Polysomnographic and Health-related Quality of Life Correlates of Restless Legs Syndrome in the Sleep Heart Health Study

Harvard Medical School, Boston, MA, USA.
Sleep (Impact Factor: 4.59). 06/2009; 32(6):772-8.
Source: PubMed


Sleep disturbance is the primary clinical morbidity of restless legs syndrome (RLS). To date, sleep disturbance in RLS has been measured in (1) clinical samples with polysomnography (PSG) or (2) population-based samples by self-report. The objective of this study was to analyze sleep by PSG in a population-based sample with symptoms of RLS.
Cross-sectional observational study.
3433 older men and women.
RLS was evaluated using an 8-item self-administered questionnaire based on NIH diagnostic criteria and required symptoms occurring > or = five times per month and associated with at least moderate distress. Health-related quality of life (HRQOL) was determined using the SF-36. Unattended, in-home PSG was performed. Data were assessed using general linear models with adjustment for demographic, health-related variables, and apnea-hypopnea index (AHI). Subjects with RLS had longer adjusted mean sleep latency (39.8 vs 26.4 min, P < 0.0001) and higher arousal index (20.1 vs 18.0, P = 0.0145) than those without RLS. Sleep latency increased progressively as the frequency of RLS symptoms increased from 5-15 days per month to 6-7 days per week. No differences in sleep stage percentages were observed between participants with and without RLS. Subjects with RLS also reported poorer HRQOL in all physical domains as well as in the Mental Health and Vitality domains.
These novel PSG data from a nonclinical, community-based sample of individuals with RLS document sleep disturbance in the home even in individuals with intermittent symptoms.

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    • "However, a number of methodological issues might question these results (Allen et al., 2014). RLS/WED is deemed as a clinically significant condition when its symptoms have a negative impact on sleep, quality of life and health (Winkelman et al., 2009; Fulda et al., 2011; Galbiati et al., 2015). "

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    • "Moreover, the belief then that a disease severely reducing sleep time would produce excessive sleepiness led to classifying the disorder as one with excessive daytime sleepiness. This was done without clinical data supporting the daytime sleepiness and, indeed, most recent studies have documented that on average RLS/WED patients have sleepiness scores within normal limits [2] [10] [11]. Subsequent research has developed the concept of hyperarousal producing poor sleep without daytime sleepiness in individuals with RLS/WED [11] [12]. "
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    ABSTRACT: There is great interest in the study of sleep in healthy and cognitively impaired elderly. Sleep disorders have been related to quality of aging. Sleep-related movements are a frequent cause of disordered sleep and daytime sleepiness. Restless legs syndrome/Willis-Ekbom disease (RLS/WED) is often unrecognized in the elderly. This review explores RLS/WED in the elderly population. The elderly population may be subdivided into 3 groups: healthy, dependent, and frail. The RLS/WED could be a predictor for lower physical function; its burden on quality of life and health care-related costs, in the elderly, should be an important clinical and public health concern. Copyright © 2015 Elsevier Inc. All rights reserved.
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    • "Please cite this article in press as: Calandra-Buonaura G, et al., Cardiovascular autonomic dysfunctions and sleep disorders, Sleep Medicine Reviews (2015), latency, shorter sleep duration, higher prevalence of insomnia, poor sleep quality and increased daytime sleepiness [91]. A significantly positive correlation between RLS and cardiovascular diseases has been demonstrated in several large populationbased cross-sectional studies [92]. "
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    ABSTRACT: Animal and human studies have shown that disorders of the autonomic nervous system may influence sleep physiology. Conversely, sleep disorders may be associated with autonomic dysfunctions. The current review describes the clinical presentation, supposed pathogenetic mechanisms and the diagnostic and prognostic implications of impaired cardiovascular autonomic control in sleep disorders. This dysfunction may result from a common pathogenetic mechanism affecting both autonomic cardiovascular control and sleep, as in fatal familial insomnia, or it may be mainly caused by the sleep disorder, as observed in obstructive sleep apnoea. For other sleep disorders, like primary insomnia, restless legs syndrome, narcolepsy type 1 and rapid eye movement sleep behaviour disorder, the causal link with the autonomic dysfunction and its possible impact on health remains unsettled. Given its clinical implications, most of the data available suggest that a systematic assessment of the association between sleep disorders and impaired autonomic control of the cardiovascular system is warranted. Understanding the mechanism of this association may also yield insights into the interaction between the autonomic nervous system and sleep. Copyright © 2015 Elsevier Ltd. All rights reserved.
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