Sleep Microstructure and Clinical Characteristics of Patients with Restless Legs Syndrome

Overview

Journal J Clin Sleep Med

Specialties Neurology
Psychiatry

Date 2022 Aug 4

PMID 35924664

Authors

Hamed AmiriFard

Melika Jameie

Samaneh Akbarpour

Khosro Sadeghniiat Haghighi

Mahsa Shojaei

Reyhaneh Heidari

Arezu Najafi

Affiliations

Soon will be listed here.

Abstract

Study Objectives: Restless legs syndrome (RLS) is a sleep-related movement disorder, often accompanied by sleep disruption. Obstructive sleep apnea (OSA) has a controversial prevalence among patients with RLS. We evaluated the clinical and sleep features of patients who attended our sleep clinic considering RLS and OSA.

Methods: In this cross-sectional study, we obtained health records of 1,497 patients during 2015-2019 who underwent polysomnography (PSG). Baseline characteristics, sleep-related and RLS questionnaires, and sleep microstructure were assessed. Descriptive and analytical assessments were performed. RLS was assessed according to the International Restless Legs Syndrome Study Group criteria.

Results: RLS was found in 19.4% of patients, with more prevalence among women (26.9% vs 16.4%). RLS affected 19.1% of patients with OSA. Patients with RLS were significantly older with higher insomnia and depression and worse PSG results. As the respiratory disturbance index increased, the odds of RLS slightly decreased (adjusted odds ratio [95% confidence interval]: 0.80 [0.67-0.94]). The odds of OSA (respiratory disturbance index ≥ 5) was not affected by RLS. OSA in patients with RLS was significantly associated with a higher limb movement index. RLS in patients with OSA was significantly associated with higher insomnia, depression, and limb movement index (men and women), higher wake after sleep onset and percentage of N1 sleep (men), and lower sleep efficiency (men).

Conclusions: Patients with RLS had worse PSG results, higher insomnia, and depression. Although men with OSA+/RLS+ had worsened PSG results, PSG parameters in women with OSA+/RLS+ did not differ from the OSA+/RLS- group. Patients with either OSA or RLS should be evaluated for possible comorbidities, including insomnia and depression. Notably, sex-specific characteristics need more consideration in sleep clinics.

Citation: Amirifard H, Jameie M, Akbarpour S, et al. Sleep microstructure and clinical characteristics of patients with restless legs syndrome. . 2022;18(11):2653-2661.

Citing Articles

Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis.

AlGaeed M, McPherson T, Lee I, Feese M, Aban I, Cutter G J Clin Sleep Med. 2024; 21(2):269-276.

PMID: 39329188 PMC: 11789237. DOI: 10.5664/jcsm.11386.

References

Lakshminarayanan S, Paramasivan K, Walters A, Wagner M, Patel S, Passi V . Clinically significant but unsuspected restless legs syndrome in patients with sleep apnea. Mov Disord. 2004; 20(4):501-503. DOI: 10.1002/mds.20366. View

Rodrigues R, Rodrigues A, Pratesi R, Krieger J . Outcome of restless legs severity after continuous positive air pressure (CPAP) treatment in patients affected by the association of RLS and obstructive sleep apneas. Sleep Med. 2006; 7(3):235-9. DOI: 10.1016/j.sleep.2005.06.009. View

Young T, Palta M, Dempsey J, Peppard P, Nieto F, Hla K . Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ. 2009; 108(5):246-9. PMC: 2858234. View

. Restless legs syndrome: detection and management in primary care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome. Am Fam Physician. 2000; 62(1):108-14. View

Morin C, Belleville G, Belanger L, Ivers H . The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011; 34(5):601-8. PMC: 3079939. DOI: 10.1093/sleep/34.5.601. View

Chung F, Yegneswaran B, Liao P, Chung S, Vairavanathan S, Islam S . STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008; 108(5):812-21. DOI: 10.1097/ALN.0b013e31816d83e4. View

Almeneessier A, Alangari M, Aldubayan A, Alsharidah A, Altaki A, Olaish A . Prevalence of symptoms and risk of obstructive sleep apnea in Saudi pregnant women. Ann Thorac Med. 2020; 15(3):163-170. PMC: 7423206. DOI: 10.4103/atm.ATM_59_20. View

Schonbrunn E, Riemann D, Hohagen F, Berger M . [Restless legs and sleep apnea syndrome--random coincidence or causal relation?]. Nervenarzt. 1990; 61(5):306-11. View

Walters A . Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord. 1995; 10(5):634-42. DOI: 10.1002/mds.870100517. View

10.

Johns M . A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14(6):540-5. DOI: 10.1093/sleep/14.6.540. View

11.

. Polysomnography in patients with obstructive sleep apnea: an evidence-based analysis. Ont Health Technol Assess Ser. 2012; 6(13):1-38. PMC: 3379160. View

12.

Hening W, Walters A, Allen R, Montplaisir J, Myers A, Ferini-Strambi L . Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study. Sleep Med. 2004; 5(3):237-46. DOI: 10.1016/j.sleep.2004.03.006. View

13.

Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N . Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015; 3(4):310-8. PMC: 4404207. DOI: 10.1016/S2213-2600(15)00043-0. View

14.

Rundo J, Downey 3rd R . Polysomnography. Handb Clin Neurol. 2019; 160:381-392. DOI: 10.1016/B978-0-444-64032-1.00025-4. View

15.

Montplaisir J, Boucher S, Poirier G, Lavigne G, Lapierre O, Lesperance P . Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria. Mov Disord. 1997; 12(1):61-5. DOI: 10.1002/mds.870120111. View

16.

Winkelman J, Redline S, Baldwin C, Resnick H, Newman A, Gottlieb D . Polysomnographic and health-related quality of life correlates of restless legs syndrome in the Sleep Heart Health Study. Sleep. 2009; 32(6):772-8. PMC: 2690565. DOI: 10.1093/sleep/32.6.772. View

17.

Decker M, Jones K, Solomon I, Keating G, Rye D . Reduced extracellular dopamine and increased responsiveness to novelty: neurochemical and behavioral sequelae of intermittent hypoxia. Sleep. 2005; 28(2):169-76. DOI: 10.1093/sleep/28.2.169. View

18.

Hornyak M, Feige B, Voderholzer U, Philipsen A, Riemann D . Polysomnography findings in patients with restless legs syndrome and in healthy controls: a comparative observational study. Sleep. 2007; 30(7):861-5. PMC: 1978374. DOI: 10.1093/sleep/30.7.861. View

19.

Ohayon M, Roth T . Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res. 2002; 53(1):547-54. DOI: 10.1016/s0022-3999(02)00443-9. View

20.

Lin S, Chen Y, Kao K, Yang C, Chuang L, Chou Y . Diseases in patients coming to a sleep center with symptoms related to restless legs syndrome. PLoS One. 2013; 8(8):e71499. PMC: 3747238. DOI: 10.1371/journal.pone.0071499. View