Abstract
To determine the frequency of nocturnal eating (NE) and sleep related eating disorder (SRED) in restless legs syndrome (RLS) versus psychophysiological insomnia (INS), and the relationship of these conditions with dopaminergic and sedative-hypnotic medications. Prospective case series. Sleep disorders center. Newly diagnosed RLS or INS. RLS or INS pharmacotherapy with systematic follow up interview for NE/SRED. Patients presenting with RLS (n = 88) or INS (n = 42) were queried for the presence of NE and SRED. RLS patients described nocturnal eating (61%) and SRED (36%) more frequently than INS patients (12% and 0%; both p < 0.0001). These findings were not due to arousal frequency, as INS patients were more likely to have prolonged nightly awakenings (93%) than RLS patients (64%; p = 0.003). Among patients on sedative-hypnotics, amnestic SRED and sleepwalking were more common in the setting of RLS (80%) than INS (8%; p < 0.0001). Further, NE and SRED in RLS were not secondary to dopaminergic therapy, as RLS patients demonstrated a substantial drop (68% to 34%; p = 0.0026) in the frequency of NE after dopamine agents were initiated, and there were no cases of dopaminergic agents inducing novel NE or SRED. NE is common in RLS and not due to frequent nocturnal awakenings or dopaminergic agents. Amnestic SRED occurs predominantly in the setting of RLS mistreatment with sedating agents. In light of previous reports, these findings suggest that nocturnal eating is a non-motor manifestation of RLS with several clinical implications discussed here.
Highlights
METHODSConsecutive adult patients who presented to the University of Minnesota Medical Center, Sleep Disorders Center or the Minnesota Regional Sleep Disorders Center with a complaint of difficulty sleeping were screened for either restless legs syndrome (RLS) or INS
Restless legs syndrome, or Willis-Ekbom Syndrome, is characterized by an underlying discomfort, primarily in the lower extremities that compels the afflicted to move
Most investigations of nocturnal eating (NE; eating after an arousal from sleep, prior to terminal awakening) have focused bRIEF SUMMARY Current knowledge/Study Rationale: This study compared the prevalence of NE and sleep related eating disorder (SRED) in restless legs syndrome (RLS) to INS, a disorder with similar sleep disruption to determine whether nocturnal feeding behavior in RLS is merely “killing time.”
Summary
Consecutive adult patients who presented to the University of Minnesota Medical Center, Sleep Disorders Center or the Minnesota Regional Sleep Disorders Center with a complaint of difficulty sleeping were screened for either RLS or INS. Once diagnosed with either RLS or INS, using a structured 1-page nocturnal eating questionnaire, patients were queried about the frequency and characterization of both nocturnal arousals and nocturnal eating. SRED was diagnosed if recurrent nocturnal eating was present with one or more of the following criteria: (1) ingestion of unusual or inedible substances, (2) difficulty falling back asleep or nonrestorative sleep, (3) sleep related injury or potentially injurious behaviors, (4) morning anorexia, (5) or adverse health consequences.[1]. RLS NE patients were asked whether they had restlessness symptoms at the time of the NE. The patients sleep initiation and maintenance symptoms, restlessness, as well as NE and SRED were serially evaluated with a structured follow-up interview
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