International Restless Legs Syndrome Study Group Research Articles

LABORATORY FINDING AND RESTLESS LEGS SYNDROME IN REGULAR HEMODIALYSIS PATIENTS

Introduction: restless leg syndrome, a complication that increases morbidity and mortality in hemodialysis patients, is a concern. To explore RLS we can start by looking at the baseline characteristics of regular hemodialysis patients. Aim: To perform baseline characteristic and prevalence of RLS in regular hemodialysis patients. Metode: This study involved 71 regular hemodialysis patients at the Haji Adam Malik Medan General Hospital using a cross sectional design. Through interviews in accordance with the criteria of the International Restless Leg Syndrome Study Group (IRLSSG) RLS status is enforce. Data of laboratory finding were obtained by laboratory examination. Using the SPSS-21 application, the data has been analyzed. Result: Various baseline characteristics based on laboratory examination results (Hemoglobin; Calcium; Phosphate; Fibroblast Growth Factors-23; ferritin serum; Serum Iron; Tranferin Saturation; and Total Iron Binding Capacity) and prevalence of RLS in regular hemodialysis patients reach 26 respondents (36.6%) Conclusion: In regular hemodialysis patients, there is an increase in levels of phosphate, calcium and FGF-23. Almost all patients were anemic. Of 71 respondents, 26 respondents (36.6%) with RLS.

Prevalence of restless legs syndrome among medical students and the effect of disease on academic performance

Aim: To investigate the prevalence of Restless Legs Syndrome (RLS) and the effect of RLS on academic performance among medical school students. Material and Methods: Second and 3rd grade medical students were included in the study. A total of 171 students were asked to complete the questionnaires. Demographic data and sleep habits of the students were recorded. RLS was diagnosed according to the questionnaire results. The RLS severity and frequency are evaluated according to the International Restless Legs Syndrome Study Group (IRLSSG) Questionnaire results. Epworth Sleepiness Scale (ESS) scores were also noted. Results: RLS was found in 17 (9.9%) of the students. Thirteen of the students with RLS were female (76.5%). The median grade point average (GPA) of students who had RLS (CC [60-64]) was significantly lower than those of other students (BB [70-79]) (p = 0.02). There was no statistically significant difference between the disease severity and GPA of the students with RLS (p = 0.516). The median GPA scores were lower in patients with a higher frequency of complaints (p = 0.045). When the GPA of students with RLS were compared in terms of the of the ESS scores, the median GPA of the students who had excessive daytime sleepiness was significantly lower (p = 0.038).Conclusion: The worse academic performance of the students with RLS was more related with frequency of RLS symptoms rather than severity of symptoms. The cognitive impairment underlying worse academic performance was probably due to insomnia-related chronic sleep deprivation secondary to RLS.

Correlation of Anaemia and Restless Legs Syndrome in Elderly: A Cross-sectional Study

Introduction: Restless Legs Syndrome (RLS) also known as Willis Ekbom Disease (WED) which manifests as a neurologic disorder among patients with anaemia, particularly with iron deficiency anaemia. Aim: To find the association of anaemia with RLS in the elderly population. Materials and Methods: In this cross-sectional study, 100 patients of age ≥60 years were enrolled and categorised into mild, moderate, and severe anaemia as per World Health Organisation (WHO) criteria. Every participant was enquired about RLS via a questionnaire based on the International RLS Study Group Rating Scale (IRLSSGRS) for its Severity and for the diagnosis (Essential clinical criteria for the diagnosis of RLS). Results: The study showed that patients with anaemia had a statistically significant correlation with RLS (p=0.04) and severity of RLS (p=0.032). Serum ferritin levels too showed a statistically significant correlation with RLS (p=0.032). Conclusion: Patients with severe anaemia and lower serum ferritin levels were more prone to RLS and had more RLS severity.

HİPOTİROİDİ VE HİPERTİROİDİ HUZURSUZ BACAK SENDROMUNU VE ONUN UYKU KALİTESİ İLİŞ

We aimed to evaluate the frequency of restless legs syndrome (RLS) and its sleep disturbance in patients with thyroid dysfunction. Methods: 31 patients with hypothyroidism and 31 patients with hyperthyroidisim as study groups and 30 age and gender-matched healthy volunteers as a control group were enrolled in the study. The diagnosis of RLS was made according to the criteria of the International RLS Study Group. Extreme daytime sleepiness, sleep quality and insomnia estimated by assessment tools Results: Among our study population, the median age was 41.50 (min-max = 20-72). 4 patients in the hypothyroid group and 7 patients in the hyperthyroid group were female. The RLS-diagnosed patients were significantly higher in the hypothyroid group than the hyperthyroid group. While subjective sleep quality and sleep latency were significantly different in the study population, there was no correlation between all groups in sleep quality according to PSQI. ESS and ISI scores were not significantly different in all groups. When the subsequent categorization of BDI into mild, moderate and severe was made, a significant difference was found between the three groups (p=0.010). Among the study groups although the percentage of low-BDI patients in the control group was higher (70%), the percentage of the severe-BDI was higher in the hyperthyroid group (16.13%). The severity of anxiety scores was not measured significantly between all groups according to the HAS (p=0.486). Conclusion: The frequency of RLS was significantly higher in the hypothyroid group. Those who had more severe depression scores according to the depression assessment scales were higher in the hyperthyroid group.

Acute post-stroke restless legs syndrome: the body of caudate nucleus considerations

ObjectivesTo investigate the relationship between the lesion location and post-stroke restless legs syndrome (RLS). MethodsA total of 376 patients with acute cerebral infarction were recruited from Tangshan Gongren Hospital, Department of Neurology between May 2016 and May 2017, all of whom were evaluated for RLS. Established RLS was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG) in 2012. Neurological functions were assessed according to the National Institutes of Health Stroke Scale (NIHSS). The lesion location was evaluated with magnetic resonance imaging (MRI). The associations between the lesion location and post-stroke RLS were then analyzed by logistic regression. ResultsA total of 49 patients (13.03%) had RLS. The multivariate logistic regression model adjusting for post-stroke RLS risk factors including gender, age, history of hypertension, history of diabetes, history of stroke, smoking, drinking, body mass index (BMI), NIHSS, hemoglobin, platelet and homocysteine determined that body of caudate nucleus and pontine were significantly associated with post-stroke RLS with odds ratio (OR) of 26.26 (95% confidence interval (CI): 9.41–73.28,p < 0.001) and OR of 4.37 (95% CI: 1.24–15.34, p = 0.021). The stepwise logistic regression model with temporal lobe, parietal lobe, occipital lobe, frontal lobe, callosum, body of caudate nucleus, thalamus, lenticulo capsule, corona radiata, centrum semi-ovale and pontine as potential predictors yielded a predictor mode. The stepwise logistic regression predictor mode indicated that body of caudate nucleus and pontine predicted post-stroke RLS with similar OR to multivariate models of 23.61 (95% CI: 9.53–58.51, p < 0.001) and 4.46 (95% CI: 1.38–14.4, p = 0.012). ConclusionsThe ischemic infarcts located in body of caudate nucleus, pontine are significantly associated with post-stroke RLS. Body of caudate nucleus acute infarcts may play a role in the development of post-stroke RLS.

Risk factors for restless legs syndrome in hemodialysis patients in Taiwan: A case-control study.

Restless legs syndrome (RLS) increases the risks of cardiovascular disease and death in hemodialysis (HD) patients. Previous studies of risk factors for RLS in HD patients have yielded varying results. We attempted to identify risk factors for RLS in HD patients in Taiwan.This case–control study recruited 59 HD patients with RLS and 353 HD patients without RLS from the largest HD center in Taiwan during the period from April 1, 2015 through August 31, 2015. Demographic and disease characteristics, information from the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic questionnaire, and IRLSSG Severity Scale scores were collected by interview. Clinical laboratory data were abstracted from medical records and then analyzed with logistic regression and Pearson correlation analysis. A P value of less than .05 was considered to indicate statistical significance.A dialysis duration of longer than 5 years (odds ratio [OR] = 2.32; 95% CI = 1.23–4.39; P = .002) and a low high-density lipoprotein cholesterol level (<40 mg/dL in men; <50 mg/dL in women) (OR = 2.73; 95% CI = 1.44–5.15; P = .009) were associated with increased risk of RLS. Among the 59 patients with RLS, 48 (81.3%) had moderate or severe symptoms (IRLSSG Severity Scale >10), and RLS severity was significantly correlated with dialysis duration (r = .26; P = .043).Among HD patients, RLS was more common among those receiving dialysis for longer than 5 years and those with a low serum high-density lipoprotein cholesterol (HDL-C) level.

Convergence of psychiatric symptoms and restless legs syndrome: A cross-sectional study in an elderly French population

ObjectiveThe objective was to evaluate the association between restless legs syndrome (RLS) with generalized anxiety disorder (GAD), major depression disorder (MDD), dysthymia, and GAD-depression comorbidity. Secondary aims were to examine the association between RLS with the cognitive-affective and somatic-vegetative disturbances experienced as part of depression and GAD. MethodsThis was a cross-sectional study of 1493 elderly participants (median age 80.6 years, 64% women) from Dijon, France. Probable RLS was assessed using the minimal diagnostic criteria of the International Restless Legs Study Group and RLS symptom frequency and treatment. Participants underwent structured interviews for MDD, dysthymia, and GAD. Participants also completed the Center for Epidemiological Studies-Depression scale (CES-D). The association between RLS and psychiatric disorders, their criterion symptoms, or symptom factors was examined using logistic regression. ResultsThe point prevalence of probable RLS in this sample was 8.2%. Probable RLS was associated with isolated GAD (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.01–4.68) and comorbid GAD-any depression disorder (OR 3.26, 95% CI 1.14–9.29), but not MDD or dysthymia. Probable RLS was also associated with the GAD criterion worry most days and feeling tense, and the CES-D factors representing depressed affect, somatic symptoms, and positive affect. ConclusionsProbable RLS was associated with GAD-depression comorbidity as well as isolated GAD. The findings challenge previous reports linking RLS solely with MDD, suggesting the association is partly driven by GAD-depression comorbidity.

Prevalence and risk factors of restless legs syndrome in patients of migraine without aura

Background: An association between migraine and Restless Legs Syndrome (RLS) has been proposed due to shared dopaminergic dysfunction. Both have substantial effects on the quality of life. Identifying co morbidities of migraine helps in optimizing patient management. Objectives To study the prevalence of RLS in patients of migraine without aura, and associated co morbidities of RLS.Methods: This was a hospital based prospective observational study. All patients diagnosed as Migraine without aura as per ICHD-3 criteria completed the questions regarding migraine headache, Migraine Disability Assessment (MIDAS) questionnaire, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI) and International RLS Study Group (IRLSSG) Rating Scale. RLS was diagnosed using the IRLSSG criteria. Serological investigations were done to look for secondary causes of RLS.Results: Out of 200 consecutive patients of migraine without aura were included in the study over a period of 18 months. Frequency of RLS was 13.5% (n=27). All patients had primary RLS. Mean PSQI score was higher in the patients of migraine without aura with RLS than in non RLS patients of migraine without aura (3.30±2.66 vs 2.24±2.03 p≤0.0168). Poor sleep quality, anxiety, depression was found in 9%, 8% and 2.5% respectively in patients of migraine without aura.Conclusions: An association between migraine without aura and RLS was demonstrated. Migraine without aura was associated with increased frequency of poor sleep quality, anxiety and depression.

Restless Legs Syndrome in Aircrew.

INTRODUCTION: Restless legs syndrome (RLS) is characterized by an uncomfortable sensation on the legs, which causes the urge to move the legs. The main cause is unknown but there are many risk factors, including geographical properties and high altitude. Our objective was to explore the frequency of RLS in aircrew.METHODS: There were 301 Turkish aircrew who were admitted to Istanbul Medipol University Hospital Neurology Department for periodic examinations and 272 healthy (non-aircrew) subjects included in the study. The International RLS Study Group's Questionnaire and the International RLS Study Group Rating Scale (IRLSSGRS) were used to evaluate RLS. The participants filled the RLS questionnaire and then both groups were divided into two subgroups as having RLS or not. The subjects years in the profession, average flight duration in a month, daily sleep duration, smoking, and coffee consumption were recorded. None of the subjects had previously been diagnosed with RLS.RESULTS: The frequency of RLS was 6.7% in the aircrew group and 7.9% in the control group, and there was no significant difference between the two groups. Age, gender, daily duration of sleep, smoking, coffee consumption, family history of RLS, being a pilot or a flight attendant, years in profession, and monthly flight hours were similar in aircrew with and without RLS.DISCUSSION: The RLS frequency in aircrew was similar to that of the control group. We can conclude flying at high altitude wasnt a risk factor for RLS.Düz OA, Yilmaz NH, Olmuscelik O. Restless legs syndrome in aircrew. Aerosp Med Hum Perform. 2019; 90(11):934937.

Relationship Between Sleep Characteristics and Sudden Unexplained Death Risk in Epilepsy.

Sleep disorders and disturbances are generally underestimated in patients with epilepsy. The aim of this study is to determine the frequency of sleep disturbances and the comorbidity of sleep disorders in people with epilepsy without any complaints about sleep and their relation of sudden unexplained death in epilepsy (SUDEP) risk. Sleep complaints and the presence of sleep disorders were assessed with 4 questionnaires in 139 patients with epilepsy. Subjective sleep features were evaluated with Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire for sleep apnea, and restless legs syndrome with International Restless Legs Syndrome Study Group (IRLSSG) severity scale. The presence of rapid eye movement/nonrapid eye movement parasomnia was asked to the patients and their relatives who share the same house. The patients' SUDEP-7 scores were also determined and associations with sleep problems were investigated statistically. Ninety-two patients with focal and 47 patients with generalized epilepsy were evaluated after their consent. The daily sleep quality was poor in 34 (24.5%) patients with PSQI. Daily sleepiness was present in 7 (5%) patients with ESS. Twenty-five patients (18%) had severe sleep apnea risk with the Berlin Questionnaire. Mild or severe RLS was detected in 24 patients (17.2%). There were no significant differences between focal or generalized epilepsy groups' scores. No statistically significant relationship was identified between SUDEP-7 scores and sleep quality or sleep-related disorders. Our results emphasized a remarkable magnitude of the comorbidity of sleep disorders in patients with epilepsy, even for those who do not have complaints about sleep. As SUDEP cases are frequently seen during sleep, it is important to evaluate sleep in patients with epilepsy.

Improvement of Subthalamic Nucleus Deep Brain Stimulation in Sleeping Symptoms in Parkinson's Disease: A Meta-Analysis.

Introduction The aim of this meta-analysis was to evaluate the effects of STN DBS on sleep quality and restless leg symptoms in individuals with PD. Methods We searched the PubMed, Web of Science, EMBASE, CNKI, and WANFANG databases published between 1990 and 2019. The articles included were those that contained both pre- and postsurgery data acquired using International RLS Study Group criteria and the Pittsburgh sleep quality index (PSQI) questionnaire with patients' follow-up of at least three months. All studies that met the quality requirements were included in a meta-analysis performed using STATA 12.0 software. Results Of 73 articles identified, 7 studies comprising 82 patients were qualified for the current meta-analysis. After adjusting for heterogeneity in study effect sizes, the random effects meta-analysis indicated that STN DBS improved sleep quality and restless leg symptoms significantly (SMD = −1.111, 95% CI: −1.918∼−0.304, P=0.007). Subgroup analysis showed that different sleep scoring criteria had different effects on the condition of sleeping after surgery. Conclusions STN DBS is a powerful method in the management of sleep quality and restless leg symptoms in PD patients, but its long-term effects with larger populations must be thoroughly assessed.

Moderate to severe but not mild RLS is associated with greater sleep-related sympathetic autonomic activation than healthy adults without RLS

IntroductionRestless legs syndrome (RLS) patients have been found to have high rates of transitory increases in the activity of the sympathetic autonomic nervous system with increases in heart rate and blood pressure. These were identified by evaluating heart rate or blood pressure changes independent of any leg movement analyses. There has been an implicit assumption this high rate of sympathetic activations is abnormal, but there has been no direct comparison for similar measures with a healthy population free of RLS. Thus, it is not known if during sleep the rates of sympathetic nervous system activation are greater for RLS than for a healthy population. The objectives of this study were to determine if: (1) RLS patients compared to healthy controls have a greater frequency of sympathetic nervous system activation (significant heart rate increases) with a higher percentage of leg movements associated with these activations; (2) the sympathetic activation frequency and its relation to leg movements correlate significantly with RLS severity in RLS patients; and (3) there is some minimum threshold for RLS severity defining an RLS population where most (eg 85%) have abnormally high rates of sympathetic activation. MethodsSleep data on 32 RLS patients and 21 matched healthy controls were obtained from a prior study. All leg movements during sleep (LMS) and periodic leg movements in sleep (PLMS) were identified following the new WASM criteria; LMS that were not PLMS were considered isolated leg movements in sleep (ILMS). All episodes with significant heart rate increases were identified following procedures established by Cassel et al., (2016, see further on for citation) ie a slope of linear regression ≥2.5 beats per minute over five consecutive heartbeats. Severity of RLS was evaluated using the International Restless Legs Study Group Scale (IRLS). ResultsRLS patients had significantly more heart rate increases than controls (67.88/hr vs. 9.87/hr). RLS patients had a significantly greater percentage of both LMS and PLMS occurring with heart rate increases than controls (44% vs. 30%; 48% vs. 18%, respectively). These measures correlated significantly with IRLS and also PLMS/hr. 85% of the RLS patients with IRLS scores >22 or PLMS >50/hr had rates of sympathetic activation that were >90th percentile for the healthy controls. ConclusionThis is the first paper documenting that RLS patients showed clearly increased sympathetic activation when identified independent of PLMS. This, however, occurs for more severe RLS and not milder RLS. It has been proposed that the abnormally high rate of sympathetic activation for RLS patients relates to development of adverse cardiovascular health consequences observed in some studies. Thus, these data may provide a basic standard for possible use in epidemiological studies to identify the level of RLS severity more likely to have adverse health consequences (eg, cardiovascular disease). Since two-thirds of RLS patients have mild to even intermittent disease, including all RLS is likely to miss the potential health consequences of RLS.

PREVALENCE OF RESTLESS LEGS SYNDROME IN CYSTIC FIBROSIS IN AN ACADEMIC ADULT CYSTIC FIBROSIS PROGRAM

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Restless Legs Syndrome (RLS) is a clinical syndrome that affects approximately 10% of the general population. It is more prevalent in patients with advanced age, renal failure, pregnancy, diabetes mellitus, medications, myopathy, neuropathy, rheumatoid arthritis, and iron deficiency anemia. Increased awareness of RLS in patients with these disorders has led to more timely treatment. However, the prevalence of RLS in patients with Cystic Fibrosis (CF) has not been fully investigated. The objective of the study was to determine the prevalence of RLS symptoms in patients with CF. We also evaluate the impact of this disorder on quality of life via RLS Quality of Life (QoL) survey and severity of symptoms via an International RLS Study Group (IRLS) Rating Scale. METHODS: This research project was done via prospective survey and chart review. Previously validated RLS survey tools were used to measure the presence of RLS. A one-page survey featuring the core symptoms of RLS was administered to 77 subjects with CF in an academic adult CF program. RLS herald symptoms as agreed upon by the IRLS were incorporated as 4 key questions addressing RLS. This survey was considered positive for RLS if 4 of 4 core symptoms were present and those patients were subsequently administered the IRLS Rating Scale and RLS QoL questionnaire. RESULTS: Results of our study show RLS symptoms prevalence of 27% in subjects with CF. Average calculated score on IRLS Rating Scale was 16, suggesting moderate severity. RLS QoL questionnaire, reveals that RLS affects concentration , social activity, sexual health and work productivity in this population. CONCLUSIONS: The association of RLS symptoms and CF has not been well defined. Our study suggests that RLS symptoms are prevalent in CF and affects their quality of life. The pathophysiology of this relationship has not been fully described, however it may involve iron deficiency anemia from chronic inflammation, hemoptysis, gastrointestinal blood loss or iron malabsorption. Additionally, colonization with Pseudomonas Aeruginosa can result in iron deficiency as it competes with its host for iron in creating its own biofilm. Furthermore, medication toxicity, renal failure and diabetes mellitus in this patient population can also be contributing factors. Further investigations are being done to better understand this association. CLINICAL IMPLICATIONS: CF patients, over time, may suffer from significant fatigue mainly because of their advancing lung disease. However, heightened awareness of other contributing factors such as RLS can aid in timely treatment and improving their overall quality of life. DISCLOSURES: No relevant relationships by Rose Franco, source=Web Response No relevant relationships by Jeanette Graf, source=Web Response No relevant relationships by Erin Hubertz, source=Web Response No relevant relationships by Dmitriy Kogan, source=Web Response No relevant relationships by Jatan Shah, source=Web Response

Restless legs syndrome - the under-recognised non-motor burden: a questionnaire-based cohort study

ABSTRACTObjectives: Non-motor symptoms (NMS) range from neuropsychiatric to pain and are an important but underexplored feature of restless legs syndrome (RLS). There are currently no tools available which enable the holistic assessment of NMS in RLS in clinical practice. The primary aim of this study was to systematically assess NMS prevalence and burden in patients with RLS using the NMS Questionnaire (NMSQuest) validated for Parkinson’s disease.Methods: Patients with idiopathic RLS according to the criteria of the international RLS study group (IRLSSG) were included. Patients underwent a physical examination and clinical interview as well as completed the NMS Questionnaire and the international restless legs syndrome study group (IRLSSG) rating scale.Results: Seventy-four patients with primary RLS were included (mean age 64.6 ± 14.4 years, 62.2% female, mean disease duration 23.5 ± 17.8 years, mean Levodopa equivalent daily dose 63.3 ± 67.4 mg). On average patients reported an IRLSSG rating scale score of 24.8 ± 8.2 (maximum 40) and NMSQuest score of 9.9 ± 5.0 (maximum 30). Patients reported a minimum of two NMS with the majority (39.2%) reporting a moderate NMS burden, followed by severe (28.4%) and very severe (17.6%) burden. The most frequent NMS were insomnia (89.2%) followed by nocturia (70.3%), feeling sad (59.5%), forgetfulness (54.1%), urgency (47.3%), feeling anxious (43.2%), unexplained pain (41.9%), difficulty concentrating (40.5%) and dizziness (40.5%). There were no significant differences in NMSQuest total scores according to disease duration and gender (p = 0.739, p = 0.849).Conclusion: In conclusion, this study is one of the first to address NMS in RLS systematically and the data underlines the need to holistically assess NMS in RLS in order to deliver true value-based healthcare for these patients.

Seasonality of restless legs syndrome: symptom variability in winter and summer times

IntroductionRestless legs syndrome (RLS) is a common sensorimotor neurological disorder, with symptoms that might cause sleep fragmentation leading to excessive daytime sleepiness. A seasonality of RLS symptoms has been suggested; however, to date, no study focused on this aspect. In order to detect a possible seasonality of RLS manifestations, we evaluated RLS symptom severity and excessive daytime sleepiness in winter and summer in RLS patients. MethodsRLS patients who performed two follow-up visits in summer and winter were included in this retrospective bicentric analysis. RLS severity, measured with the International RLS Study Group rating scale (IRLS), and daytime sleepiness, measured with the Epworth Sleepiness Scale (ESS), were recorded in both seasons in Innsbruck and Rome Sleep Medicine Centers. ResultsIn sum, 64 RLS patients were included. In the overall sample, IRLS in summer was higher than in winter (p = 0.008). After gender stratification, this held true only in men (p = 0.008). When stratifying for centers, the seasonal variation in RLS severity was present exclusively in Rome (p < 0.001). Moreover, 20 RLS patients completed ESS in both seasonal periods, and scores in summer were higher than in winter (p < 0.001). ConclusionThis retrospective observational study showed an increase of RLS severity during summer compared to winter, supporting the hypothesis that RLS symptoms are more troublesome when temperatures are higher. Changes in microvascular regulation, sweating, and serum iron level changes may support this difference in RLS symptoms across the year. The documented seasonal variation in RLS severity with worsening in the warmer months needs to be investigated further in prospective studies.

Restless arms syndrome: prevalence, impact, and management strategies.

This literature review focuses on restless arms syndrome (RAS), an upper limb variant of restless legs syndrome (RLS). RLS, also known as Willis-Ekbom disease, is a frequently occurring neurological disorder characterized by an irresistible urge to move the lower limbs often accompanied by unpleasant sensations in the legs, worsened at rest and in the evening, improved by movement. Extension of leg restlessness to the upper limbs is frequently reported in typical patients who had RLS only in the legs and usually occurs later in the course of RLS, restlessness remaining most invalidating in the lower limbs. In RAS, the arms are predominantly affected with little or no involvement of the legs. Cases of restless shoulders syndrome or periodic arm movements without arm restlessness were not considered. A total of 9 articles with 10 cases were included and analyzed for the adherence to the five essential diagnostic criteria of the International RLS Study Group (IRLSSG) classification, as well as for the additional supportive features. All of the reported cases were classified as having definite RAS. The clinical history and disease evolution of two previously reported patients were completed and updated. Overall, the clinical picture of RAS does not differ from that of RLS, except for the symptoms localization on the upper limbs. Underlying mechanisms of the spread of RLS to upper limb restlessness and of RAS remain unknown. Whether RAS is a phenotypic variant of RLS or a separate entity needs further investigations. RAS likely remains underdiagnosed and according to IRLSSG diagnostic criteria RAS should be considered when RLS-like symptoms are present in one or both arms, especially when they have a circadian pattern and are improved by movement and dopaminergic therapy. Clinicians should be aware of this rare condition, especially as treatment using dopaminergic agonists proves to be very efficient.

&lt;p&gt;Frequency of sleep disorders in patients with rheumatoid arthritis&lt;/p&gt;

Purpose: To determine the prevalence of common sleep problems among patients with rheumatoid arthritis (RA) and their relationship with the disease activity and quality of life.Patients and methods: The study sample consisted of 101 patients who attended a rheumatology clinic at a university hospital between October 2015 and May 2016. All subjects were clinically examined and interviewed by physicians using a questionnaire. The collected information included sociodemographic characteristics, the patients’ medical histories, the Disease Activity Score (DAS28), the Berlin questionnaire to assess the risk of obstructive sleep apnea (OSA), the Epworth Sleepiness Scale to assess excessive daytime sleepiness (EDS), the Athens Insomnia Scale to assess insomnia, the International RLS Study Group score to diagnose restless legs syndrome (RLS), and the Health Assessment Questionnaire (HAQ) to assess the quality of life.Results: The mean age of the participants was 48.7±14.6 years, and 95% of the participants were females. Approximately 60% of the participants were in the remission/low category of disease activity, and the average DAS28 score was 3.3±0.8 years. The prevalence rates of insomnia, EDS, sleep disturbance, risk of OSA, and RLS were 63%, 20%, 20%, 37%, and 63%, respectively. Furthermore, the distribution of sleep disorders was not affected by the disease activity. The association between the HAQ and sleep disorders among the RA patients was not significant.Conclusion: Sleep disorders are common among RA patients and may require further attention by treating clinicians; nevertheless, these disorders are not associated with disease activity and do not affect the quality of life.

Association between predialysis hypermagnesaemia and morbidity of uraemic restless legs syndrome in maintenance haemodialysis patients: a retrospective observational study in Zhejiang, China

ObjectiveThe aim of the present study was to determine whether the predialysis serum magnesium level was associated with morbidity of uraemic restless legs syndrome (RLS) in maintenance haemodialysis patients.DesignA retrospective...

Impact, Frequency, and Severity of Restless Legs Syndrome in Patients with Multiple Sclerosis in Argentina.

Restless legs syndrome (RLS) frequency, and its association with depression, anxiety, sleep disorders, and fatigue, has not been previously studied in Latin American patients with multiple sclerosis (MS). We aimed to assess RLS frequency in patients with MS living in Argentina and to examine potential associations with depression, anxiety, and sleep disorders. A cross-sectional study (n = 427) was conducted using a self-administered questionnaire, including International RLS Study Group criteria, to compare RLS frequency in patients with MS versus controls. The Hospital Anxiety and Depression Scale and the Fatigue Severity Scale were administered to all participants. Insomnia, excessive daytime somnolence, and other risk factors in patients with MS with RLS were analyzed using logistic regression. We included 189 patients with definite MS and 238 controls. The RLS frequency was 29.1% in patients with MS versus 13.0% in controls (odds ratio [OR] = 2.74, P = .00005). Moreover, clinically significant RLS (csRLS; ie, symptoms present ≥2 days per week) frequency was 19.4% in patients with MS versus 4.2% in controls (OR = 5.37, P < .00001). Longer MS duration and presence of anxiety, depression, insomnia, and smoking cigarettes were all significantly associated with RLS. Multivariate analysis showed that anxiety and fatigue were significantly associated with MS with RLS and MS with csRLS. Both RLS and csRLS showed strong association with MS, supporting the need to screen for anxiety/depression, sleep quality, and fatigue in this patient population. We believe that identifying the presence and severity of these conditions would contribute to better MS management and treatment.

Sleep Complaints and Sleep Quality in Spinal Cord Injury: A Web-Based Survey.

The purpose of this study was to determine sleep quality and presence of sleep disorders in participants with spinal cord injury (SCI). A web-based survey, available online from February 2011 to July 2013, using validated sleep questionnaires, advertised via the internet and locally through SCI consumer organizations in the United States, Australia, New Zealand, and Canada, was designed to evaluate sleep in adults with self-reported SCI. Demographic characteristics and medical history were obtained from participant self-report. In our study population, 70% of the 304 participants were male with a mean age of 45 ± 13 years. The mean duration of injury was 16 ± 12 years. Cervical injuries were reported by 49% and thoracic injuries noted in 40% of participants. Increased sleep apnea risk was noted in 31% of participants, with 66% reporting snoring. Insomnia symptoms were reported by 54% of the respondents. Almost 40% of participants ranked their sleep quality as "fairly bad" to "very bad" in the previous month, 29% reported "often" or "almost always" waking up because of pain, and 22% had difficulty falling asleep because of leg cramps. In the past year, 27% of the respondents reported daily uncomfortable leg sensations and 28% found these leg symptoms to be "moderately to extremely distressing." This study increases the awareness that insomnia, sleep apnea, and poor sleep quality are common in individuals with chronic SCI; often coexisting. There is a need for increased screening for sleep problems by healthcare providers taking care of individuals living with SCI.