A Polysomnographic and Cluster Analysis of Periodic Limb Movements in Sleep of Restless Legs Syndrome Patients with Psychiatric Conditions

Arthur S Walters,Karen Spruyt,Sébastien Catoire,Marie-Françoise Suaud-Chagny,Jérôme Brunelin

doi:10.3390/psychiatryint2030019

Abstract

Only survey studies have linked specific individual psychiatric disorders such as anxiety, depression and schizophrenia to Restless Legs Syndrome (RLS), Periodic Limb Movements in Sleep (PLMS) or both. We therefore aim to polysomnographically characterize sleep in a sample of physician-based, newly diagnosed cases of RLS with various ICD-10 psychiatric diagnoses. Retrospective analysis of data from a convenience sample of psychiatric patients (n = 43) per standard clinical sleep disorder cut-offs was conducted. Next, a cluster analysis was performed on the sleep data, taking into account the psychiatric diagnosis, comorbid non-psychiatric somatic problems and medication. We found that 37.2% of our sample showed clinically significant PLMS ≥ 15 and 76.5% exhibited an apnea hypopnea index (AHI) ≥ 5. Sleep structure was unaltered apart from the PLMS-related parameters. Two clusters were statistically identified: Cluster 1 primarily representing recurrent major depressive issues and Cluster 2 representing present but not predominant mood symptomatology as well as mixed disorders with personality problems. The known confounders were controlled. A PLMS index ≥ 15 was differentially distributed among the two clusters with Cluster 1: 10 out of 17 with PLMS index ≥ 15; Cluster 2: 1 out of 16 with PLMS index ≥15; whilst AHI was not different. Patients in Cluster 1 have a higher rate of periodic leg movements than patients in Cluster 2. This suggests that the high association with PLMS is primarily driven by affective disorders. Our findings warrant questioning of RLS symptomatology in patients with psychiatric conditions.

Highlights

Restless legs syndrome (RLS) is characterized by four obligatory features: (a) an urge to move the legs usually associated with leg discomfort; (b) symptoms are worse at rest, e.g., lying or sitting; (c) symptoms are worse later in the day or evening; and (d) there is at least partial and temporary relief by activity such as walking or stretching or bending the legs
This was due to premature ending of the sleep recording, leaving the bed multiple times for prolonged periods, complaints of extreme pain or reading at nighttime resulting in discontinued recordings, scattered recordings or multiple artifacts
Future studies may consider assessing the severity of anxiety and depression, as well as the impact of antidepressants such as SSRIs [45]. This convenience sample concurs that comorbidity in Restless Legs Syndrome might be widespread, and that there is a potential risk of under-recognition if the symptoms of Restless Legs Syndrome are not queried

Summary

Introduction

Restless legs syndrome (RLS) is characterized by four obligatory features: (a) an urge to move the legs usually associated with leg discomfort; (b) symptoms are worse at rest, e.g., lying or sitting; (c) symptoms are worse later in the day or evening; and (d) there is at least partial and temporary relief by activity such as walking or stretching or bending the legs. RLS is a common neurological, sensorimotor disorder, with a prevalence rate of about. The leg discomfort in RLS leads to significant sleep-onset difficulties or insomnia [3,4]. Patients with RLS may sleeplessly pace the floor at night in order to get rid of the leg discomfort so that they can go back to sleep. Some studies have indicated that the quality of life of patients with RLS is as bad as that experienced in patients with diabetes or in osteoarthritis with. Psychiatry Int. 2021, 2 hypertension [1]. Eighty to eighty-seven per cent of patients with RLS may have

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