Abstract
BackgroundThere are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders. The present study aimed to evaluate the prevalence and clinical correlates in psychiatric inpatients in Germany and Switzerland.MethodsThis is a multicenter cross-sectional study of psychiatric inpatients with an age above 18 years that were diagnosed and evaluated face-to-face using the International RLS Study Group criteria (IRLSSG) and the International RLS severity scale (IRLS). In addition to sociodemographic and biometric data, sleep quality and mood were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). In addition to univariate statistics used to describe and statistically analyze differences in variables of interest between patients with and without RLS, a logistic model was employed to identify predictors for the occurrence of RLS.ResultsThe prevalence of RLS in a sample of 317 psychiatric inpatients was 16.4%, and 76.9% of these were diagnosed with RLS for the first time. RLS severity was moderate to severe (IRLS ± SD: 20.3 ± 8.4). The prevalences in women (p = 0.0036) and in first-degree relatives with RLS (p = 0.0108) as well as the body mass index (BMI, p = 0.0161) were significantly higher among patients with RLS, while alcohol consumption was significantly lower in the RLS group. With the exception of atypical antipsychotics, treatment with psychotropic drugs was not associated with RLS symptoms. Regarding subjective sleep quality and mood, scores of the PSQI (p = 0.0007), ISI (p = 0.0003), and ESS (p = 0.0005) were higher in patients with RLS, while PHQ-9 scores were not different. A logistic regression analysis identified gender (OR 2.67; 95% CI [1.25; 5.72]), first-degree relatives with RLS (OR 3.29; 95% CI [1.11; 9.73], ESS score (OR 1.09; 95% CI [1.01; 1.17]), and rare alcohol consumption (OR 0.45; 95% CI [0.22; 0.94] as predictors for RLS.ConclusionsClinically significant RLS had a high prevalence in psychiatric patients. RLS was associated with higher BMI, impaired sleep quality, and lower alcohol consumption. A systematic assessment of restless legs symptoms might contribute to improve the treatment of psychiatric patients.
Highlights
Restless legs syndrome (RLS), known as Willis–Ekbom disease, is a common neurological sensorimotor disorder often associated with severe sleep disturbances and an impaired quality of life [1]
A total of 52 of the 317 patients met the diagnostic criteria of RLS according to the International RLS Study Group (IRLSSG) [1], representing a prevalence of 16.4%
The diagnoses of the patients were classified according to the following ICD10 codes: F10-19: Mental and behavioral disorders due to psychoactive substance use; F20-29: Schizophrenia, schizotypal, and delusional disorders; F30-39: Mood [affective] disorders; F40-48: Neurotic, stress-related and somatoform disorders; F60-69: Disorders of adult personality and behavior; F90-98: Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
Summary
Restless legs syndrome (RLS), known as Willis–Ekbom disease, is a common neurological sensorimotor disorder often associated with severe sleep disturbances and an impaired quality of life [1]. The reported RLS prevalence varies between 3.9 and 14.3% depending on the population studied and the criteria used [2]. Some but not all reports suggest marked geographic differences in the prevalence of RLS with a lower prevalence in Asian countries [3–5]. If the former four minimal [6] or later revised four essential diagnostic criteria are used [7], RLS is reported in 7.2–10.6% of the Caucasian population [8–14]. By further downregulating the dopamine receptors, medication at night might paradoxically worsen restless legs symptoms, a phenomenon known as augmentation which is the most important long-term adverse effect of dopaminergic therapy [29]. There are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders.
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