Predictors Of Restless Legs Syndrome Research Articles

Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis.

Inflammatory and immune mechanisms are considered in restless legs syndrome (RLS) pathophysiology with several autoimmune diseases associated with RLS. There is a paucity of studies examining RLS prevalence in myasthenia gravis (MG), an autoimmune neuromuscular disease. This study investigated RLS prevalence and association with patient-reported measures in a large registry of participants with MG using a validated RLS diagnostic questionnaire. The Myasthenia Gravis Foundation of America MG Patient Registry is used on a semi-annual basis to survey participants with MG. Patients aged ≥18 years, living in the United States, and answering "Yes" to physician diagnosed MG were invited by email to enroll in an RLS-customized web-based survey. Collection of data included demographics, disease variables, patient-reported measures with a simple depression scale, MG 15-item Quality of Life (MG-QOL15r), MG-Activities of Daily Living (MG-ADL) instruments, and 13-item short-form Cambridge-Hopkins diagnostic questionnaire for RLS (CH-RLSq13). Multivariable logistic regression models explored the association between RLS and MG variables of interest. 630 eligible participants with MG (age: 62.8±13.2; 54.9% female; 91.6% White) completed the survey. The overall prevalence of RLS was 14.8%. The prevalence of clinically significant RLS was 8.4%. The odds of having RLS were increased with higher (worse) MG-ADL, MG-QOL15r, and depression scores. History of "Thymic tumor with thymectomy" and "CPAP therapy" were also independent predictors of RLS. RLS is common in patients with MG and is associated with worse functional status, quality of life, and depression. The thymus could play a key role in an autoimmune process associating MG with RLS.

Prevalence and Predictors of Restless Legs Syndrome in Patients Having Chronic Obstructive Pulmonary Diseases: A Systematic Review and Meta-analysis

Prevalence and Predictors of Restless Legs Syndrome in Patients Having Chronic Obstructive Pulmonary Diseases: A Systematic Review and Meta-analysis

The Prevalence and Predictors of Restless Legs Syndrome in Patients with Liver Cirrhosis.

Introduction and aim. Sleep disorders are highly prevalent in patients with liver cirrhosis. The aim of this study was to investigate the prevalence of restless legs syndrome (RLS), as well as its risk factors and possible predictors, in a cohort of patients with liver cirrhosis. Material and methods. We performed a cross-sectional prospective study over a period of 14 months and enrolled 69 patients with liver cirrhosis, after applying the inclusion and exclusion criteria. The cases of RLS were assessed according to the International Restless Legs Syndrome Study Group (IRLSSG) criteria and severity scale. Results. Out of the total number of patients, 55% fulfilled the criteria for RLS. Age, diabetes, severity of cirrhosis, serum creatinine, glomerular filtration rate (GFR), and mean hemoglobin were associated with the presence of RLS. Moreover, there was a significantly higher prevalence of RLS among patients with decompensated cirrhosis. From all the risk factors introduced into the multivariate analysis, only the GFR could predict the presence of RLS. Conclusions. This research shows that patients with liver cirrhosis have a high risk of RLS. Even though there are multiple risk factors associated with RLS, only the GFR could predict its occurrence in our cohort.

Phenotypical predictors of pregnancy-related restless legs syndrome and their association with basal ganglia and the limbic circuits

Restless legs syndrome (RLS) in pregnancy is a common disorder with a multifactorial etiology. A neurological and obstetrical cohort of 308 postpartum women was screened for RLS within 1 to 6 days of childbirth and 12 weeks postpartum. Of the 308 young mothers, 57 (prevalence rate 19%) were identified as having been affected by RLS symptoms in the recently completed pregnancy. Structural and functional MRI was obtained from 25 of these 57 participants. A multivariate two-window algorithm was employed to systematically chart the relationship between brain structures and phenotypical predictors of RLS. A decreased volume of the parietal, orbitofrontal and frontal areas shortly after delivery was found to be linked to persistent RLS symptoms up to 12 weeks postpartum, the symptoms' severity and intensity in the most recent pregnancy, and a history of RLS in previous pregnancies. The same negative relationship was observed between brain volume and not being married, not receiving any iron supplement and higher numbers of stressful life events. High cortisol levels, being married and receiving iron supplements, on the other hand, were found to be associated with increased volumes in the bilateral striatum. Investigating RLS symptoms in pregnancy within a brain-phenotype framework may help shed light on the heterogeneity of the condition.

The Assessment of Risk and Predictors of Sleep Disorders in Patients with Psoriasis-A Questionnaire-Based Cross-Sectional Analysis.

Psoriasis is a chronic, inflammatory skin disease affecting 2–4% of the general population. Accompanying subjective symptoms (pruritus or pain) may cause decreased life quality including sleep disorders (SD). Sixty psoriatic patients fulfilled the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), STOP BANG for the obstructive sleep apnea syndrome (OSAS) assessment, and Restless Legs Syndrome (RLS) Severity Scale. Patients’ laboratory and clinical data were also investigated. All data obtained were compared to 40 participants without dermatoses. Mean PSQI, risk of OSAS, and RLS severity of psoriatics were significantly higher than in controls (p < 0.0001, p < 0.05, p < 0.05 respectively). There was a positive correlation between the time of suffering from psoriasis and the risk of OSAS (R = 0.286, p < 0.05). We did not observe any significant relationship between PSQI, risk of OSAS, or RLS and psoriasis severity assessed with PASI (Psoriasis Area and Severity Index). We identified four possible predictors of RLS: glucose, CRP and total cholesterol concentrations, and PSQI. SD are significantly more frequent in psoriatics than in people without chronic dermatological diseases but surprisingly they are not correlated with psoriasis severity. SD decrease patients’ life quality and may result in serious consequences. Therefore, establishing recommendations concerning screening for SD and their predictors should be considered.

Prevalence and predictors of restless legs syndrome in non-pregnant Saudi women of childbearing age.

This study assessed the prevalence of restless legs syndrome (RLS) and its correlates and severity among non-pregnant Saudi women of childbearing age. Consecutive non-pregnant female visitors (age 15-44 years) of the primary care centers of the female University campus at King Saud University (n = 1,136) were interviewed face-to-face to determine the presence and severity of RLS using the International Restless Legs Syndrome (IRLS) Study Group criteria and IRLS severity scale. A total of 271 participants (24%) were diagnosed with RLS. Of these cases, severe/very severe RLS was diagnosed in 13% and mild/moderate in 87%. None of these participants had been diagnosed or treated for RLS before. Subjects with RLS were older, had a higher body mass index, and a higher prevalence of vitamin D deficiency and diabetes mellitus than those without RLS. Multivariate binary logistic regression analysis identified the following independent predictors of RLS: age (OR 1.03 [1.009-1.051], p = 0.004), vitamin D deficiency (OR 2.147 [1.612-2.86], p < 0.001), and diabetes mellitus (OR 4.408 [1.946-9.982], p < 0.001). Our results indicate that RLS is very common and underdiagnosed among non-pregnant Saudi women of a childbearing age-attending primary care cents. RLS was linked to age, vitamin D deficiency, and diabetes mellitus.

Sleep quality &amp; prevalence of restless legs syndrome among healthcare professionals

Aim: Healthcare professionals constitute a high-risk group for occupational stress as a consequence of difficult working conditions and therefore, they are prone to sleep disorders. The present study aimed to determine the prevalence of poor sleep quality and restless legs syndrome among healthcare professionals working daytime duty at a tertiary center, and to identify potential factors influencing sleep quality.Methods: A total of 150 participants including physicians, nurses and other health professionals were included in this questionnaire-based cross-sectional study. All participants completed a self-administered questionnaire comprised of the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI) and Restless Legs Syndrome (RLS) Study Group Diagnostic Criteria, as well as demographic characteristics. Results: Global PSQI score was 6.8 and the mean BDI score was 11.8. A PSQI score of >5, which indicates poor sleep quality, was noted in 69 participants (46%), while Restless legs syndrome was found in 31 (21%) and depression in 40 (26%) of the participants. Workplace violence, working at an intensive care unit, working in the operating room, and BDI scores were found to be factors that independently contributed to poor sleep quality. Furthermore, age, occupational experience, working at intensive care unit, work environment unrest and BDI scores were predictors of RLS. Conclusions: In a substantial proportion of healthcare professionals, sleep quality is somewhat impaired and RLS and depressive symptoms are also frequent in this population. Work environment unrest, working conditions and intensity of depressive symptoms are determinants of sleep disorders in healthcare professionals. Healthcare professionals should be regularly screened for the presence of sleep disorders to recognize and treat the underlying causative conditions.

Prevalence of restless legs syndrome among pregnant women: A case-control study.

BACKGROUND:This cross-sectional case–control study aimed to assess the prevalence of restless legs syndrome (RLS) and its correlates and severity among Arab (Saudi) pregnant women attending antenatal care clinics.METHODS:We interviewed 742 consecutive pregnant women attending antenatal clinics face-to-face using the International RLS Study Group (IRLSSG) criteria. We assessed the severity of RLS using the IRLSSG severity scale for RLS (IRLS). A similar number of age-matched nonpregnant women were enrolled in a control group.RESULTS:Among the cases, 104 (14%) were in the first trimester, 232 (31.3%) in the second trimester, and 406 (54.7%) in the third trimester. The RLS prevalence in cases and controls was 30% and 26.5%, respectively, (P = 0.134). Among cases, severe/very severe RLS was diagnosed in 25% and mild/moderate in 75%, compared with 15% of controls having severe/very severe RLS and 85% having mild/moderate RLS (P < 0.001). Multivariate binary logistic regression analysis identified the following parameters as independent predictors of RLS: parity (odds ratio [OR] 1.113 [confidence intervals [CI] 1.012–1.223], P = 0.027), anemia (OR 1.452 [1.033–2.042], P = 0.03), diabetes mellitus (OR 1.734 [CI 1.084–2.774], P = 0.022), Vitamin D deficiency (OR 2.376 [CI 1.488–3.794],P < 0.001), and smoking (OR 3.839 [CI 1.463–10.074], P = 0.006). None of the cases had been diagnosed or treated for RLS in the antenatal clinics.CONCLUSION:RLS is common, but underdiagnosed, among Saudi pregnant women and nonpregnant women of childbearing age. The study revealed that RLS during pregnancy is linked to parity, anemia, diabetes mellitus, Vitamin D deficiency, and smoking.

Restless legs syndrome in end stage renal disease patients undergoing hemodialysis

BackgroundThe prevalence of Restless legs syndrome (RLS) in End Stage Renal Disease (ESRD) patients is higher than that in the general population. However, the associations of RLS within the ESRD population are inconsistent and RLS is usually neglected in dialysis centers, although it impairs the life quality among ESRD patients. We aim to investigate the prevalence of RLS in patients with ESRD undergoing maintenance hemodialysis and evaluate the risk factors of developing RLS and the effect of RLS on quality of life among ESRD patients.MethodsESRD patients undergoing maintenance hemodialysis in Shanghai General Hospital dialysis unit from July 2016 to October 2016 were enrolled in the study. RLS was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG). IRLSSG Severity Scale was used to evaluate the severity of RLS. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and Hospital Anxiety and Depression Scale (HADS) was used to estimate anxiety and depression. Serologic and historic variables were analyzed to determine predictors of RLS in the ESRD population.ResultsA total of 137 ESRD patients were enrolled. The prevalence of RLS among the ESRD patients was 20.44%. The risk of RLS was increased significantly in females (OR = 2.729, p = 0.032) and daily alcohol drinkers (OR = 4.716, p = 0.022). RLS increased the risks of sleep disorders (25/28, 89.3% vs 73/109, 67.0%, p = 0.02) and sedative hypnotics intake (7/28, 25.0% vs 10/109, 9.2%, p = 0.047) and impaired the sleep quality (7/109 vs 11/28, p = 0.001) according to PSQI sum scores.ConclusionA high RLS prevalence among the ESRD patients undergoing hemodialysis was confirmed. ESRD patients who are women and drinking alcohol have a higher risk of RLS. The sleep quality was significantly impaired and sleeping medication use was more common among the ESRD patients with RLS.

Decline in dopamine agonists prescribing and characteristics of drugs prescribed during ambulatory office visits for restless legs syndrome: the National Ambulatory Medical Care Survey 2007–2015

ObjectiveTo examine prescribing of drugs treating or exacerbating restless legs syndrome (RLS) during U.S. physician office visits for RLS for the years 2007–2015; and to assess potential prescribing predictors of these drugs. MethodsUsing the National Ambulatory Medical Care Survey data, we conducted a retrospective cross-sectional study. We calculated weighted percentages of RLS-related office visits associated with RLS treatment drugs (alpha-2-delta ligands, dopamine agonists, and other drugs used for RLS) and exacerbating drugs. Using logistic regression, we examined the adjusted association between potential predictors and prescribing of major RLS treatment (dopamine agonists and alpha-2-delta ligands) and exacerbating drugs. ResultsA total of 456 RLS-related office visits were included for analysis, representing approximately 9.9 million visits. The weighted percentages of visits with dopamine agonists (excluding levodopa) decreased from 50% to 22% (RR 0.44; 95% CI 0.26, 0.77). A visit to a neurologist was associated with a 76% increase in prescribing of the major RLS treatment drugs compared with a visit to a family/general or internal medicine physician (RR 1.76; 95% CI 1.29, 2.42). RLS exacerbating drugs were listed in 28% (95% CI 21–36) of RLS-related visits, mostly for antidepressants (83%). Younger age groups (18–44 and 45–64) were predictors of RLS exacerbating drug prescribing, compared with the older age group (RR 2.46; RR 2.00, respectively). ConclusionPrescribing of dopamine agonists during RLS-related visits decreased during 2007–2015, but prescribing of RLS exacerbating drugs remained high. More investigation is necessary concerning whether clinicians assess the appropriateness of RLS exacerbating drugs for RLS patients before newly prescribing or continuing those drugs. Also, future research would need to investigate what factors contribute to the difference in the RLS treatment prescribing patterns between neurologists and family/general or internal medicine physicians.

Perceived sleep deficit is a strong predictor of RLS in multisite pain – A population based study in middle aged females

BackgroundChronic pain conditions as well as Restless Legs Syndrome (RLS) are known to be associated with subjectively and objectively disturbed sleep. RLS has been recently described as highly prevalent in multisite pain and the role of sleep as a modifying factor in this RLS phenotype is unknown. This study aimed to investigate if perceived sleep deficit and other sleep related parameters predict RLS in subjects with multisite pain. Current knowledge/study rationaleWe have recently demonstrated a strong association between Restless Legs Syndrome (RLS) and number of pain locations. In the current analysis we hypothesized that impaired sleep predicts RLS in subjects with multisite pain. MethodQuestionnaire-based data from 2727 randomly selected women aged 18–64 years were used to analyze RLS symptoms, self-reported sleep quality, and the degree of daytime sleepiness (Epworth Sleepiness Scale (ESS)) in relation to type, degree and localization of body pain. Potential confounders including anthropometrics, pain localization, co-morbidities, and medication were adjusted for in the Generalized Linear Models (GLM). ResultsPerceived sleep deficit ≥90min (OR 2.4 (1.5–3.8), p<0.001) and frequent nocturnal awakenings (OR 2.3 (1.4–3.6), p<0.001) were the strongest sleep related predictors for RLS in subjects with multisite pain. Additional factors include prolonged sleep latency (≥30min, OR 1.8 (1.1–2.8), p=0.01) and daytime symptoms like elevated daytime sleepiness (ESS score ≥9, OR 1.8 (1.2–2.7), p=0.005). Accordingly, RLS diagnosis was associated with impaired sleep quality (TST (Total Sleep Time) −8.2min, sleep latency +8.0min, and number of awakenings from sleep +0.4, p<0.01). ESS score increased with RLS diagnosis (+0.74, p<0.01) and number of pain locations (0.5, 1.7, and 1.8 for 1, 3, and 5 pain areas, p<0.001). In addition, confounders like pain severity, the history of psychiatric disease, and current smoking were associated with impaired sleep quality in this group of females. ConclusionsPerceived sleep deficit and sleep fragmentation are the strongest sleep related predictors of RLS in multisite pain. Potential implication of our results are that clinical management programmes of RLS in subjects with multisite pain need to consider both sleep quality and sleep quantity for individually tailored treatment regimes. Study impactRLS, pain, and sleep disorders are highly interrelated. Our study strongly suggests that clinical management of RLS in patients with multisite pain needs to consider sleep quality as an independent risk factor.

P203 Factors associated with restless legs syndrome in patients with ulcerative colitis: a study in a tertiary care center in Romania

Background: Ulcerative colitis (UC) is a lifelong systemic multifactorial disease with a negative impact on health-related quality of life (HRQoL). Restless Legs Syndrome (RLS) as an extraintestinal manifestation of UC is not very common. This association has been investigated in a small number of studies but results remain controversial. The primary aim of the current study was to investigate the prevalence and association between RLS and UC. Methods: 120 subjects (man/female: 67/53, age at diagnosis: 39.3 years, SD: 16.2) with biopsy confirmed UC and 120 age and gender matched controls were included in this prospective single-center study. All patients with diabetes, peripheral neuropathy, renal failure and those who underwent treatment with antipsychotic drugs and antidepressants that increase serotonin were excluded from the study. Basic demographic data, clinical information and laboratory findings were collected and comprehensively reviewed. All subjects were prospectively evaluated using the International Restless Legs Syndrome Study Group criteria (IRLSSG). The IRLSSG ten-item severity scale was also used. Gender, age at diagnosis, family history, occupation, smoking status, caffeine intake, BMI, iron, vitamine B12, folate and hemoglobin levels were analyzed as potential impact factors. Results: Based on our findings, the prevalence of RLS in UC patients is 24.1% compared with 5% in the control group (p=0.001). Symptom severity in the RLS group (according to the IRLSSG rating scale) was mild in 4 patients (13.7%), moderate in 10 patients (34.4%), severe in 13 patients (44.8%) and very severe in 2 patients (5.8%). In a multivariate analysis performed by binary logistic regression, elderly onset UC (age at diagnosis >60 years), BMI ≥30kg/m2 and caffeine intake were the strongest predictors of RLS in patients with UC. There was no significant correlation between RLS and occupation, iron, folate, hemoglobin and vitamin B12 levels. RLS was significantly correlated with sleep disorders (86.2%), fatigue (60.9%) and anxiety (31.03%) in patients with UC (p<0.001). Conclusions: Our study demonstrates that RLS is rather common in patients with UC. The results of our research are limited by the small number of patients enrolled in the study. Further investigations are needed to confirm RLS as an extraintestinal manifestation of UC.

Susceptible genes of restless legs syndrome in migraine.

Objective Several genetic variants have been found to increase the risk of restless legs syndrome (RLS). The aim of the present study was to determine if these genetic variants were also associated with the comorbidity of RLS and migraine in patients. Methods Thirteen single-nucleotide polymorphisms (SNPs) at six RLS risk loci ( MEIS1, BTBD9, MAP2K5, PTPRD, TOX3, and an intergenic region on chromosome 2p14) were genotyped in 211 migraine patients with RLS and 781 migraine patients without RLS. Association analyses were performed for the overall cohort, as well as for the subgroups of patients who experienced migraines with and without aura and episodic migraines (EMs) vs. chronic migraines (CMs). In order to verify which genetic markers were potentially related to the incidence of RLS in migraine patients, multivariate regression analyses were also performed. Results Among the six tested loci, only MEIS1 was significantly associated with RLS. The most significant SNP of MEIS1, rs2300478, increased the risk of RLS by 1.42-fold in the overall cohort ( p = 0.0047). In the subgroup analyses, MEIS1 augmented the risk of RLS only in the patients who experienced EMs (odds ratio (OR) = 1.99, p = 0.0004) and not those experiencing CMs. Multivariate regression analyses further showed that rs2300478 in MEIS1 (OR = 1.39, p = 0.018), a CM diagnosis (OR = 1.52, p = 0.022), and depression (OR = 1.86, p = 0.005) were independent predictors of RLS in migraine. Conclusions MEIS1 variants were associated with an increased risk of RLS in migraine patients. It is possible that an imbalance in iron homeostasis and the dopaminergic system may represent a link between RLS incidence and migraines.

Selective Serotonin Reuptake Inhibitor/Serotonin-Norepinephrine Reuptake Inhibitor Use as a Predictor of a Diagnosis of Restless Legs Syndrome.

Because restless legs syndrome (RLS) is a problematic syndrome, demonstrating an association between use of selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) and RLS may help direct patient care. The goals of this study were (1) to establish the incidence of RLS in mental health patients being treated with SSRIs or SNRIs in a local Veterans Affairs medical center and (2) to evaluate the frequency with which certain SSRIs or SNRIs are associated with RLS and the trend in frequency of the diagnosis since the revision of the criteria for RLS offered by the International Restless Leg Syndrome Study Group (IRLSSG), the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the International Classification of Sleep Disorders, Revised (ICSD-3). A retrospective chart review was used to evaluate the number of patients receiving SSRI/SNRI therapy with and without a diagnosis of RLS, with the date of the RLS diagnosis and initiation of SSRI/SNRI therapy noted. The frequency with which certain SSRIs/SNRIs were associated with RLS, and the frequency of RLS diagnoses since January 2012 were also noted. Descriptive statistics and logistic regression were used for data analysis. A total of 254 charts were reviewed. A majority of the patients (89.8%) were male, and 14 (5.5%) were diagnosed with RLS. A logistic regression equation approached significance in predicting RLS (P=0.053). Age and sex emerged as significant predictors of RLS. The prevalence of any individual SSRI or SNRI being associated with RLS was indeterminable. No difference was seen in the number of RLS diagnoses since the refining of the IRLSSG, DSM-5, and ICSD-3 criteria. The use of SSRIs/SNRIs does not seem to be associated with a diagnosis of RLS. In addition, the diagnosis of RLS does not seem to have become more common since the revision of the diagnostic criteria for the disorder.

Restless Legs Syndrome Following Lung Transplantation

Complications following lung transplantation are common and significantly reduce quality of life, and increase morbidity and mortality. Increasing evidence suggests sleep disorders are prevalent following lung transplantation, but factors associated with their development are not known. We sought to evaluate the prevalence of restless legs syndrome (RLS) in a lung transplant population and determine if a relationship exists between RLS and exposure to immunosuppressant medications. Subjects were recruited through the University of Wisconsin Hospital and Clinics Lung Transplant Clinic (N = 125). Participants (N = 81) completed sleep questionnaires, including the four RLS diagnostic criteria, insomnia severity index, and Sheehan disability scale. Cumulative tacrolimus exposure was determined in 62 subjects by calculating an area under the curve (AUC) to assess for a relationship with restless legs syndrome. Prevalence of RLS was 35 percent. Cumulative mean ± SEM tacrolimus exposure was similar in patients with RLS versus those without RLS (17446 ± 1855 ng days/mL vs. 15303 ± 1643 ng days/mL, respectively; p = 0.42). Insomnia severity index scores (12.5 ± 1.0 vs 6.8 ± 0.7, p < 0.0001) and Sheehan disability scores (7.8 ± 1.3 vs 3.6 ± 0.6, p = 0.003) were significantly higher in those with vs those without RLS symptoms, respectively. Our data confirms increased prevalence of RLS following lung transplantation reported by previous studies. RLS symptoms were not related to estimated tacrolimus exposure. Predictors of RLS following lung transplantation need to be further investigated to better identify and control RLS symptoms and reduce associated insomnia and disability.

Heredity of Restless Legs Syndrome in a Pregnant Population

To synthesize published research on genetic and heredity findings related to restless legs syndrome (RLS) in a pregnant population. PubMed, CINAHL, and PsycINFO databases and reference lists from published articles. Literature searches were conducted for primary research studies published in English on the genetic and heredity findings of RLS in pregnant populations. Study characteristics and findings related to genetic and heredity aspects of RLS in a pregnant population. Five data-based articles met the criteria for study inclusion. Study findings comprised Level-2 and Level-3 evidence. Four of the five studies were larger population studies and contained a subset of pregnant participants. Parity and family history were important predictors of RLS proband status. Probands reported symptoms were often initiated during or after pregnancy. Symptoms of RLS for female probands are often initiated during pregnancy or after childbirth. A history of RLS in a previous pregnancy and family history of RLS were strong predictors of RLS in the current pregnancy. Future research on genetic associations of RLS in pregnancy is warranted.

Ethnic Differences in the Prevalence and Predictors of Restless Legs Syndrome between Hispanics of Mexican Descent and Non-Hispanic Whites in San Diego County: A Population-Based Study

To investigate the prevalence and predictors of RLS in Hispanics of Mexican descent (HMD) and non-Hispanic whites (NHW). A population-based random digit dialing telephone questionnaire. San Diego County California 1,754 HMD and 1,913 NHW adults ≥ 18 years of age able to participate in a telephone interview in English or Spanish. None. RLS was defined by the presence of all 4 criteria of the International Restless Legs Study Group. Sleepiness was measured by the Epworth Sleepiness Scale. Acculturation was evaluated using the Short Acculturation Scale for Hispanics. Risk factors for RLS were by self-report. The survey was conducted in the subject's language of choice. RLS prevalence was significantly lower in HMD than in NHW (14.4% vs.18.3%, p = 0.002). High acculturation HMD had a significantly greater RLS prevalence than the low acculturation group (17.4% vs. 12.8%, p = 0.008). Predictors of RLS varied between HMD and NHW. Female gender (OR 1.40, 95% CI 1.04, 1.90, p = 0.027), smoking (OR 1.82, 95% CI 1.27, 2.61, p = 0.001), and acculturation (OR 1.47, 95% CI 1.10, 1.97, p = 0.009) were independent predictors of RLS in HMD, while only older age (OR 1.01, 95% CI 1.0, 1.02) was an independent predictor of RLS for NHW. The prevalence of RLS was significantly lower in HMD than in NHW, and significantly greater in high acculturation HMD. Our data suggest that risk factors for RLS vary by race/ethnicity and acculturation is an independent risk for RLS in HMD.

Restless legs syndrome in dialysis patients: a comparison between hemodialysis and continuous ambulatory peritoneal dialysis

Restless legs syndrome (RLS) is common in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). A few studies so far have investigated RLS prevalence in ESRD patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The aim of this study was to compare the prevalence, characteristics, consequences and predictors of RLS between HD and CAPD patients. We recruited 58 HD and 28 CAPD patients. A neurologist expert in sleep medicine performed RLS diagnosis during a face-to-face interview. The prevalence of RLS was slightly higher in HD than in CAPD patients (19 vs. 10.7%). RLS appeared after the onset of kidney complaint in HD patients; in contrast, in CAPD patients RLS preceded the occurrence of renal disease. Five HD patients reported that RLS symptoms occurred throughout the dialysis session. HD patients with RLS(+) had a higher mean number of HD sessions per week and a longer mean duration of HD session than the RLS(-) ones. Prevalence of females was significantly higher in CAPD patients with RLS(+) than in the RLS(-) ones. RLS frequently affects both HD and CAPD patients. RLS impaired sleep in both groups, but use of dopaminergic agents was uncommon in our sample. Dialysis schedule was associated with RLS in HD patients, while female sex was related to RLS in CAPD patients. Awareness concerning RLS identification and treatment in HD and CAPD patients is recommended.

Family recurrence and oligo-anuria predict uremic restless legs syndrome

To determine clinical and laboratory predictors of restless legs syndrome (RLS) in patients with end-stage kidney disease (ESKD) undergoing long-term hemodialysis (HD). One hundred and sixty-two consecutive patients were assessed. History of sleep disturbances, neurological examination, clinical, and laboratory data were collected. Patients with and without RLS were compared, and a logistic regression model described the relations between independent predictors and RLS. Fifty-one patients (32%) currently had RLS (RLS+). RLS+ vs RLS- patients were more frequently women (49% vs 29%, P = 0.012), had first-degree relative with RLS (22% vs 6%, P = 0.004), insomnia (59% vs 36%, P = 0.007), peripheral neuropathy (41% vs 21%, P = 0.006), and low residual diuresis (92% vs 68% with below 500 ml/24 h, P = 0.001). Low (OR = 8.71, CI = 2.27-33.41; P = 0.002) and absent (OR = 4.96, CI = 1.52-16.20; P = 0.008) residual diuresis, peripheral neuropathy (OR = 4.00, CI = 1.44-11.14; P = 0.008), and first-degree relative with RLS (OR = 3.82, CI = 1.21-12.13; P = 0.023) significantly predicted RLS in ESKD patients undergoing HD. Positive family history for RLS together with reduced/absent residual renal function and peripheral neuropathy predicts the risk for RLS in ESKD patients undergoing HD. Longitudinal studies are warranted to correlate RLS occurrence with genetic and environmental factors.

Iron status and chronic kidney disease predict restless legs syndrome in an older hospital population

Background Iron deficiency is important in the pathogenesis of restless legs syndrome (RLS), and serum ferritin measurement, using a cutoff of 45–50 ng/ml, is widely recommended as the optimal screening test for iron deficiency in RLS. Serum ferritin often increases with inflammation, and a higher cutoff may be better in those with acute and chronic inflammatory conditions, including those with chronic kidney disease (CKD). Methods The relationships between RLS and potential secondary causes were examined in hospital patients aged 50 years or more. Diagnosis of RLS was based on a clinician interview. Results Of 301 patients, 55 (18.3%) had RLS. Ferritin levels less than 40 ng/ml and between 40 and 69 ng/ml and Stage 4 CKD (estimated glomerular filtration rate [eGFR] between 15 and 29 ml/min and not on dialysis) were associated with significantly higher odds for RLS in univariate and multivariate analyses. Conclusion Iron deficiency and chronic kidney disease are the strongest predictors of RLS in older hospital patients. Ferritin less than 70 ng/ml is the best cutoff for identifying possible iron deficiency in RLS patients with inflammatory conditions. Independent of iron status, RLS is strongly associated with chronic kidney disease that is not severe enough to require dialysis, and the results of this study suggest that eGFR values and stages of CKD should be reported in future studies of RLS.