Polysomnography findings in patients with restless legs syndrome and in healthy controls: A comparative observational study

Center for Sleep Research and Sleep Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany.
Sleep (Impact Factor: 4.59). 07/2007; 30(7):861-5.
Source: PubMed


Sleep disturbances and their sequelae are the most common complaints of patients with restless legs syndrome (RLS). We compared polysomnography (PSG) findings in a large cohort of patients with idiopathic RLS and of healthy subjects.
Comparative observational study.
University hospital sleep laboratory.
Age- and sex-matched patients with idiopathic but untreated RLS versus healthy controls.
N/A RESULTS: Each group consisted of 29 females and 16 males. RLS subjects and controls were 47.4 +/- 10.9 and 47.3 +/- 10.5 years old, respectively. RLS severity was 24.0 +/- 6.2 points on the IRLS scale, indicating moderately severe RLS symptoms. We found strong multivariate group effects on PSG parameters (Wilks' lambda, P <0.001): RLS patients exhibited prolonged sleep onset latencies (according to the 10-min criterion but not to the one-epoch criterion), shorter total sleep time, lower sleep efficiency, higher arousal index, higher number of stage shifts, and longer REM sleep latency. During the sleep period time, percentage of wake and sleep stage 1 were increased, and sleep stage 2 and REM sleep were decreased in RLS patients. The PLMS indices and the sleep fragmentation index were markedly increased in the RLS group.
We present the largest polysomnography study to date that compares patients with idiopathic RLS with age- and sex-matched healthy subjects. The findings demonstrate markedly fragmented sleep with deterioration of both NREM and REM sleep in RLS patients.

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    • "The symptoms of WED/RLS interfere with sleep and many WED/RLS patients complain of initial or middle insomnia (Anderson et al, 2013). Not only does WED/RLS lead to initial insomnia or multiple nocturnal awakenings, it is also impairs sleep quality by promoting sleep fragmentation (Hornyak et al, 2007) The periodic limb movements (PLMS) which are associated with WED/RLS produce microarousals which in turn worsen the quality of sleep (Fig 1C) (Sfroza et al, 1999). Affected patients therefore often complain of non-refreshing sleep upon awakening in the morning. "
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    ABSTRACT: Recent scientific evidences have brought a paradigm shift in our approach towards the concepts of insomnia and its management. The differentiation between primary and secondary insomnia was proved more hypothetical than actual and based upon the current evidences insomnia subtypes described in earlier system have been lumped into one-Insomnia Disorder. Research in this field suggests that insomnia occurring during psychiatric or medical disorders has a bidirectional and interactive relationship with and coexisting medical and psychiatric illnesses. The new approach looks to coexisting psychiatric or medical disorders as comorbid conditions and hence specifying two coexisting conditions. Therefore, the management and treatment plans should address both conditions. A number of sleep disorders may present with insomnia like symptoms and these disorders should be treated efficiently in order to alleviate insomnia symptoms. In such cases, a thorough history from the patient and his/her bed-partner is warranted. Moreover, some patients may need polysomnography or other diagnostic tests like actigraphy to confirm the diagnosis of the underlying sleep disorder. DSM-5 classification system of sleep-wake disorders has several advantages, e.g., it has seen insomnia across different dimensions to make it clinically more useful; it focuses on the assessment of severity and guides the mental health professional when to refer a patient of insomnia to a sleep specialist; lastly, it may encourage the psychiatrists to opt for the Sleep Medicine as a career.
    Asian Journal of Psychiatry 09/2014; 12(1). DOI:10.1016/j.ajp.2014.09.003
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    • "Disturbances in sleep onset, sleep maintenance, and total sleep time are reported by as many as 85 % of patients with RLS with nearly a third of patients with RLS reporting severe sleep disturbances [4, 34, 56]. Because PLMS often accompany RLS and their occurrence frequently results in arousals from sleep, PLMS can exacerbate sleep disturbances [33, 56]. Therefore, an examination of the associations between hypertension and CVD with insomnia and OSA may provide context to similar risks related to RLS and PLMS and may help in the understanding of where CV risks arise in the patients who suffer from RLS and PLMS. "
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    ABSTRACT: Untreated sleep disorders may contribute to secondary causes of uncontrolled hypertension, cardiovascular disease (CVD), and stroke. Restless legs syndrome, or Willis-Ekbom Disease (RLS/WED), is a common sensorimotor disorder with a circadian rhythmicity defined by an uncontrollable urge to move the legs that worsens during periods of inactivity or at rest in the evening, often resulting in sleep disruptions. Sleep disorders such as insomnia and obstructive sleep apnea (OSA) are established risk factors for increased risk of hypertension and vascular diseases. This literature review outlines the lessons learned from studies demonstrating insomnia and OSA as risk factors for hypertension and vascular diseases to support the epidemiologic and physiologic evidence suggesting a similar increase in hypertension and vascular disease risk due to RLS. Understanding the relationships between RLS and hypertension, CVD, and stroke has important implications for reducing the risks associated with these diseases.
    Journal of Neurology 08/2013; 261(6). DOI:10.1007/s00415-013-7065-1 · 3.38 Impact Factor
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    • "Recent studies have reported that patients with RLS may have underlying cognitive deficit [2]. RLS patients suffer from sleep disturbance [3], which causes chronic partial sleep loss, and because cognitive function appears to be particularly sensitive to sleep loss, sleep deprivation due to the symptoms of RLS might be the cause of cognitive dysfunction. Pearson et al. reported that RLS patients show cognitive deficits, particularly in prefrontal function, which are comparable to the loss of a night's sleep [2]. "
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    ABSTRACT: It has been reported that patients with restless legs syndrome (RLS) may have cognitive deficit. The authors performed EEG and ERP analysis during daytime to identify electrophysiologic relations with cognitive dysfunction in unmedicated RLS patients. Seventeen drug naive RLS patients (53.7±9.6 years) and 13 age-matched healthy controls participated in the present study. EEG was recorded during the waking-resting state and during a visual oddball task. RLS severities were determined using the International RLS Severity Scale. Stanford sleepiness scale (SSS) and bothersomeness visual analog scale (VAS) scores were determined immediately after ERP sessions. EEG power spectra and P300 amplitude and latency were compared for patients and controls. Clinical variables were correlated with P300 findings. Waking-resting EEG showed that RLS patients had significantly higher beta activity in frontocentral regions than controls. SSS scores were not different in the two groups. But the bothersomeness VAS scores of RLS patients were significantly higher than those of controls. Furthermore, P300 latency was significantly longer in patients, and patients had significantly lower P300 amplitudes in frontal and central locations. In addition, P300 latency was found to be significantly correlated with bothersomeness during the ERP test, whereas P300 amplitude showed no such tendency. Our study supports the notion that RLS patients have an underlying cognitive dysfunction. Significant correlations found between P300 latency and bothersomeness, a lack of sleepiness during the ERP test, and increased beta activity in resting state EEGs suggest that a combination of inattention and cortical dysfunction underlie cognitive dysfunction in RLS.
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