Diagnosis Of Restless Legs Syndrome Research Articles

Evaluation of the relationship between restless legs syndrome, mental status, and sleep disorders among Moroccan women during their third trimester of pregnancy.

Restless legs syndrome (RLS) is a motor disorder encountered during pregnancy and leads to psychological and sleep impairments. The latter seems to be non-restorative and its occurrence alters the quality of life of pregnant women. The objective of this study was to evaluate the prevalence of RLS and its relationship with both anxio-depressive symptoms and sleep disorders among a population of Moroccan pregnant women during their third trimester of pregnancy. A cross-sectional study was conducted in a population of pregnant women in their third trimester (n=178) admitted to two health facilities in the city of Marrakech: Youssef Ibn Tachafine and Oasis. The face-to-face questionnaire was used to collect data including demographic and clinical characteristics, the four diagnostic criteria of RLS, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups RLS+ (women with RLS) and RLS- (women without RLS). The prevalence of RLS was 59.5%; this syndrome was more common in the ninth month (74.15%) compared with the seventh and eighth months. Sleep impairment, including sleep efficiency, was significantly higher in RLS+ than RLS- (P-value 0.05). Anxiety but not depression is significantly increased in RLS+ compared to RLS- (48.11% versus 38.8%, P = 0.000). There were no significant differences between RLS+ and RLS- in terms of socio-demographic and other clinical characteristics. RLS is encountered during the prenatal period, with a higher prevalence in the last trimester. During this stage of pregnancy, women suffering from RLS were vulnerable to anxiety and sleep disorders. Prevention and early diagnosis of RLS could be a proactive healthcare management leading to better health outcomes and better conditions of pregnancy, which precedes childbirth.

A survey-based approach on restless legs syndrome: practices and perspectives among Italian neurologists.

Restless Legs Syndrome (RLS) is a widely prevalent and complex neurological disorder. Despite notable advancements in managing RLS, the disorder continues to face challenges related to its recognition and management. This study seeks to gain comprehensive insights into the knowledge and clinical practices among Italian neurologists regarding RLS diagnosis, management, and treatment, comparing approaches among general neurologists, movement disorder specialists, and sleep experts. Members of the Italian Society of Neurology, the Italian Society of Parkinson and Movement Disorders, and the Italian Association of Sleep Medicine were invited to participate in a 19-question online survey. Among the 343 surveyed neurologists, 60% categorized RLS as a "sleep-related movement disorder." Forty% indicated managing 5-15 RLS patients annually, with sleep specialists handling the highest patient volume. Of note, only 34% adhered strictly to all five essential diagnostic criteria. The majority (69%) favored low-dosage dopamine agonists as their first-line treatment, with movement disorder specialists predominantly endorsing this approach, while sleep experts preferred iron supplementation. Regular screening for iron levels was widespread (91%), with supplementation typically guided by serum iron alterations. In cases of ineffective initial treatments, escalating dopamine agonist dosage was the preferred strategy (40%). These findings underscore a lack of a clear conceptualization of RLS, with a widespread misconception of the disorder as solely a movement disorder significantly influencing treatment approaches. Disparities in RLS understanding across neurology subspecialties underscore the necessity for improved diagnostic accuracy, targeted educational initiatives, and management guidelines to ensure consistent and effective RLS management.

Time to Resolution of Iron Deficiency: A 10-Year Single State Retrospective Review

Introduction: Iron deficiency can have clinical consequences even without anemia, including fatigue, exercise intolerance and mood disorders. The time from laboratory diagnosis to resolution of iron deficiency has not been previously evaluated. Methods: In a retrospective review of electronic medical record (EMR) data from a single state health system, we identified patients meeting laboratory criteria for iron deficiency (defined as a ferritin level < 25 ng/mL). Patients with at least one follow-up ferritin level of any value within 3 years were included in the final cohort. Patients with a follow-up ferritin > 50 ng/mL at any time point within 3 years were classified as having resolved iron deficiency. Diagnoses of interest included iron deficiency anemia (IDA), as well as other conditions where iron deficiency is routinely assessed and treated irrespective of anemia, namely heart failure (HF) and restless leg syndrome (RLS). Descriptive statistics and time to event analyses (via Cox proportional hazards regression) were performed to determine time to resolution of iron deficiency in the cohort and characteristics predictive of achieving resolution. Results: We identified 13,084 patients with iron deficiency detected between 2010 to 2020. The majority of patients were female (86.6%) and White (79.3%); 57.3% had an EMR diagnosis of IDA (Table 1). We found that 5,485 (41.9%) had resolution of iron deficiency within 3 years of diagnosis, while 7,599 (58.1%) had unresolved iron deficiency. Among those with resolved iron deficiency, the median time to resolution was 1.9 years (IQR 0.8, 3.9 years). Factors associated with resolution of iron deficiency included increasing age (aHR 1.42 [95% CI 1.31 - 1.54], p < 0.001 for age > 60), male gender (1.49 [1.39 - 1.59], p < 0.001) and a diagnosis of HF (1.23 [1.11 - 1.36], p < 0.001) (Table 2). Black race (0.75 [0.68 - 0.83], p < 0.001) and absence of an EMR diagnosis of IDA, HF or RLS (0.75 [0.71 - 0.81], p < 0.001) were associated with a lower likelihood of iron deficiency resolution. Conclusion: Prolonged and unresolved iron deficiency were prevalent in this cohort, with young age, female gender and Black race increasing risk of non-resolution. Interventions are needed to raise awareness of the clinical consequences of non-anemic iron deficiency and of diagnostic ferritin thresholds.

Structural and functional multilayer network analysis in restless legs syndrome patients.

The combination of brain structural and functional connectivity offers complementary insights into its organisation. Multilayer network analysis explores various relationships across different layers within a single system. We aimed to investigate changes in the structural and functional multilayer network in 69 patients with primary restless legs syndrome (RLS) compared with 50 healthy controls. Participants underwent diffusion tensor imaging (DTI) and resting state-functional magnetic resonance imaging (rs-fMRI) using a three-tesla MRI scanner. We constructed a structural connectivity matrix derived from DTI using a DSI program and made a functional connectivity matrix based on rs-fMRI using an SPM program and CONN toolbox. A multilayer network analysis, using BRAPH program, was then conducted to assess the connectivity patterns in both groups. At the global level, significant differences there were between the patients with RLS and healthy controls. The average multiplex participation was lower in patients with RLS than in healthy controls (0.804 vs. 0.821, p = 0.042). Additionally, several regions showed significant differences in the nodal level in multiplex participation between patients with RLS and healthy controls, particularly the frontal and temporal lobes. The regions affected included the inferior frontal gyrus, medial orbital gyrus, precentral gyrus, rectus gyrus, insula, superior and inferior temporal gyrus, medial and lateral occipitotemporal gyrus, and temporal pole. These results represent evidence of diversity in interactions between structural and functional connectivity in patients with RLS, providing a more comprehensive understanding of the brain network in RLS. This may contribute to a precise diagnosis of RLS, and aid the development of a biomarker to track treatment effectiveness.

Restless legs syndrome.

Restless legs syndrome (RLS) is a common sensorimotor disorder causing significant distress and is commonly seen in the primary care setting. This article outlines the epidemiology, pathophysiology, diagnosis and management of RLS, with a focus on the primary care setting. RLS is a clinical diagnosis, although mimics exist. Brain iron deficiency, dopaminergic dysfunction and genetics underpin the poorly understood pathophysiology of this common condition. After repleting iron stores, reviewing any exacerbating medications and attending to non-pharmacological management options, there are pharmacological options that prove to be effective, although with class-specific effects that need to be considered.

Perceptions of exercise and restless legs syndrome: Results from a nationwide survey.

Restless legs syndrome is a prevalent, sensorimotor sleep disorder temporarily relieved by movement, with evidence of symptomatic improvement with regular exercise. The present study describes perceptions of the effects of exercise on symptoms of restless legs syndrome. Participants (N = 528) completed a mixed-methods (i.e. numerical and narrative), nationwide survey including items assessing personal experiences with exercise and restless legs syndrome (both positive and negative), as well as restless legs syndrome diagnosis, restless legs syndrome severity, and demographic and clinical characteristics. Responses varied widely on specific experiences with exercise, but a higher percentage of participants indicated positive experiences with exercise than those who reported negative experiences (72%-40%, respectively) with exercise. Further, 54% of respondents reported that exercise only improves restless legs syndrome, while 24% reported exercise only worsens symptoms. Participants described that any abrupt change in exercise routine would almost always elicit restless legs syndrome symptoms (e.g. hiking for a long time, stopping an exercise routine), and that a consistent pattern of exercise improved restless legs syndrome symptoms with an overall beneficial effect on the frequency of symptomatic bouts. Participants further described time of day as impactful for their exercise experience, with > 50% indicating morning exercise improves symptoms and evening exercise worsens symptoms. Participants described several questions that they wanted answered regarding the evidence for exercise in restless legs syndrome and specific exercise prescription recommendations. The present study describes information crucial to the creation of stakeholder-informed health promotion programs for individuals with restless legs syndrome to optimize personalized treatment plans that could prevent and manage symptoms.

SUBCLINICAL TARGET ORGAN DAMAGE IN PATIENTS WITH RESTLESS LEGS SYNDROME. A PRELIMINARY OBSERVATIONAL STUDY

Objective: Restless legs syndrome (RLLS) is a frequent and often underdiagnosed type of insomnia. Since other types of insomnia present a strict association with cardiovascular disease, our study aimed to evaluate the possible association of RLLS with some early markers of cardiovascular organ damage. Design and method: Patients with other types of insomnia and those with central nervous system diseases were excluded. Twenty-eight patients (mean age: 63,1±13,9 years; 28.6% males) participated in the study. Fourteen subjects with diagnosis of RLLS according to International diagnostic criteria (Allen RP et al. 2014 Sleep Medicine) (disease mean duration 9.6±9.2 years; International Restless Legs Scale score 22.9±5.2) were matched for sex, age and major cardiovascular risk factors with 14 controls. In both groups, peripheral Blood Pressure (pBP), central Blood Pressure (cBP) and Pulse Wave Velocity (PWV) were assessed by the SphygmoCorXCEL. Carotid Intima-Media Thickness (cIMT) and the carotid Distensibility Coefficient (cCD) were assessed by ultrasound connected with an image acquisition and analysis system (CardiovascularSuite). Results: We did not find any significant difference between the two groups in the indices of subclinical vascular damage. In the RLS group, blood pressure measurements significantly correlated with all the markers of subclinical vascular damage, particularly pSBP was associated with PWV (r = 0.53, p = 0.009), Pulse Pressure correlated with cIMT (r = 0.58, p = 0.01) and cDBP was inversely related to cDC (r = -0.53; p = 0.03). Conclusions: Our data did not show significant differences in markers of early vascular damage between patients with RLS and matched controls. As expected, the markers of vascular damage were associated with BP. The present is only a pilot study; further studies with a larger sample size are required to confirm our findings.

Restless Legs Syndrome and Restless Sleep Disorder in Children.

Restless legs syndrome (RLS) affects 2% of children presenting with symptoms of insomnia, restless sleep, decreased quality of life, and effects on cognition and behavior. The International RLS Study Group and the American Academy of Sleep Medicine have published guidelines for the diagnosis and treatment of RLS in children. Restless sleep disorder has been recently identified in children and presents with frequent movements during sleep and daytime symptoms with polysomnography findings of at least 5 large muscle movements at night. Treatment options for both disorders include iron supplementation, either oral or intravenous with improvement in nighttime and daytime symptoms.

Restless Legs Syndrome in Parkinson's Disease.

Restless legs syndrome (RLS) might worsen sleep quality and quality of life in people with Parkinson's disease (PwPD). The main aim of the present study is to explore the associations between RLS and sleep, quality of life and other non-motor symptoms (NMS) in a sample of PwPD. We compared the clinical features of 131 PwPD with and without RLS, in a cross-sectional study. We used several validated scales for assessment: the International Restless Legs Syndrome Study Group rating scale (IRLS), Parkinson's Disease Sleep Scale version 2 (PDSS-2), Parkinson's Disease Questionnaire (PDQ-39), Non-Motor Symptoms Questionnaire (NMSQ) and International Parkinson and Movement Disorder Society Non-Motor Rating Scale (MDS-NMS). Thirty-five patients (26.71%) out of the total PwPD met the RLS diagnostic criteria, without significant differences between male (57.14%) and female (42.87%) (p = 0.431). Higher total scores of PDSS-2 were recorded among PwPD + RLS (p < 0.001), suggesting worse sleep quality. Significant correlations were observed between the diagnosis of RLS and some types of pain (especially nocturnal pain), physical fatigue and probable sleep-disordered breathing, according to the MDS-NMSS assessment. RLS has a high frequency in PwPD and it requires proper management, considering its consequences on sleep and quality of life.

0698 Contrasting Painful and Painless Restless Legs Phenotypes: An Adult Twin Family Study

Abstract Introduction Several studies characterized painful and painless restless legs syndrome (RLS) phenotypes based on clinical, topographical, polysomnographic, and genetic background. One pediatric twin family study demonstrated a clear contrast between these two forms of RLS. The painful pediatric RLS being familial, probably genetically influenced, and associated with primary pain disorders (non-migraines headaches; recurrent abdominal pain), the painless pediatric RLS being familial but probably not genetically determined, and associated with iron deficiency, female gender, and persistent/chronic pain disorders. The current study investigated these contrasting painful and painless RLS phenotypes in the adult population. Methods The Twins Research Australia database was used to recruit adult twins and their families. The subjects were surveyed and responded to questions related to their demographics, the Cambridge-Hopkins diagnostic questionnaire for RLS diagnosis and categorization into painful and painless RLS subgroups, the history of physician-confirmed iron deficiency, the presence of selected chronic and primary pain disorders, and also other medical, non-pain conditions associated with RLS. Association analyses, using logistic regression with application of generalized estimating equations to control for twin influences, and adjusting for gender and age, were conducted. Results A total of 1449 adult subjects responded to the RLS diagnostic questionnaire and to pain related and other medical conditions questions (64.4% females). A total of 1327 adult subjects responded to the iron deficiency pertinent questions (65.7% females). Numbers of dizygous twins and painful RLS subjects were insufficient for heritability testing and for association analyses with medical conditions. Painless RLS was associated with iron deficiency (OR= 1.59; p=0.003), while painful RLS was not (OR=1.26; p=0.444). Painful RLS was associated with migraine (OR=2.35; p=0.004), recurrent abdominal pain (OR=1.96; p=0.026), growing pains (OR=2.13; p=0.050), diverse chronic pain (OR=2.88; p=0.017), chronic spinal pain (OR=3.65; p=0.001) and dysmenorrhea (OR=2.46; p=0.009). Painless RLS was not associated with any pain disorder. Conclusion This study further confirmed contrasting associations in adults with painless and painful phenotypes of RLS (association with iron deficiency and multiple pain disorders, respectively). Support (if any) This work was supported by the School of Women's and Children's Health, Medicine, University of New South Wales, Kensington 2052, NSW, Australia; Private donors.

0987 Asking the Right Questions: A Case of Restless Legs Syndrome and Spinal Muscular Atrophy

Abstract Introduction The association between iron deficiency and restless legs syndrome (RLS) is well established. However, there is limited data on the association between motor neuron diseases such as spinal muscular atrophy (SMA) and RLS. A forty-three-year-old with Type 2 SMA presented to clinic for management of chronic respiratory failure. She had recently undergone surgery and chemotherapy for newly diagnosed anal cancer. However, she reported persistent abdominal pain, anorexia, weight loss, and rectal bleeding. She reported “muscle twitching” and bilateral lower extremity pain and tingling that was worse at night. Her husband would awaken every 2 hours to massage her legs. She assumed these symptoms had emerged as a result of an increase in motor function due to risdiplam, a survival motor neuron 2 splicing modifier drug. Further questioning led to the diagnosis of RLS. Bloodwork revealed severe iron deficiency anemia (hemoglobin of 6.0 g/dL, iron 13 mcg/dL, and ferritin 3 ng/ml). She received a blood transfusion and underwent sigmoidoscopy for evaluation of cancer recurrence given the report of bleeding. Fortunately, her cancer remained in remission. Her symptoms of RLS significantly improved after blood transfusions and iron supplementation. Report of case(s) n/a Conclusion RLS is a complex sensorimotor syndrome. The diagnosis of RLS is clinical, relying on diagnostic criteria that requires lower extremity movement. The case is a reminder of the variable presentation of RLS in individuals with neuromuscular disorders, including SMA. How are symptoms of restless legs disclosed in patients with the inability to move and with potentially altered sensorium? The focus of the patient encounter could have anchored on the common and expected sequalae of SMA, chronic respiratory failure. Unfortunately, anchoring bias would have delayed the diagnosis and treatment of what could have been a potentially fatal disease – metastatic cancer. Ironically, the patient’s longing for motor function repressed her ability to lament. To the patient, symptoms of frequent nighttime awakenings and limb discomfort were perceived as a desired side effect of a medication that would increase movement. This case emphasizes the importance of the patient interview and its value of uncovering subtle complaints that may broaden the differential diagnosis and guide further work-up. Support (if any)

Association between Inflammatory Bowel Disease and Subsequent Development of Restless Legs Syndrome and Parkinson's Disease: A Retrospective Cohort Study of 35,988 Primary Care Patients in Germany.

In addition to the gastrointestinal symptoms, inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is associated with extraintestinal manifestations, including neurological disorders, which are gaining increasing attention due to a recently increased focus on the gut-brain axis. Here we aim to evaluate the association between IBD and restless legs syndrome (RLS) as well as Parkinson's disease (PD) in a cohort of primary care patients in Germany. The study included 17,994 individuals with a diagnosis of IBD (7544 with CD and 10,450 with UC) and 17,994 propensity-score-matched individuals without IBD from the Disease Analyzer database (IQVIA). An initial diagnosis of RLS or PD was assessed as a function of IBD. Associations between CD and UC with RLS and PD were analyzed using Cox regression models. During the 10-year observation period, 3.6% of CD patients vs. 1.9% of matched non-IBD pairs (p < 0.001) and 3.2% of UC patients vs. 2.7% of matched pairs (p < 0.001) were diagnosed with RLS. The results were confirmed by Cox regression analysis, which showed a significant association between UC (HR: 1.26; 95% CI: 1.02-1.55) and CD (HR: 1.60; 95% CI: 1.23-2.09) and subsequent RLS. The incidence of PD in IBD patients was not significantly increased. However, we observed a non-significant trend towards a higher incidence of PD in male patients with CD but not UC (HR: 1.55; 95%CI: 0.98-2.45, p = 0.064). The present analysis suggests a significant association between IBD and the subsequent development of RLS. These findings should stimulate further pathophysiological research and may eventually lead to specific screening measures in patients with IBD.

Dopamine agonists and risk of lung cancer in patients with restless legs syndrome.

To examine the association between long-term use of dopamine agonists (DAs) and the risk of lung cancer in patients with restless legs syndrome (RLS). We conducted a retrospective cohort study using Optum Clinformatics® database. We included adults ≥40 years diagnosed with RLS during the study period (1/2006-12/2016). Follow-up started with the first RLS diagnosis and ended on the earliest of: incident diagnosis of lung cancer, end of enrollment in the database or end of the study period. The exposure of interest was cumulative duration of DAs use, measured in a time-varying manner. We constructed a multivariable Cox regression model to estimate HRs and 95% CIs for the association between lung cancer and cumulative durations of DA use, adjusting for potential confounding variables. We identified 295 042 patients with a diagnosis of RLS. The mean age of the cohort was 62.9; 66.6% were women and 82.3% were white. The prevalence of any DA exposure was 40.3%. Compared to the reference group (no use and ≤1year), the crude HRs for lung cancer were 1.16 (95% CI 0.99-1.36) and 1.14 (95% CI 0.86-1.51) for 1-3 years and >3 years of cumulative DA use, respectively. The adjusted HR for lung cancer was 1.05 (95% CI 0.88-1.25) for 1-3 years and 1.02 (95% CI 0.76-1.37) for >3 years of cumulative DA use, respectively. At typical doses for the clinical management of RLS, long-term DA use was not associated with risk of lung cancer.

Genetic hemochromatosis is not a risk factor for Restless Legs Syndrome

BackgroundIron dysmetabolism has long been identified as a primary key factor involved in Restless Legs Syndrome (RLS) pathophysiology and may account for the high prevalence of RLS observed in chronic liver diseases (CLD). Prevalence of RLS was also reported to be high in genetic hemochromatosis (GH) but whether this is due to the unique iron metabolism disorder and to treatment procedure in GH remains unknown. If this assumption is true, then one would hypothesize that RLS prevalence is higher in GH than in another CLD such as chronic hepatitis B (CHB). Materials and methodsWe conducted a prospective questionnaire-based survey to assess the prevalence of RLS symptoms in consecutive patients with either GH or CHB. Patients who were screened positive for RLS based on the criteria of the International RLS Study Group were further interviewed by telephone and if needed by face to face assessment to confirm RLS diagnosis. ResultsSymptoms of confirmed RLS were confirmed in 8.9% of the 101 participants with CHB and in 10% of the 105 patients with GH. Low ferritin levels were not associated with the presence of RLS in both groups nor were the severity of the liver disease. ConclusionGH is not a risk factor for RLS occurrence as any other cause of CLD, as RLS prevalence in both GH and CHB is within the range of RLS prevalence in the general Caucasian population.

Opioids and restless legs syndrome: a double-edged sword.

Free AccessCommentaryOpioids and restless legs syndrome: a double-edged sword John W. Winkelman, MD, PhD John W. Winkelman, MD, PhD Address correspondence to: John Winkelman, MD, PhD, 1 Bowdoin Square, 6th Floor, Boston, MA 02114; Email: E-mail Address: [email protected] Massachusetts General Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Search for more papers by this author Published Online:April 1, 2023https://doi.org/10.5664/jcsm.10524SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONOpioids have been used to treat restless legs syndrome (RLS) for hundreds of years.1 More recently, 2 randomized controlled trials have demonstrated the efficacy of this class of medications for RLS.2,3 The larger study enrolled refractory patients, who, even though they were resistant to other treatments, had a beneficial therapeutic response to oxycodone/naloxone at low–moderate doses. Further, large-scale, open-label observational studies demonstrate the continued efficacy of these medications (predominantly methadone) over 2–10 years for RLS, although a minority require small dose increases over time.4–8In general medical practice, opioids are primarily used for the treatment of both acute and chronic pain. They are also administered outside of medical practice by those with opioid use disorder (OUD). Discontinuation of chronic opioids is often unsuccessful for a variety of reasons, including the aversive symptoms of opioid withdrawal. Opioid withdrawal symptoms are monitored in medical detoxification settings with the use of clinical scales employing both behavioral and physiological indicators; chief among these are the COWS (Clinical Opioid Withdrawal Scale9) and the SOWS (Subjective Opioid Withdrawal Scale10).“Restlessness” has long been recognized as one of the cardinal features of opioid withdrawal and is 1 of the 10 items in the COWS assessment. Only recently has it been recognized that this restlessness is in fact RLS, directly as a consequence of opioid withdrawal (“secondary RLS,” like that due to pregnancy, iron deficiency, or end-stage renal disease). Two recent studies have documented an incidence of RLS of approximately 50% in patients undergoing inpatient detoxification for OUD.11,12 Although RLS as an opioid withdrawal symptom is widely recognized among those with OUD, the medical community, even those working in detoxification programs, is mostly unaware of this. Unfortunately, for many of those with substantial RLS symptoms during opioid withdrawal, a return to opioids is perceived as the only recourse for their relief.In this issue of the Journal of Clinical Sleep Medicine McCarter et al13 report a 36% incidence of RLS, with maximum appearance 2 weeks after discharge, for patients with chronic pain attending a 15-day outpatient program supporting withdrawal from long-term use (mean = 87 months) of opioids. Symptoms were moderate–severe. Those with withdrawal-related RLS had nearly double the opioid doses at admission to the program than those without such emergent symptoms, and morphine milligram equivalents > 20 at admission was a strong predictor of such symptoms. The majority of those with withdrawal-related RLS symptoms had remission of symptoms by 3 months after discharge from the program. They did not present data on longer-term outcomes of opioid use.RLS diagnosis in clinical practice, where symptoms can be precisely assessed, is often straightforward. However, RLS ascertainment by brief self-administered surveys is much more difficult. This is particularly true where patients have conditions with symptoms that overlap with the core features of RLS (eg, Parkinson’s disease,14,15 multiple sclerosis,16 adrenoleukodystrophy,17 akathisia,18 peripheral neuropathy19). For this reason, a recent International Restless Legs Syndrome Study Group task force strongly recommended that, where feasible, prevalence studies should always employ confirmatory follow-up clinical interviews20 following such self-administered surveys.It should be noted that the studies cited above examining incidence of opioid withdrawal–related RLS, including that by McCarter et al, used the Cambridge-Hopkins brief questionnaire, a self-completed survey that asks about the core diagnostic features of RLS and the presence of common mimics.21 However, none of the studies cited above, including our own, used follow-up clinical interviews. Given that opioid withdrawal includes multiple symptoms that mimic RLS22 (ie, generalized restlessness, anxiety, neuropathy, muscle cramps), both RLS prevalence and incidence figures in these studies must be considered tentative. In particular, the 27% RLS prevalence in patients entering the detoxification program in the McCarter et al study, while taking opioids, and with 52% of their patients taking alpha-2-delta ligands at therapeutic RLS doses, raises eyebrows.Regardless of the precise incidence of RLS in the context of opioid withdrawal, the important issue is that it is not uncommon. RLS is not only distressing and produces substantial sleep disturbance but it may in fact interfere with opioid abstinence. Both opioid withdrawal symptoms,23 as well as sleep disturbance, independently24 contribute to relapse to opioid use. Anecdotally, patients with OUD describe a return to opioid use directly related to seeking relief from RLS. RLS also has other relevant substantial morbidity, including suicide and self-harm events.25 On the other hand, case reports suggest26,27 that, like most cases of both “primary” and “secondary” RLS, opioid withdrawal–related RLS is treatable with dopaminergic agonists. To examine this issue more carefully, a National Institute of Drug Abuse-funded trial of28 short-term pramipexole treatment of opioid withdrawal–related RLS is underway, examining the hypothesis that not only RLS symptoms and sleep disturbance are effectively treated with this dopaminergic agonist in a detoxification setting but that opioid craving and detoxification treatment adherence are improved.As was the case 30 years ago for primary RLS prior to the success of randomized controlled trials and educational initiatives, the first steps in advancing treatment of opioid withdrawal–related RLS are recognition of the problem and appropriate diagnosis. The McCarter et al paper in the current issue of the Journal is a valuable addition to this process. If short-term dopamine agonists prove successful in the treatment of RLS in the acute period of opioid withdrawal, their use in this context may be an important advance in reducing the morbidity of opioid withdrawal, maintaining participation in detoxification programs, and thus improving outcomes in OUD.DISCLOSURE STATEMENTJohn Winkelman receives consultation fees from Emalex, Noctrix, and Disc Medicine, and research support from National Institute of Drug Abuse, the RLS Foundation, and the Baszucki Brain Research Fund.REFERENCES1. Miranda M, Williams AM, Garcia-Borreguero D. Thomas de Quincey and his restless legs symptoms as depicted in “Confessions of an English Opium-Eater”. Mov Disord. 2010;25(13):2006–2009 . CrossrefGoogle Scholar2. Walters AS, Wagner ML, Hening WA, et al.. Successful treatment of the idiopathic restless legs syndrome in a randomized double-blind trial of oxycodone versus placebo. Sleep. 1993;16(4):327–332 . CrossrefGoogle Scholar3. 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Novel Technologies to Advance Sleep Research and Clinical Care for Older Adults

Sleep and circadian rhythm disturbances are core features of most neuropsychiatric disorders but can also be viewed as modifiable targets to improve health, functioning, and quality of life. Older adults are at particularly high risk for the negative consequences of poor sleep due to age-related risks for insomnia and obstructive sleep apnea as well as the increased risks of pharmacotherapies for sleep.Technological advances can be harnessed to promote and improve sleep and circadian rhythm disturbances to help advance clinical care. Much work goes into the process of the development of these technologies and adapting them for improved feasibility and usability. There are specific geriatric-related considerations that cannot be overlooked relating to the disease processes and also to the adaptability of technology for use by older adults to promote their inclusion in this use.In this session, Marie Anne Gebara, M.D., will provide an overview of Restless Leg Syndrome (RLS) in older adults with Alzheimer's disease dementia. She will present preliminary findings from a study to develop and modify a novel wearable sleep device (RestEaze) to facilitate the diagnosis of RLS in this population. Michael Ma will present on his group's work in developing a novel app to augment cognitive behavioral therapy for insomnia in adults who are aging with schizophrenia. He will describe the process of developing the app to integrate with existing commercial devices and present initial beta testing findings. Stephen Smagula Ph.D. will present on his work developing a novel rest-activity rhythm assessment to improve health outcomes for older adults. He will describe the development of a novel app and pilot findings from its use in older adults with dementia and histories of stroke, depression, and daytime sleepiness. Olusola Ajilore, M.D., Ph.D., will moderate and lead a discussion of the potential for and challenges of developing innovative technologies to assess and improve sleep for older adult populations.All presenters will put their research in the context of the clinical challenges.

Sleep Disorders Among Individuals With Rheumatoid Arthritis.

Self-reported sleep problems are common in rheumatoid arthritis (RA), with potential negative health implications, yet relatively little research has focused on sleep in RA. We examined the prevalence of obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS) symptoms, and short sleep (SS) in a large RA cohort (n=4,200) and factors associated with each. Data are from FORWARD, The National Databank for Rheumatic Diseases. Validated screening measures assessed OSA risk and RLS symptoms. SS was based on self-reported average sleep time (<6 hours). The Medical Outcomes Study Sleep Problems Index I measured self-reported sleep quality. Multivariable logistic regression models identified independent predictors of sleep disorders and sleep quality and the independent association of OSA risk, RLS symptoms, and SS with self-reported poor sleep quality. Twenty-one percent (n=899) had OSA diagnosis or risk, 30% (n=1,272) had RLS symptoms or diagnosis, and 43% (n=1,737) reported SS, and RA disease activity was associated with each sleep disorder. Abatacept use was associated with lower odds of RLS and SS. Use of conventional disease-modifying antirheumatic drugs or abatacept was less frequent in the SS group. No medications were associated with OSA in multivariable analyses. Both RLS and SS was associated with worse perceived sleep quality. Almost two-thirds met criteria for at least one sleep disorder. RA disease activity and pain were significantly associated with each sleep condition. Additional research is needed to identify the causal pathway between sleep disorders and RA disease activity and pain and the long-term consequences of sleep disorders in RA.

Restless legs syndrome in patients with psoriasis: association with inflammation and sleep quality.

We aimed to evaluate if psoriasis associated with restless legs syndrome (RLS) due to its close relationship with metabolic disorders. This was a cross-sectional study in which the relationship between RLS and psoriasis was evaluated. Seventy consecutive psoriasis patients and 70 controls without any skin disorder were included in this study. Data including age, gender, body weight, height, and Psoriasis Area Severity Index (PASI) scores were recorded. Diagnosis of RLS was established using International RLS Study Group (IRLSSG) diagnostic criteria. International RLS Rating Scale (IRLSRS) was used to evaluate the severity of symptoms. Each participant completed forms of the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Dermatology Life Quality Index (DLQI). The RLS frequency in patients with psoriasis was 18.6% vs. 5.7% in the control group (P=0.018). In psoriasis patients, BMI, DLQI, IRLSRS, hemoglobin, ferritin, CRP, and uric acid levels were significantly higher than those of the controls. In psoriasis patients with RLS, PASI, DLQI, PSQI, IRLSRS scores, CRP level, and BMI were significantly higher, and hemoglobin level was significantly lower relative to the psoriasis patients without RLS. PASI score was the sole independent associate of RLS presence in psoriasis patients. Restless legs syndrome was significantly more common in psoriasis patients, and the presence of RLS was associated with significantly more severe psoriasis, more severe systemic inflammation, lower serum hemoglobin values, worse quality of life, and sleep quality.

Prevalence and Determinants of Restless Legs Syndrome (Willis-Ekbom Disease) in an Older Greek Population

ABSTRACT Objectives The present study aimed to explore the descriptive and analytic epidemiology of restless legs syndrome (RLS) in the older Greek population, with a specific focus on lifestyle indicators. Methods Baseline data from the randomly selected non-demented older participants of the population-based HELIAD cohort were analyzed. Multivariable binary logistic regression with RLS diagnosis as the dichotomous dependent outcome was performed. Demographic, socioeconomic, anthropometric, dietary, sleep-related and psychological parameters, physical activity, use of psychoactive substances and personal medical history were investigated for potential associations. Results A total of 133 from the eligible sample of 1,838 participants were diagnosed with RLS. The mean age-sex standardized prevalence of RLS among the elderly was estimated at 6.1% (95%CI = 5.0–7.2), with a female (8.0%, 95%CI = 6.4–9.6) to male (3.7%, 95%CI = 2.4–5.1) ratio of 2.1. The prevalence of RLS peaked during the 8th decade of life and diminished thereafter. The positive associations of RLS with female sex [OR = 2.06, 95%CI = (1.19–3.57)], anxiety levels [assessed by the 22-point HADS scale, OR = 1.08, 95%CI = (1.03–1.13)] and traumatic brain injury [OR = 2.22, 95%CI = (1.37–3.62)] were reproduced. Good sleep quality was related to 55% [95%CI~(24–83%)] lower odds of having RLS in comparison with both poor and moderate quality. Adherence to the Mediterranean dietary pattern [assessed by a 55-point scale, OR = 1.06, 95%CI = (1.01–1.11)], and low daily energy intake [low-moderate vs. low: OR = 0.45, 95%CI = (0.26–0.79)]; [moderate-high vs. low: OR = 0.69, 95%CI = (0.40–1.22)]; [high vs. low: OR = 0.31, 95%CI = (0.13–0.69)] were related to RLS for the first time. Conclusions More emphasis should be placed on the dietary-nutritional aspects of RLS.

The Effect of Mindfulness-Based Stress Reduction on Restless Legs Syndrome in Hemodialysis Patients: A Randomized Clinical Trial

Background: There is currently no definitive cure for restless legs syndrome (RLS), and the common treatments are only used to reduce symptoms. Mindfulness-based stress reduction (MBSR) is an intervention that has shown beneficial effects in many mental and physical disorders.Purpose: This study aimed to determine the effect of MBSR on RLS in hemodialysis patients.Methods: This study was a randomized clinical trial involving 60 hemodialysis patients with RLS recruited by convenience sampling each group. Inclusion criteria were patients with RLS diagnosis, age 18-65, Hb&gt;10, no cognitive disorders, ability to read and write, no vision or hearing problems, and history of hemodialysis ≥6 months. The intervention group received eight sessions of the MBSR program, and the control group received routine care in a government dialysis center. International Restless Legs Syndrome Scale and Restless Legs Syndrome Severity Scale were used to measure RLS. Statistical analyses were conducted using independent and pair t-test and ANCOVA.Results: Significant difference was found in the severity the RLS (Mean(SD) score) between the intervention group (12.90(4.58)) and the control group (22.27(4.19)) (95% CI:-11.66 to -7.08, p&lt;0.0001). The effect size between groups was obtained based on Cohen’s d of 2.13.Conclusion: MBSR showed a significant reduction in the severity of RLS in hemodialysis patients. This preliminary study suggests that MBSR can be a promising treatment option in the management of RLS patients.