Restless legs syndrome in patients with chronic obstructive pulmonary disease.
ABSTRACT To evaluate the prevalence of restless legs syndrome (RLS) in patients with chronic obstructive pulmonary disease (COPD) and the relationship between RLS and clinical/laboratory findings of COPD.
One hundred and thirty-four COPD patients without secondary causes of RLS were included. Thirty-nine (29.1%) patients were diagnosed with RLS and classified as Group 1. The control group consisted of 65 age-matched COPD patients without RLS. Group 1 was divided into subgroups according to the Johns Hopkins Severity (JHS) scale. Patients with a score of 0, 1, or 2 were classified as JHS 0-2 and those with a score of 3 as JHS 3. Group 1 and the control group and subgroups were compared for clinical and laboratory characteristics.
We found that the duration of COPD was longer and that airway obstruction, hypercapnia, and hypoxia were more evident in patients with RLS than those without. Similar differences were also detected between JHS subgroups 3 (more severe) and 0-2. Polyneuropathy frequency was significantly higher in Group 1 compared to controls. However, Group 1 subgroups showed a similar frequency of polyneuropathy. In a multivariate analysis, hypercapnia made a significant independent contribution to both JHS 0-2 and JHS 3 patients when RLS severity was set as the dependent variable. Polyneuropathy and the duration of COPD were significant independent variables for patients in the JHS 3 subgroup. Polyneuropathy was the strongest predictor for the JHS 3 patients.
We conclude that RLS is frequent in COPD, particularly in patients with severe hypoxemia/hypercapnia and in late stages of the disease.
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ABSTRACT: This study investigates the prevalence and the association between restless legs syndrome (RLS) and a large variety of health variables in two well-characterized random samples from the general population in Reykjavik, Iceland, and Uppsala, Sweden. Using the national registries of inhabitants, a random sample from adults aged 40 and over living in Reykjavík, Iceland (n=939), and Uppsala, Sweden (n=998), were invited to participate in a study on the prevalence of COPD (response rate 81.1% and 62.2%). In addition, the participants were asked to answer the following questionnaires: International RLS Rating Scale, Short Form-12, the Epworth Sleepiness Scale, and questions about sleep, gastroeosophageal reflux, diabetes and hypertension, as well as pharmacological treatment. Interleukin-6 (IL-6), C-reactive protein (CRP) and ferritin were measured in serum. RLS was more commonly reported in Reykjavik (18.3%) than in Uppsala (11.5%). Icelandic women reported RLS almost twice as often as Swedish women (24.4 vs. 13.9% p=0.001), but there was no difference in prevalence of RLS between Icelandic and Swedish men. RLS was strongly associated with sleep disturbances and excessive daytime sleepiness. Subjects with RLS were more likely to be ex- and current smokers than subjects without RLS (p<0.001). Respiratory symptoms and airway obstruction were more prevalent among those reporting RLS and they also estimated their physical quality of life lower than those without RLS (p<0.001). RLS was not associated with symptoms of the metabolic syndrome like hypertension, obesity, markers of systemic inflammation (IL-6 and CRP) or cardiovascular diseases. Ferritin levels were significantly lower in RLS participants (p=0.0002), but not (p=0.07) after adjustment for center, age, sex and smoking history. Restless legs syndrome was twice as common among Icelandic women compared to Swedish women. No such difference was seen for men. RLS was strongly associated with smoking and respiratory symptoms, decreased lung function, sleep disturbances, excessive daytime sleepiness, and physical aspects of life quality. RLS was not associated with markers of the metabolic syndrome like hypertension, obesity, cardiovascular diseases or biomarkers of systemic inflammation.Sleep Medicine 10/2010; 11(10):1043-8. DOI:10.1016/j.sleep.2010.08.006 · 3.10 Impact Factor
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ABSTRACT: Recently published literature indicates that sleep disorders present with medical comorbidities quite frequently. The coexistence of a sleep disorder with a medical disorder has a substantial impact for both the patient and the health system. Insomnia and hypersomnia are highly comorbid with medical conditions, such as chronic pain and diabetes, as well as with various cardiovascular, respiratory, gastrointestinal, urinary and neurological disorders. Restless legs syndrome and periodic leg movement syndrome have been associated with iron deficiency, kidney disease, diabetes, and neurological, autoimmune, cardiovascular and respiratory disorders. Rapid eye movement behaviour disorder has been described as an early manifestation of serious central nervous system diseases; thus, close neurological monitoring of patients referring with this complaint is indicated. Identification and management of any sleep disorder in medical patients is important for optimizing the course and prognosis. Of equal importance is the search for undetected medical disorder in patients presenting with sleep disorders.Current opinion in psychiatry 07/2011; 24(4):346-54. DOI:10.1097/YCO.0b013e3283473375 · 3.55 Impact Factor
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ABSTRACT: A few previous studies have reported that the patients with chronic obstructive pulmonary disease (COPD) have a 29.1% to 36.8% frequency of restless legs syndrome (RLS). In this study, we observed RLS symptoms in patients experiencing COPD exacerbation to better understand the relationship between the many clinical parameters of COPD and the presence of RLS and to attract the attention of specialists on the association between the two conditions. Twenty-two male patients in COPD exacerbation; 17 healthy individuals were evaluated in this study. The patients were evaluated using the 2003 RLS symptom criteria outlined by the International Restless Legs Syndrome Study Groups (IRLSSG). The Pittsburgh Sleep Quality Index and Epworth daytime sleepiness scale were used to assess the sleep quality of patients. The RLS symptoms were correlated with blood levels of laboratory and clinical parameters. Statistical analyses were performed using SPSS 17.0 statistical software packet. The Pittsburgh Sleep Quality Index and Epworth daytime sleepiness scale scores were increased in COPD patients and correlated significantly with RLS symptoms. It was found that 54.5% of COPD patients with acute exacerbations were observed to have RLS symptoms. The Pittsburgh Sleep Quality Index was significantly higher in COPD patients with RLS symptoms compared to COPD patients without RLS symptoms (p < 0.05). We did not observe any significant difference in the previously reported metabolic and clinical parameters associated with RLS in COPD patients with and without RLS. RLS symptoms increase during COPD exacerbation and lead to decreased sleep quality.COPD Journal of Chronic Obstructive Pulmonary Disease 12/2011; 8(6):437-43. DOI:10.3109/15412555.2011.623737 · 2.62 Impact Factor