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Abstract
Study Objective: Studies have shown increased prevalence of restless legs syndrome (RLS) in sleep disordered breathing (SDB), however limited data have focused on the impact of SDB therapy on RLS. We hypothesize that positive airway pressure (PAP) will improve the International Restless Legs Syndrome (IRLS) score among SDB patients compared to patients without PAP. Methods: Patients with AHI ≥ 5 who responded positively to a RLS qualifier question from January 2010 to May 2015 were included in this retrospective study. IRLS score was used to measure RLS symptom severity. Two-sample t-tests and one-way analysis of variance were used to compare changes in IRLS score and linear regression models were created to examine IRLS change with PAP use and PAP adherence (PAP usage ≥4 h nightly for ≥70% of nights), adjusting for potential confounders. Results: In 434 patients (51.9 ± 13.4years, 50.5% female, 77.6% Caucasian; 325 PAP, 109 control), IRLS scores improved from baseline to follow-up, with the PAP group achieving significant improvement after adjustment for covariates (difference in IRLS: −1.8 (CI −3.6,0.00), p = 0.050). In self-reported PAP adherent patients, IRLS improvement was greater than controls (−5.3 ± 7.4 vs. −2.7 ± 7.6 respectively, p = 0.045), and comparable to non-adherent patients (−5.3 ± 7.4 vs. −3.0 ± 7.0, p = 0.091). Conclusions: Among SDB patients with a positive RLS qualifier, those who used PAP therapy achieved significantly greater improvement in IRLS scores than patients who did not use PAP, with more significant changes in the PAP adherent group. This is the first large clinical study to examine these relationships, providing a basis for future prospective interventional trials and informing clinicians of expected improvement in IRLS score in PAP treated SDB populations.
Highlights
Restless legs syndrome (RLS), known as Willis–Ekbom disease, is a chronic sensorimotor disorder with a prevalence of approximately 10% in the general population, yet often underdiagnosed and undertreated [1]
Excluded: *84 had pre-International Restless Legs Syndrome (IRLS) scores done >90 days *607 had no post-IRLS scores within 30–365 days *3 who were on other obstructive sleep apnea (OSA) treatment in addition to positive airway pressure (PAP)
We found that PAP adherent patients achieved greater IRLS score improvement than non-adherent patients and controls; non-adherent patients achieved no greater improvement than controls, and PAP use/adherence was associated with clinically significant IRLS score improvement
Summary
Restless legs syndrome (RLS), known as Willis–Ekbom disease, is a chronic sensorimotor disorder with a prevalence of approximately 10% in the general population, yet often underdiagnosed and undertreated [1]. It is suggested that RLS is more prevalent in SDB patients than in the general population; the Icelandic Sleep Apnea Cohort reported. RLS in 23–36% of SDB patients, compared to 13–25% of controls [4]. Another prospective study found RLS less prevalent in SDB patients than the general population, observing newly diagnosed RLS in 1 out of every 12 patients undergoing polysomnography (PSG) for sleep apnea [5]. Regardless, the recognition of RLS among SDB patients is clinically important, as SDB may worsen RLS symptoms [5]
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