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: 5.06). 07/2007; 30(7):861-5.
Source: PubMed

ABSTRACT 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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Available from: Dieter Riemann, Jul 30, 2015
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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. DOI:10.1016/j.ajp.2014.09.003
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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.
    Sleep Medicine 03/2011; 12(4):416-21. DOI:10.1016/j.sleep.2010.08.018 · 3.10 Impact Factor
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    ABSTRACT: SUMMARY Objectives: Restless Legs Syndrome (RLS) is a sensorimotor disorder with a primary symptom of a strong, often irresistible, urge to move the leg. Most of the studies report prevalences of RLS between 6% and 12%. In this study we aimed to determine RLS prevalence, anatomic localisation, etiological and clinical factors in Medical School Students. Patients and Methods: Afyon Kocatepe University School of Medicine students were enrooled to the study. The study was made in two phases. In phase 1, a short questionnaire including questions about symptoms related to RLS and International Restless Legs Study Group, (IRLSSG) criteria was performed to the students. In phase 2, suspected students were evaluated according to IRLSSG diagnostic criteria by movement disorders expert and a diagnosis has been made. Results: Two hundred and twenty students were included in this study. 104 (47.3 %) men and 116 (52.7 %) women were enrolled to the study and evaluated according to the IRLSSG criteria. In 6 (2.3 %) students RLS detected. A family history was found in 3 students. In all 6 students symptoms were only in the legs. According to the IRLSSG rating scale in 2 students symptoms were mild and in 4 students symptoms were moderate. In 3 students serum ferritin level was low. Conclusion: In this study we evaluated RLS prevalence, clinical features and anatomic distribution in a young population that has the same level of education. Awareness of the students of their RLS has shown that especially in mild and moderate degrees RLS could be detected only if it has been asked.
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