants (47.9 ± 15.8 years, 68 females) completed the survey. Seventy-eight percent (n = 69) scored >5 on the PSQI; 32% (n = 28) scored ≥10 on the ESS; 52% (n = 46) scored ≥16 on the SHI; 51% (n = 45) scored ≥10 on the ISI; 28% (n = 25) had intermediate or high risk of OSA; and 40% (n = 35) indicated possible RLS. Pain level was significantly associated with PSQI (r(86) = 0.277, p = .009) and ISI (r(86) = 0.268, p = .012).

CONCLUSIONS

There was a higher prevalence of sleep disturbances in adults seeking physical therapy services than in the general population. Increased pain severity was associated with poorer sleep quality and increased insomnia symptoms. This study highlights the need to screen patients for sleep disturbances.

Evidence-Based Assessment of Developmental Disorders

Developmental disorders are diverse, common, and impairing; still, many clinicians lack comprehensive training in their assessment. This review presents thorough guidelines for the evaluation and diagnosis of common communication, sleeping, feeding, and elimination disorders that often onset in the early developmental period and that are commonly encountered in clinical practice. Thorough guidance on the evidence-based assessment of developmental disorders is critical, as they are prevalent, impairing, and commonly comorbid with other psychiatric disorders of childhood. This review is the first of its kind-providing critically needed, step-by-step guidance on the existing evidence-based methodologies and assessment tools available for diagnosis. This review also makes clear the dire need for further development and validation of relevant screening and diagnostic measure and calls for specific attention to the development of specific screening and diagnostic assessment measures for feeding disorders and elimination disorders in particular. Clinicians and researchers alike may find this article useful in guiding diagnostic, treatment, and research procedures.

Cost-Effectiveness of Tonic Motor Activation (TOMAC) Therapy for Patients with Restless Legs Syndrome: An Exploratory Analysis

INTRODUCTION

Tonic motor activation (TOMAC) therapy is a novel non-pharmacologic treatment approach for patients suffering from medication-refractory restless legs syndrome (RLS). The objective of this study was to explore the potential cost-effectiveness of TOMAC in the US healthcare system.

METHODS

A decision-analytic Markov model was constructed to project strategy-specific treatment costs and benefits over 3 years and lifetime. Cohort characteristics (mean age 57.4 years, 39.8% male) and treatment effects were derived from the sham-controlled RESTFUL study. Study-observed International RLS Study Group (IRLS) scores were used to estimate changes in healthcare resource utilization and quality of life based on mapping algorithms informed by published data. The incremental cost-effectiveness ratio (ICER) was evaluated against established willingness-to-pay thresholds of $50,000/$150,000 per QALY to determine cost-effectiveness. Extensive scenario analyses were performed, including longer-term extension study data.

RESULTS

 TOMAC and sham reduced IRLS scores from baseline 25.3 to 18.10 and 21.60, respectively, at 4 weeks (treatment effect - 3.4 vs. sham), with an increase in utility from 0.80 to 0.84 (0.75-0.84 vs. baseline). Over 3 years and lifetime, the TOMAC vs. sham effect size corresponded to an added 0.10 and 0.49 QALYs (2.36 vs. 2.26; 12.59 vs. 12.10) at incremental costs of $8061 and $36,373 ($36,707 vs. $28,646; $224,040 vs.$187,667), resulting in ICER estimates of $83,822 and $73,600, respectively. Compared to baseline, TOMAC resulted in ICER estimates of $29,569 and $23,690 over 3 years and lifetime, respectively. TOMAC remained cost-effective or dominant across all scenarios, with ICERs ranging from $10,530-$83,822 and - $8061 to $29,569 vs. sham and baseline, respectively. Larger TOMAC effect sizes, achieved per extension study data, further increased cost-effectiveness.

CONCLUSION

 Based on this exploratory analysis of published trial data, TOMAC therapy appears to offer meaningful improvements in patient health-related quality at net costs that render it a cost-effective intervention. Further analyses are warranted.

Initial Cervical Spinal Cord Demyelinating Lesions are not Associated with Restless Legs Syndrome in Patients with Multiple Sclerosis

Purpose

This study aims to determine the prevalence and severity of restless legs syndrome (RLS) in patients with multiple sclerosis (MS) and its association with spinal cord lesions, fatigue, quality of life, and sleep disturbance.

Methods

We recruited 222 consecutive MS patients admitted to MS outpatient clinic. Beck's Depression Inventory (BDI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and MS Quality of Life-54 (MSQoL-54) questionnaire scores of all patients were measured. Initial cervical spinal cord magnetic resonance imaging (MRI) of the patients at first clinical evaluation for diagnosis was reviewed for accompanying demyelinating lesions.

Results

RLS was diagnosed in 53 (23.87%) patients. RLS was associated with poor sleep, worse quality of life, increased fatigue, and depressive mood. The sleep quality index, FSS, and MSQoL-54 physical composite scores significantly correlated with RLS severity (P < 0.001, P = 0.001, P < 0.001, respectively). Of the 200 patients, 127 (63.5%) had spinal cord lesions. 22.83% of the patients with cervical spinal cord lesions had RLS comorbidity. We found no significant difference regarding spinal cord demyelinating lesions between RLS positives and negatives. (P = 0.77). In addition, having multiple spinal cord demyelinating lesions did not differ between the two groups (P = 0.84). Besides, the severity of RLS symptoms did not differ in patients who had a single cervical spinal lesion and those who had multiple lesions (P = 0.35).

Conclusion

We have demonstrated the negative impact of comorbid RLS on fatigue, sleep quality, mood, and quality of life in MS patients. However, initial spinal cord lesions did not correlate with RLS comorbidity. The severity of RLS symptoms is associated with poor sleep and physical health.

Assessment of Sleep Disturbances on Mental Health in Patients with Restless Legs Syndrome

Background and Objective

In our study, we aimed to evaluate the sleep disturbances of patients diagnosed with restless legs syndrome (RLS) regarding their mental health according to the severity of the disease.

Materials and Methods

The study included 166 patients diagnosed with RLS and 161 healthy controls in the same age interval as patients. Sleep disturbances of patients were defined with the "personal information form" (PIF) prepared by the researchers, while the mental health status of patients was defined with the "Brief Symptom Inventory" (BSI).

Results

All RLS patients had an increase in BSI subscale points, with a positive correlation to disease severity, and subscale points were significantly higher than the control group (p < 0.05). Those with the "frequent waking" problem had higher BSI subscale points compared to those without the problem (p<0.01 or 0.001). Those with "waking with respiratory distress," "daytime sleepiness," "very early waking," and "sleep disorder" problems had statistically significantly high BSI subscale points for all subscales, apart from hostility, compared to those without these problems (p<0.01 or 0.001).

Conclusion

It is considered that assessment of sleep disturbances causing disrupted quality of life and mood disorders is beneficial for the treatment of patients with RLS. Our study data appears to be related to the result that sleep disturbances and mental health disruptions might be associated with the disease severity among RLS patients.

Modification and Validation of a Diagnostic Questionnaire for Restless Legs Syndrome: Modified-Restless Legs Syndrome Diagnostic Questionnaire (m-RLS-DQ)

Background

Diagnostic questionnaire that are available for restless legs syndrome does not include items related to RLS mimics and, hence, increases chances of false positive cases. This study aimed at modification and validation of RLS-diagnostic Questionnaire.

Methods

During modification, additional items were identified, developed, and subjected to evaluation by experts. Experts were requested to validate the content of each item. Based on their responses, content validity indices (average and universal agreement) were calculated. It was then translated to Hindi and validated in a clinical population that included patients with RLS, somatic symptoms disorder, anxiety, other RLS mimics, and osteoarthritis. In addition, a group of healthy controls was also included. Face, concurrent, and discriminant validities were calculated.

Results

Among 209 subjects, nearly 40 subjects had clinical diagnosis of RLS, osteoarthritis, somatic-symptoms-disorder, and anxiety disorder, each. In addition, 16 patients had other RLS mimics (akathisia, varicose veins, BFS, leg-cramps, chronic insomnia) and 30 were healthy controls. After multiple revisions, content validity indices achieved a score of 1 for m-RLS-DQ. Sensitivity and specificity of m-RLS-DQ v. 1.4 for the diagnosis of RLS were 94.9% and 94.1%, respectively. For the diagnosis of RLS, PPV was 78.7%, and NPV was 98.7% with an accuracy of 94.3%. Less than one fourth of participants having chronic insomnia, somatic symptoms disorder, anxiety disorder, and knee osteoarthritis were found to be false positive on m-RLS-DQ; however, none of the healthy controls were found positive on m-RLS-DQ. Concurrent validity with clinical diagnosis of RLS was 0.83 (P < 0.001). Discriminant validity with somatic symptoms disorder was -0.14 (P = 0.03) and with osteoarthritis -0.24 (P < 0.001).

Conclusion

m-RLS-DQ is a valid instrument with acceptable psychometric properties, which can be used for the screening as well as diagnosis of RLS in clinical practice and research studies.

Restless legs syndrome in patients with psoriasis: association with inflammation and sleep quality

BACKGROUND

We aimed to evaluate if psoriasis associated with restless legs syndrome (RLS) due to its close relationship with metabolic disorders.

METHODS

This was a cross-sectional study in which the relationship between RLS and psoriasis was evaluated. Seventy consecutive psoriasis patients and 70 controls without any skin disorder were included in this study. Data including age, gender, body weight, height, and Psoriasis Area Severity Index (PASI) scores were recorded. Diagnosis of RLS was established using International RLS Study Group (IRLSSG) diagnostic criteria. International RLS Rating Scale (IRLSRS) was used to evaluate the severity of symptoms. Each participant completed forms of the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Dermatology Life Quality Index (DLQI).

RESULTS

The RLS frequency in patients with psoriasis was 18.6% vs. 5.7% in the control group (P = 0.018). In psoriasis patients, BMI, DLQI, IRLSRS, hemoglobin, ferritin, CRP, and uric acid levels were significantly higher than those of the controls. In psoriasis patients with RLS, PASI, DLQI, PSQI, IRLSRS scores, CRP level, and BMI were significantly higher, and hemoglobin level was significantly lower relative to the psoriasis patients without RLS. PASI score was the sole independent associate of RLS presence in psoriasis patients.

CONCLUSION

Restless legs syndrome was significantly more common in psoriasis patients, and the presence of RLS was associated with significantly more severe psoriasis, more severe systemic inflammation, lower serum hemoglobin values, worse quality of life, and sleep quality.

Relationship of restless legs syndrome with number of pregnancies, duration of pregnancy and positive family history

Objectives:

The aim of this cross-sectional study was to examine the correlation between gestational age and number of previous pregnancies in group of pregnant women with restless legs syndrome and the connection of restless legs syndrome with family history positive versus family history negative group of pregnant and non-pregnant women.

Methods:

Four hundred and sixty-two women were involved in this study: 231 pregnant women and the same number of non-pregnant women of compatible age as a control group. We defined restless legs syndrome as presence of International Restless Legs Syndrome Study Group criteria. During the face-to-face interview with the researcher, respondents answered questions about duration of pregnancy, number of previous pregnancies and family history of restless legs syndrome.

Results:

Before the 16th week of pregnancy, restless legs syndrome appeared in 7.1% of pregnant women and after 16 weeks of pregnancy in 22.6% of them (t = 2.07, p = 0.039). Restless legs syndrome appeared in 11.4% of pregnant women without restless legs syndrome in the family and in 74.2% of pregnant women who did have restless legs syndrome in the family (t = 7.67, p < 0.001). It was also found that among non-pregnant women with a family history of restless legs syndrome, 42.9% had restless legs syndrome, and among those without a family history of restless legs syndrome, only 4.9% had restless legs syndrome (t = 3.49, p = 0.001). No statistically significant correlation between restless legs syndrome and number of previous pregnancies in pregnant women has been found.

Conclusion:

Our study confirmed a higher frequency of restless legs syndrome in women pregnant for 17 or more weeks and in both pregnant and non-pregnant women with a positive family history of this syndrome. We have not proven a connection between restless legs syndrome and multiparity.

Prevalence of Restless Legs Syndrome and its Symptoms among Patients with Spinal Disorders

Restless legs syndrome (RLS) is a neurological disorder that causes uncomfortable sensations in the legs. The purpose of this study was to evaluate the symptoms of RLS in patients with spinal disorders and the impact of RLS on the clinical outcomes of lumbar spinal stenosis (LSS). The records of 278 patients (age range 65–92 years) with spinal disorders who visited our outpatient clinic were reviewed. We used a survey to identify subjects with RLS based on the International RLS Study Group diagnostic criteria. We further recorded patient characteristics, surgical outcomes, sleeping time, mental health condition, and the occurrence of leg cramps. Thirty-two patients (11.5%) met the criteria for RLS. The prevalence of anxiety (46.9% vs. 26.6%, p = 0.023) and leg cramps (90.6% vs. 73.2%, p = 0.030) was higher in patients with RLS than in those without. RLS was present in 12.3% of LSS patients. The visual analog scale score for lower back pain before surgery and at the final follow-up was significantly higher in LSS patients with RLS than in those without. However, the Japanese Orthopaedic Association (JOA) score, JOA score improvement ratio, and VAS score for leg numbness were not significantly different between the groups.

Restless leg syndrome presenting as chronic severe limb pain in a dialysis patient

"Chronic pain" is a commonly reported symptom among hemodialysis patients. Despite its high prevalence and the poor health-related quality of life associated with it, chronic pain remains an ineffectively assessed and managed entity in dialysis patients. We report a case of a 55-year-old gentleman on maintenance hemodialysis who presented with 3 months history of "excruciating flitting and fleeting type" of pain largely involving both lower limbs and occasionally neck, shoulder, chest, and upper limbs. The pain was so intolerable that it even triggered suicidal intentions in the patient. Common causes of chronic pain in dialysis patients were considered, but the initial history and clinical examination remained elusive. The patient was empirically started on oral analgesics, benzodiazepines, calcitriol, and levocarnitine supplementation but had no significant effect on his symptoms. A comprehensive repeat clinical history revealed the nocturnal periodicity of symptoms, specific aggravation of pain with inactivity, and its temporary relief with movement. This helped us narrow down the diagnosis to restless leg syndrome (RLS) amidst the myriad causes of chronic pain in dialysis patients. The "constant urge to move the legs" which is the defining characteristic of RLS was inconspicuous in our patient and excruciating pain was the predominant manifestation. This atypical presentation of RLS with agonizing pain involving multiple sites of the body led to a delay in the diagnosis and initiation of appropriate therapeutic measures. The patient had a dramatic response to therapy with dopamine agonists and withdrawal of the drug led to reappearance of his symptoms which further confirmed the diagnosis of RLS. RLS should be considered in the evaluation of chronic pain in dialysis patients and renal health care providers should familiarize themselves with the varied atypical, forme fruste manifestations of RLS to avoid diagnostic delay of this disabling but treatable condition.

Restless legs syndrome among subjects having chronic liver disease: A systematic review and meta-analysis

Sleep disturbances are commonly reported in patients with chronic liver disease (CLD). Changes in quality of sleep in patients with CLD could be related to multiple factors viz., elevated levels of tryptophan, histamine, and increased turnover of dopamine in caudate-putamen and cingulate cortex. Also, iron metabolism disturbances are reported in patients with CLD. These changes may result in restless legs syndrome (RLS) that worsens sleep-quality. There have been reports suggesting an increased prevalence of RLS among patients with CLD. Literature was searched in PubMed, EMBASE, and Google Scholar. A total of twenty-two relevant articles were found. Out of these, nine studies have assessed the prevalence of RLS among patients with chronic liver disease or cirrhosis in the clinical population. Population prevalence reported from various studies was used to calculate odds ratio. Having included studies using various methods for diagnosis (clinical as well as questionnaires) pooled odds-ratio for the RLS was 8.62. It remains unaffected by study-method, gender, age, and geographical-area. However, studies using clinical diagnosis for RLS had lower odds compared to questionnaire based diagnosis. Studies varied with regards to diagnostic methods, age, gender, etiology, and severity of liver dysfunction. The severity and etiology of CLD and biochemical correlate of CLD were not found to be associated with RLS. Possible pathophysiological mechanisms are discussed for the occurrence of RLS in this population. In conclusion, the prevalence of RLS is higher among patients with CLD, however, the correlates are unknown.

Developing a biomarker for restless leg syndrome using genome wide DNA methylation data

This study reports on an epigenetic biomarker for restless leg syndrome (RLS) developed using whole genome DNA methylation data. Lymphocyte-derived DNA methylation was examined in 15 subjects with and without RLS (discovery cohort). T-tests and linear regressions were used followed by a principal component analysis (PCA). The principal component model from the discovery cohort was used to predict RLS status in a peripheral blood (N = 24; including 12 cases and 12 controls) and a post-mortem neural tissue (N = 71; including 36 cases and 35 controls) replication cohort as well as iron deficiency anemia status in a publicly available dataset (N = 71, 59 cases with iron deficiency anemia, 12 controls). Using receiver-operating characteristic analysis the optimum biomarker model - that included 49 probes - predicted RLS status in the blood-based replication cohort with an area under the curve (AUC) of 87.5% (confidence interval = 71.9%-100%). In the neural tissue samples, the model predicted RLS status with an AUC of 73.4% (confidence interval = 61.5%-85.3%). An AUC of 83% was found for predictions of iron deficiency anemia. Thus, the blood-based biomarker model reported here and built with epigenome-wide data showed reasonable replicability in lymphocytes and neural tissue samples. A limitation of this study is that we could not determine the metabolic or neurobiological pathways linking epigenetic changes with RLS. Further research is needed to fine-tune this model for prospective predictions of RLS and to enable translation for clinical use.

[Restless legs syndrome in Parkinson's disease]

Disturbances in sleep and wakefulness are important symptoms of Parkinson's disease (PD) and are associated with negative effects on patients' quality of life. The analysis of literature on the relationship between RLS and PD revealed three main hypotheses explaining the relatively high incidence of RLS in PD: (1) RLS can be considered as an early (prodromal) manifestation or a predictor of PD that can outpace its main symptoms by several years (by analogy with conduct disorder during sleep with REM); (2) the high incidence of RLS in the advanced stage of PD may be associated with augmentation of previously latent RLS symptoms during prolonged dopaminergic therapy of PD; (3) a significant proportion of RLS cases in PD patients are not «classical» RLS, but represent, for example, manifestations of motor or non-motor fluctuations or a special form of stereotypy in the legs. Further research is needed to determine if any of these statements are true.

Association of genetic variants in migraineurs with and without restless legs syndrome

Objective

Several single‐nucleotide polymorphisms (SNPs) are associated with restless legs syndrome (RLS). This study investigated whether or not additional SNP variants increase the risk of RLS in migraineurs and in migraine with aura (MA) and migraine without aura (MoA) subgroups.

Methods

Migraineurs with and without RLS were genotyped using an Affymetrix array. We performed association analyses for the entire cohort and the MA and MoA subgroups, which were divided further into episodic migraine (EM) and chronic migraine (CM). Potential correlations between SNPs and clinical indices in migraineurs with RLS were examined by multivariate regression analysis.

Results

The rs77234324 and rs79004933 SNPs were found in migraineurs with (P = 2.57E‐07) and without (P = 3.03E‐07) RLS. The A allele frequency for rs77234324 (on LGR6) was 0.1321 in migraineurs with RLS and 0.0166 in those without RLS (odds ratio, 8.978). The T allele frequency for rs79004933 (in the intergenic region) was 0.1981 in migraineurs with RLS and 0.0446 in those without (odds ratio, 5.281). rs2858654, rs76770509, rs4243475 in UTRN, rs150762626, and rs2668375 were identified in migraine with and without RLS in the MoA subgroup (P = 7.56E‐09, P = 2.30E‐08, P = 1.19E‐07, P = 6.86E‐07, and P = 8.05E‐07, respectively). There was a suggestion of an association between rs10510331 (P = 1.50E‐06) and CM and EM in patients with MoA and RLS. Multivariate regression showed a significant relationship between rs79004933 and the Beck Depression Inventory score.

Interpretation

rs77234324 in LGR6 and rs79004933 in the intergenic region were associated with RLS in migraineurs. Five SNPs increased the risk of RLS in patients with MoA.

Brain mechanisms of insomnia: new perspectives on causes and consequences

While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by genetic variants, early life stress, major life events, and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to-or receives more input from-the salience network and related circuits, even during rapid eye movement sleep, when it should normally be sound asleep. This vulnerability may ignite a downward spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal, which, in turn, impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.

Convergence of psychiatric symptoms and restless legs syndrome: A cross-sectional study in an elderly French population

OBJECTIVE

The objective was to evaluate the association between restless legs syndrome (RLS) with generalized anxiety disorder (GAD), major depression disorder (MDD), dysthymia, and GAD-depression comorbidity. Secondary aims were to examine the association between RLS with the cognitive-affective and somatic-vegetative disturbances experienced as part of depression and GAD.

METHODS

This was a cross-sectional study of 1493 elderly participants (median age 80.6 years, 64% women) from Dijon, France. Probable RLS was assessed using the minimal diagnostic criteria of the International Restless Legs Study Group and RLS symptom frequency and treatment. Participants underwent structured interviews for MDD, dysthymia, and GAD. Participants also completed the Center for Epidemiological Studies-Depression scale (CES-D). The association between RLS and psychiatric disorders, their criterion symptoms, or symptom factors was examined using logistic regression.

RESULTS

The point prevalence of probable RLS in this sample was 8.2%. Probable RLS was associated with isolated GAD (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.01-4.68) and comorbid GAD-any depression disorder (OR 3.26, 95% CI 1.14-9.29), but not MDD or dysthymia. Probable RLS was also associated with the GAD criterion worry most days and feeling tense, and the CES-D factors representing depressed affect, somatic symptoms, and positive affect.

CONCLUSIONS

Probable RLS was associated with GAD-depression comorbidity as well as isolated GAD. The findings challenge previous reports linking RLS solely with MDD, suggesting the association is partly driven by GAD-depression comorbidity.

New awakenings: current understanding of sleep dysfunction and its treatment in Parkinson's disease

The non-motor features of Parkinson’s disease (PD) are increasingly being recognised. This review deals with the spectrum of sleep disorders associated with PD, which have a multifactorial aetiology and can significantly have an impact on the quality of life of patients and their carers. Some sleep disorders represent a prodromal phase of PD, with REM sleep behaviour disorder (RBD) being of particular interest in this regard, whereas others become more common as the disease advances. Understanding the pathophysiology of these sleep disturbances will hopefully lead to new treatment opportunities in the future. The recent discovery of the glymphatic system for removal of waste products from the brain has also raised the possibility that sleep disruption may cause or accelerate the underlying disease process.

The experience of living with restless legs syndrome: A qualitative study

Restless legs syndrome is a sensorimotor disorder that significantly affects quality of life. This study explored the experience of people living with restless legs syndrome. Focus groups were analysed thematically resulting in five themes. Participants described disempowerment in managing symptoms, difficulty coping and poor understanding of the condition. Participants tried many therapies with little relief and were unable to monitor treatment effects. Concerns with healthcare services were common. Feeling understood provided validation and empowerment. Healthcare providers can help people with restless legs syndrome by improving restless legs syndrome awareness, providing psychosocial support and education, and assisting people to monitor treatment effects.

The heterotetrameric structure of the adenosine A1-dopamine D1 receptor complex: Pharmacological implication for restless legs syndrome

Dopaminergic and purinergic signaling play a pivotal role in neurological diseases associated with motor symptoms, including Parkinson's disease (PD), multiple sclerosis, amyotrophic lateral sclerosis, Huntington disease, Restless Legs Syndrome (RLS), spinal cord injury (SCI), and ataxias. Extracellular dopamine and adenosine exert their functions interacting with specific dopamine (DR) or adenosine (AR) receptors, respectively, expressed on the surface of target cells. These receptors are members of the family A of G protein-coupled receptors (GPCRs), which is the largest protein superfamily in mammalian genomes. GPCRs are target of about 40% of all current marketed drugs, highlighting their importance in clinical medicine. The striatum receives the densest dopamine innervations and contains the highest density of dopamine receptors. The modulatory role of adenosine on dopaminergic transmission depends largely on the existence of antagonistic interactions mediated by specific subtypes of DRs and ARs, the so-called A_2AR-D₂R and A₁R-D₁R interactions. Due to the dopamine/adenosine antagonism in the CNS, it was proposed that ARs and DRs could form heteromers in the neuronal cell surface. Therefore, adenosine can affect dopaminergic signaling through receptor-receptor interactions and by modulations in their shared intracellular pathways in the striatum and spinal cord. In this work we describe the allosteric modulations between GPCR protomers, focusing in those of adenosine and dopamine within the A₁R-D₁R heteromeric complex, which is involved in RLS. We also propose that the knowledge about the intricate allosteric interactions within the A₁R-D₁R heterotetramer, may facilitate the treatment of motor alterations, not only when the dopamine pathway is hyperactivated (RLS, chorea, etc.) but also when motor function is decreased (SCI, aging, PD, etc.).

Differential Diagnosis and Treatment of Restless Legs Syndrome: A Literature Review

Restless legs syndrome (RLS) is a chronic neurological disorder affecting a growing number of people. Patients describe an irresistible urge to move their lower limbs in times of immobility. Due to its vague symptoms and similarity to other disorders, it has become increasingly difficult for primary care clinicians to properly diagnose and manage RLS. As a result, patients with RLS are routinely misdiagnosed and continue their lives without proper management. This literature review examines the current understanding of the disorder, provides key points to assist clinicians in differentiating RLS from similar disorders, and explores recently updated evidence-based guidelines for the effective management of RLS.

An update on the treatment of Restless Legs Syndrome/Willis-Ekbom Disease: prospects and challenges

INTRODUCTION

Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is a sleep disorder characterized by an urge to move the legs, frequently associated or triggered by unpleasant sensations in the lower limbs that affects approximately 2.5% of adults. Therapy and management of RLS/WED require long-term interventions, since the typical manifestation of this disorder is chronic. Areas covered: In this review, we provide an update regarding the treatment of RLS/WED with particular attention to future challenges for its management. We reviewed a large variety of treatments studied in clinical trials and supported by the most updated guidelines. Alongside with first-line interventions other pharmacological options including opioids, benzodiazepines, iron therapy, and newly studied drugs are discussed. Furthermore, due to the occurrence of augmentation and worsening of symptoms we also reviewed the development of non-pharmacologic alternatives. Expert commentary: The management of RLS/WED is a challenge because of different long-term issues. Several complications, such as loss of the therapeutic effect of dopaminergic or non-dopaminergic agents and augmentation, are still unsolved concerns. However, the development of new drugs acting on adenosinergic and glutamatergic neurotransmission seems promising. Randomized controlled trials are needed in order to recognize effectiveness of new drugs or non-pharmacological treatment strategies.

Restless legs syndrome is associated with increased risk of migraine

Migraine and restless legs syndrome (RLS) are common disorders that are associated with a high level of individual suffering and major comorbidities. The aetiologies of the disorders are largely unknown, although both migraine and RLS have been linked to disturbances in the dopaminergic system and sleep issues, suggesting a relationship between the disorders. This study examines the association between RLS and migraine in a large population of otherwise healthy adults who are not taking medication. Cross-sectional study that included 20,938 participants enrolled in the Danish Blood Donor Study from 1 May 2015 to 1 February 2017. The study included complete information on migraines, the Cambridge-Hopkins RLS questionnaire, the Major Depression Inventory Scale, sex, age, body mass index (BMI), educational level, smoking status and alcohol consumption. Associations between RLS and migraine, with and without aura, were examined using multivariable logistic regression analysis. Among the participants, 4827 were self-reported migraine sufferers and 1091 were classified as suffering from RLS. Individuals with RLS had an increased risk of migraine compared to non-RLS sufferers, with an odds ratio (OR) = 1.52 (95% confidence interval: 1.33–1.73). For the investigated subtypes of migraine, this association was found to be OR = 1.55 (1.31–1.83) for migraines with aura and OR = 1.29 (1.09–1.52) for migraines without aura. We found a significantly increased occurrence of migraine in individuals with RLS. This risk was independent of sex, age, BMI, educational level, smoking status, alcohol consumption and depressive disorder. Our findings suggest that RLS and migraine may have a common aetiology.

High-Resolution Nerve Ultrasound and Electrophysiological Findings in Restless Legs Syndrome

BACKGROUND AND PURPOSE

Restless legs syndrome (RLS) is a multifactorial network disorder of a sensorimotor system extending from dopaminergic and glutamatergic cerebral structures to the spinal neurons and peripheral nerves. The role of peripheral nerve damage in the causality and severity progression for RLS patients remains unclear.

METHODS

We performed a clinical and epidemiological study on a cohort of 34 RLS patients focusing on RLS risk factors and disease severity. We investigated the peripheral nerves with nerve conduction studies and with high-resolution nerve ultrasound (HRUS).

RESULTS

In 18 of the 34 patients (mean age 67.4 ± 15 years old), a sensorimotor axonal neuropathy was diagnosed. These patients presented with late-onset RLS were treated with membrane stabilizing agents, whereas no neuropathy predisposing comorbidity could be identified for the majority of them. We could show an inverse correlation between the amplitudes of the tibial nerve for the patients with polyneuropathy and the RLS severity index. Neuropathy patients were characterized by an increase of the cross-sectional area (CSA) of the tibial nerve in the popliteal fossa and by increased intranerve and internerve variability values showing an asymmetry of CSA distribution. This pattern resembles previous studies on diabetic neuropathy.

CONCLUSIONS

Early diagnosis, characterization, and treatment of neuropathy are increasingly relevant for RLS patients as it correlates with disease severity. HRUS revealed a pattern resembling diabetic neuropathy, which implies a similar pathophysiology with metabolic and ischemic origin of RLS-related axonal neuropathy.

Diagnosis and treatment of restless legs syndrome

Restless legs syndrome (RLS) is a disorder characterized by an irresistible urge to move the legs during rest, usually accompanied by uncomfortable sensations in the affected extremity or extremities. RLS can manifest at any age but prevalence increases with advancing age. This article describes the symptoms of RLS, associated comorbidities, and how to diagnose and manage RLS.

Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials

Introduction: Restless legs syndrome (RLS) is a sensorimotor disorder characterised by an uncomfortable urge to move the legs. Management is primarily pharmacological. Effects for non-pharmacological, non-surgical options are published but lack systematic examination. Objectives: To synthesise results of non-pharmacological/non-surgical treatment compared to no-treatment controls or alternative treatment for RLS on any relevant outcome. Methods: Databases and reference lists of reviews were searched for randomised controlled trials (RCTs) comparing non-pharmacological treatment to alternative or no treatment controls for idiopathic RLS. Search results were independently screened for inclusion by two researchers; disagreements regarding eligibility were resolved with discussion. Outcomes were summarised, and pooled where possible in meta-analysis. Results: The search yielded 442 articles. Eleven trials met inclusion criteria. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture were significantly more effective for RLS severity than control conditions. Vibration pads, cryotherapy, and transcranial direct current stimulation were ineffective in reducing RLS severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture significantly improved some sleep-related outcomes. Conclusions: Few studies were identified and quality of evidence was not high. Some non-pharmacological interventions may be beneficial for reducing RLS severity and enhancing sleep. Implications for Rehabilitation The current management of restless leg syndrome is primarily pharmacological, and medications can have unwanted side effects. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture may reduce restless leg syndrome severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture may improve some sleep-related outcomes in restless leg syndrome. Non-pharmacological interventions for RLS may cause placebo effects and rehabilitation professionals should control for this possibility in future investigations.

Restless legs syndrome is associated with major comorbidities in a population of Danish blood donors

BACKGROUND

Restless Legs Syndrome (RLS) is characterized by uncomfortable nocturnal sensations in the legs making sedentary activities and sleep difficult, and is thus linked with psychosocial distress. Due to the symptomatology and neurobiology of RLS (disrupting brain iron and dopamine) it is likely that RLS associates with poorer health-related quality of life (HRQL) and depressive disorder. The objective of this study was to investigate the RLS-HRQL and the RLS-depressive disorder links in a generally healthy population that is not biased by medications.

METHODS

Complete data, including the Cambridge-Hopkins RLS questionnaire, the 12-item short-form standardized health survey (SF-12), the Major Depression Inventory (MDI), body mass index, smoking status, alcohol consumption, and education were available for 24,707 participants enrolled in the Danish Blood Donor Study from May 1, 2015 to February 1, 2017. Information on quality of sleep was available for all RLS cases. T-tests and multivariable logistic regression models were applied to examine the associations of RLS and MDI scores, and the physical and mental component scores (PCS and MCS) of SF-12, respectively. Analyses were conducted separately for men and women.

RESULTS

RLS associated with poorer MCS and poorer PCS. Moreover, Participants with RLS were more likely to classify with depressive disorder. Poor quality of sleep was associated with depressive disorder and poorer MCS among RLS cases, and with poorer PCS in female RLS cases.

CONCLUSION

Thus, we demonstrated that RLS is associated with a significantly lower HRQL and a higher prevalence of depressive disorder among otherwise healthy individuals.

Association Between Restless Legs Syndrome and Adult ADHD in a German Community-Based Sample

OBJECTIVE

Previous research in clinical samples indicated a significant association between ADHD and restless legs syndrome (RLS). The present study examined the association between adult ADHD and RLS in the German population.

METHOD

Self-rating instruments to assess RLS, childhood ADHD, and adult ADHD were administered to a community-based sample ( N = 1,632). In addition, current depression and anxiety, sleep disturbances, weight, and height were assessed by self-report.

RESULTS

Adult ADHD was associated with statistically significant increases in the odds of meeting diagnostic criteria for RLS even when adjusting for potential confounding variables such as weight (odds ratio [OR] = 3.18, 95% confidence interval [CI] = [1.29, 7.63], p< .001). However, the association did not hold true after adjusting for the presence of sleep disturbances (OR = 2.02, 95% CI = [0.82, 4.96], p = .13).

CONCLUSION

The findings suggest a strong link between RLS and adult ADHD symptoms. Clinicians should be aware of RLS among adult ADHD patients, especially as there might be a negative interactive effect.

Adult ADHD and Comorbid Somatic Disease: A Systematic Literature Review

OBJECTIVE

To systematically review, synthesize, and appraise available evidence, connecting adult ADHD with somatic disease.

METHOD

Embase, Psychinfo, and Medline databases were searched for studies published from 1994 to 2015 addressing adult ADHD and somatic comorbidity. Somatic conditions were classified according to International Classification of Diseases (ICD-10) codes. Levels of evidence were graded as inconclusive, tentative, or well documented.

RESULTS

Most of the 126 studies included in the qualitative synthesis were small and of modest quality. Obesity, sleep disorders, and asthma were well-documented comorbidities in adult ADHD. Tentative evidence was found for an association between adult ADHD and migraine and celiac disease. In a large health registry study, cardiovascular disease was not associated with adult ADHD.

CONCLUSION

There are few large systematic studies using standardized diagnostic criteria evaluating adult ADHD and somatic comorbidities. Significant associations are found between adult ADHD and several somatic diseases, and these are important to consider when assessing and treating either adult ADHD or the somatic diseases.

Suicidality in sleep disorders: prevalence, impact, and management strategies

Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep-suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep-suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders.

Prevalence of restless legs syndrome in migraine patients with and without aura: a cross-sectional, case-controlled study

BACKGROUND

Although the comorbidity of migraine and restless legs syndrome (RLS) has been well-documented, the association between RLS and migraine frequency has yet to be elucidated. The present study aims to evaluate the prevalence of RLS among individuals who experience low-frequency, high-frequency, or chronic migraine presenting with and without aura.

METHODS

We conducted a cross-sectional, case-controlled study involving 505 participants receiving outpatient headache treatment. Standardized questionnaires were administered to collect information on experiences of migraine, RLS, sleep quality, anxiety, depression, and demographics. Participants were categorized into low-frequency (1-8/month), high-frequency (9-14/month), and chronic (≥15/month) headache groups. RLS was diagnosed according to the criteria outlined by the International RLS Study Group (IRLSSG). The Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality and identify symptoms of anxiety and depression. Associations between migraine frequency and RLS prevalence were investigated using multivariate linear and logistic regression.

RESULTS

Univariate analysis revealed an effect of migraine frequency on RLS prevalence (p = 0.026), though this effect did not persist following adjustment for baseline characteristics (p = 0.256). The trend was robust in patients whose migraines presented with auras (p _univariate = 0.002; p _multivariate = 0.043) but not in those without auras (p _univariate and p _multivariate > 0.05). Higher anxiety [odds ratio (OR) = 1.18, p = 0.019] and sleep disturbance (OR = 1.17, p = 0.023) scores were associated with higher RLS prevalence.

CONCLUSIONS

Higher migraine frequency correlates with a higher prevalence of RLS, particularly among patients with auras.

Susceptible genes of restless legs syndrome in migraine

Objective Several genetic variants have been found to increase the risk of restless legs syndrome (RLS). The aim of the present study was to determine if these genetic variants were also associated with the comorbidity of RLS and migraine in patients. Methods Thirteen single-nucleotide polymorphisms (SNPs) at six RLS risk loci ( MEIS1, BTBD9, MAP2K5, PTPRD, TOX3, and an intergenic region on chromosome 2p14) were genotyped in 211 migraine patients with RLS and 781 migraine patients without RLS. Association analyses were performed for the overall cohort, as well as for the subgroups of patients who experienced migraines with and without aura and episodic migraines (EMs) vs. chronic migraines (CMs). In order to verify which genetic markers were potentially related to the incidence of RLS in migraine patients, multivariate regression analyses were also performed. Results Among the six tested loci, only MEIS1 was significantly associated with RLS. The most significant SNP of MEIS1, rs2300478, increased the risk of RLS by 1.42-fold in the overall cohort ( p = 0.0047). In the subgroup analyses, MEIS1 augmented the risk of RLS only in the patients who experienced EMs (odds ratio (OR) = 1.99, p = 0.0004) and not those experiencing CMs. Multivariate regression analyses further showed that rs2300478 in MEIS1 (OR = 1.39, p = 0.018), a CM diagnosis (OR = 1.52, p = 0.022), and depression (OR = 1.86, p = 0.005) were independent predictors of RLS in migraine. Conclusions MEIS1 variants were associated with an increased risk of RLS in migraine patients. It is possible that an imbalance in iron homeostasis and the dopaminergic system may represent a link between RLS incidence and migraines.

Restless Legs Syndrome in Patients With Chronic Kidney Disease

Symptoms of restless legs syndrome (RLS) are common in patients with chronic kidney disease (CKD) on dialysis; symptoms of RLS are estimated to affect up to 25% of patients on dialysis when the international RLS diagnostic criteria are applied. RLS is a neurologic disorder with a circadian rhythmicity characterized by an overwhelming urge to move the legs during rest, which can be relieved temporarily by movement. RLS has been associated with an increase in sleep disturbance, higher cardiovascular morbidity, decreased quality of life, and an increased risk of death in patients with CKD. Although the exact pathophysiology of RLS is unknown, it is thought to involve an imbalance in iron metabolism and dopamine neurotransmission in the brain. The symptoms of moderate to severe RLS can be treated with several pharmacologic agents; however, data specific to patients on dialysis with RLS are lacking. The purpose of this article is to examine the relationship between, and complications of, RLS and CKD both in dialysis and nondialysis patients, and discuss the treatment options for patients on dialysis with RLS.

Restless Legs Syndrome in Patients with Hypertension and Diabetes Mellitus

Aim:

The aim of this study was to analyze frequency of restless legs syndrome (RLS) in patients with hypertension and diabetes mellitus.

Patients and Methods:

It was analyzed 120 subjects (from Health Center Živinice/Family Medicine Department) through a survey conducted in the period from March to June 2015, of which 30 (8 men/22 women). Subjects were 30 patients with longtime hypertension (HT)(18 men/12 women), 30 patients with diabetes mellitus (DM) type I or II (9 men/21 women), 30 patients with long standing DM type I or II and HT (12 men /18 women), and 30 control subjects (12 men/18 women). RLS were evaluated by questionnaire - International RLS Study Group Criteria. The average age of patients in the group with HT was 58.70 ± 9.07, in the group with DM 48.43 ± 15.37, and in the group of patients with HT and DM 63.90 ± 7.49 years. In the control group mean age was 52.76 ± 14.83 years. Statistical data were analyzed in Excel and SSPS statistical program.

Results:

RLS was identified in 10 (30%) of those with HT; 7 (21%) in patients with DM, and 10 (30%) in patients with HT+DM. In the control group RLS was verified in 4 (12%) patients. Comparing the results, it was observed significant difference between the HT and the control group (p=0.0012) and HT+ DM and control group (p=0.0012). The frequency of RLS between DM and the control group was not significantly significant (p=0.107).

Conclusion:

RLS is frequent in patients with hypertension (30%), hypertension+ diabetes mellitus (30%), and patients with DM (21%).

Sleep Disturbance, Obstructive Sleep Apnoea and Abnormal Periodic Leg Movements: Very Common Problems in Fabry Disease

OBJECTIVES

To assess the prevalence of sleep disorder(s) in males with Fabry disease and explore possible association with disease phenotype.

BACKGROUND

Fabry disease, an X-linked lysosomal storage disease caused by deficiency in α-galactosidase, results in intracellular accumulation of globotriaosylceramide. It causes organ dysfunction, most significantly affecting renal, cerebrovascular and cardiovascular systems. Respiratory involvement may include obstructive lung disease, reduced diffusing capacity and thickened soft and hard palates. Patients commonly develop small-fibre sensory peripheral neuropathy manifested by acroparaesthesia and pain crises. Combined with self-reported sleep disturbance and snoring, these features suggest an increased risk of sleep disorders.

METHODS

In-laboratory polysomnography (PSG) studies and sleep inventory assessments, including Epworth Sleepiness Scale (ESS), were performed in a cohort of male Fabry patients. PSGs were reviewed by a sleep physician. Sleep-disordered breathing and periodic leg movements were targeted for analysis. Associations with renal, cardiovascular and cerebrovascular function were sought.

RESULTS

Twenty males underwent overnight PSG. Patient baseline characteristics included age 43.9 ± 10.7 years, BMI 24.3 ± 3.8 kg/m², neck circumference 39.7 ± 3.3 cm and ESS 9.8 ± 5.1 (7/20, abnormal ESS >10). Abnormal periodic leg movement index (PLMI) was present in 95% (mean frequency 42.4 ± 28.5/min) and sleep-disordered breathing in 50% patients. Periodic leg movements were associated with pain and depression but not with increased cortical arousal.

CONCLUSIONS

Sleep-disordered breathing and abnormal PLMI are highly prevalent in patients with FD. The presence of abnormal PLMI alone appears to have minimal impact on sleep disturbance, but is associated with depression and analgesic requirement.

Comparison of impact of insomnia on depression and quality of life in restless legs syndrome/Willis-Ekbom disease and primary insomnia patients

BACKGROUND

Although insomnia is common among people with restless legs syndrome (RLS), its impact on the daily suffering of those with RLS remains unclear. This study aimed to compare the differential impact of clinical insomnia on depression and quality of life (QoL) among people with RLS, primary insomnia, and healthy controls.

METHODS

A total of 148 people with RLS, 115 with primary insomnia, and 117 healthy controls were enrolled into this cross-sectional study. Participants completed sleep, depression, and QoL questionnaires. Clinical insomnia was defined as Korean version of the Insomnia Severity Index (K-ISI) ≥ 15. Correlation coefficients between sleep measures and both depression and QoL were calculated. Multivariate regression was used to identify the clinical factors that were most closely associated with depression and QoL among people with RLS and primary insomnia.

RESULTS

Participants with RLS had insomnia and sleep quality at intermediate levels between the healthy controls and primary insomnia subjects, but those with clinical insomnia had equivalent depression and QoL scores regardless of RLS diagnosis. Insomnia severity correlated with depression and QoL in RLS and primary insomnia. Multivariate regression, however, revealed that RLS severity was the most overall predictive factor for depression and QoL among those with RLS. Insomnia severity was the strongest predictor in primary insomnia.

CONCLUSION

Insomnia was more closely associated with depression and QoL among people with primary insomnia than those with RLS, but clinical insomnia may have a significant impact in RLS as well. Future RLS studies should account for sleep quality in addition to RLS symptom severity when investigating mood and QoL.

Sleep disorders and respiratory function in amyotrophic lateral sclerosis

Sleep disorders in amyotrophic lateral sclerosis (ALS) present a significant challenge to the management of patients. Issues include the maintenance of adequate ventilatory status through techniques such as non-invasive ventilation, which has the ability to modulate survival and improve patient quality of life. Here, a multidisciplinary approach to the management of these disorders is reviewed, from concepts about the underlying neurobiological basis, through to current management approaches and future directions for research.

Chronic conditions and sleep problems among adults aged 50 years or over in nine countries: a multi-country study

Background

Data on the association between chronic conditions or the number of chronic conditions and sleep problems in low- or middle-income countries is scarce, and global comparisons of these associations with high-income countries have not been conducted.

Methods

Data on 42116 individuals 50 years and older from nationally-representative samples of the Collaborative Research on Ageing in Europe (Finland, Poland, Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) conducted between 2011–2012 and 2007–2010 respectively were analyzed.

Results

The association between nine chronic conditions (angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, obesity, and stroke) and self-reported severe/extreme sleep problems in the past 30 days was estimated by logistic regression with multiple variables. The age-adjusted prevalence of sleep problems ranged from 2.8% (China) to 17.0% (Poland). After adjustment for confounders, angina (OR 1.75–2.78), arthritis (OR 1.39–2.46), and depression (OR 1.75–5.12) were significantly associated with sleep problems in the majority or all of the countries. Sleep problems were also significantly associated with: asthma in Finland, Spain, and India; chronic lung disease in Poland, Spain, Ghana, and South Africa; diabetes in India; and stroke in China, Ghana, and India. A linear dose-dependent relationship between the number of chronic conditions and sleep problems was observed in all countries. Compared to no chronic conditions, the OR (95%CI) for 1,2,3, and≥4 chronic conditions was 1.41 (1.09–1.82), 2.55 (1.99–3.27), 3.22 (2.52–4.11), and 7.62 (5.88–9.87) respectively in the overall sample.

Conclusions

Identifying co-existing sleep problems among patients with chronic conditions and treating them simultaneously may lead to better treatment outcome. Clinicians should be aware of the high risk for sleep problems among patients with multimorbidity. Future studies are needed to elucidate the best treatment options for comorbid sleep problems especially in developing country settings.