Restless Legs Syndrome Group Research Articles

Sarcopenia Seems to Be Common in Older Patients With Restless Legs Syndrome.

Restless legs syndrome (RLS) is a disorder characterized by nocturnally exacerbating pain that leads to significant sleep disturbances. The hormonal and metabolic changes caused by sleep disruption may increase the incidence of muscle-related diseases like sarcopenia in older adults, which is defined by a progressive loss of muscle strength and mass. This study aimed to investigate the relationship between RLS and sarcopenia, which may affect each other through common pathophysiological pathways in older adults. This was a cross-sectional study including 109 patients with RLS and 220 without RLS who applied to the geriatric clinic. RLS was assessed using the Turkish version of the International Restless Legs Syndrome Study Group (IRLSSG). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People-2 criteria. All the demographics, comorbid conditions, medications and findings of comprehensive geriatric assessments were recorded. The association between RLS and sarcopenia was examined by logistic regression. The mean age was 75 ± 7.4 and 73.8 ± 7 years for the RLS and the control groups, respectively (p > 0.05) and the ratio of females was higher in the RLS group (69.7% vs. 57.9%) (p = 0.035). The frequencies of coronary artery disease (CAD), hypertension (HT) and peripheral artery disease (PAD) were significantly higher in RLS patients (p = 0.020, p = 0.047, p = 0.010, respectively), while the prevalence of anaemia was 41% and 25-OH Vitamin D levels (25[OH]D) were higher than in the control group (p < 0.001). The frequency of probable sarcopenia and sarcopenia was higher in patients with RLS than in controls (20% vs. 11%, p = 0.037 and 8% vs. 2.3%, p = 0.047, respectively). A significant association between RLS and an increased likelihood of probable sarcopenia, sarcopenia and slow gait speed (odds ratio [OR]: 2.621, 95% confidence interval [CI] [1.265, 5.431]; OR: 4.542, 95% CI [1.284, 16.071]; OR: 2.663, 95% CI [1.432, 4.951], respectively) was found after adjusting for factors such as gender, HT, CAD, PAD, serum 25(OH)D levels, anaemia, chronic kidney disease (CKD) and nutritional status. However, the significance of low muscle mass disappeared (p > 0.05). This study demonstrated that sarcopenia is prevalent among older patients with RLS, which seems to be associated with low muscle strength and slow gait speed. Given the negative health outcomes related to sarcopenia, interventions aimed at preventing its development could be significantly beneficial for patients with RLS in older adults as well.

Investigating olfactory and gustatory dysfunction in patients with restless legs syndrome: A comparative analysis with healthy controls

Background/Aim: This study aims to examine the correlation between dopamine deficiency and olfactory dysfunction in patients with restless legs syndrome (RLS) and to juxtapose these findings with gustatory function. This comprehension of the relationship may illuminate the pathophysiology of RLS, suggesting possible therapeutic targets. Methods: We included a total of 100 male participants aged 40 and older, comprising 50 healthy volunteers and 50 patients with RLS. Participants were recruited from the Neurology Clinic at Sultan Abdulhamid Han Training and Research Hospital between September 2016 and April 2017. We objectively assessed olfactory function using the Sniffin’ Sticks Test Battery, while gustatory function was evaluated using the Taste Strip test—participants identified the flavors presented to them. Results: The mean age of the RLS patient group was 52.5 years, while it was 52.7 years for the healthy group. Olfactory test scores were significantly lower in the RLS group compared to the healthy group (P&lt;0.05). Likewise, gustatory test scores were also significantly lower in RLS patients (P=0.032). A strong positive correlation was observed between the olfactory and gustatory test results (r=+0.72), indicating a significant decline in both sensory functions in RLS patients. Conclusion: This study reveals a significant association between dopamine deficiency, olfactory dysfunction, and impaired taste perception in RLS patients. These findings suggest that RLS may involve underlying neurodegenerative processes affecting sensory perception. Further research is crucial to shed light on RLS mechanisms, which remain partially understood, and guide the development of targeted therapeutic strategies.

Clinical impact of restless legs syndrome in patients with migraine: a 12-year, single-center, longitudinal study

AbstractAlthough many studies have indicated a significant association between migraine and restless legs syndrome (RLS), few long-term longitudinal studies have examined RLS in patients with migraine. We conducted a single-center, 12-year, longitudinal study of migraine patients and assessed whether RLS was present in 2010, 2017, or 2022 to evaluate its associations with clinical factors. Headache-related disability was assessed using the Migraine Disability Assessment (MIDAS). Sleep quality, daytime sleepiness, and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Beck Depression Inventory-II (BDI-II), respectively. Of the 262 patients included at baseline (2010), 101 were available after 7 years (2017), and 74 were available after 12 years (2022). The RLS incidence rates were 13.7%, 20.8%, and 24.3% in 2010, 2017, and 2022, respectively. The RLS severity score did not significantly differ among the three time points. The persistent RLS group, defined as those who were positive for RLS at the last evaluation in addition to the first and/or second evaluations, had significantly higher MIDAS, BDI-II, PSQI and ESS scores than did the never RLS group, defined as those who did not exhibit RLS at any of the three time points. Our 12-year longitudinal study revealed significant impacts of RLS on the burden of patients with migraine.

Compromised Dynamic Cerebral Autoregulation in Patients with Restless Legs Syndrome.

Restless legs syndrome (RLS) is a prevalent sensorimotor nervous system disorder in patients accompanied with insomnia, blood pressure fluctuation, and sympathetic dysfunction. These symptoms may disrupt cerebral hemodynamics. Dynamic cerebral autoregulation (dCA) describes the temporary response of cerebrovascular system to abrupt fluctuations in blood pressure, which keep cerebral blood flow stable and serve as a marker of cerebrovascular system ability. This research aimed to assess dCA in RLS patients. In this study, RLS patients were recruited and subsequently classified into four groups (mild, moderate, severe, and very severe) based on the International RLS Rating Scale (IRLS). Healthy controls matched for age and sex were enrolled. All participants were evaluated dCA by assessing phase difference (PD). A portion of patients with RLS was reassessed for dCA after one month of medication therapy (pramipexole [0.125 mg/day] and gabapentin [300 mg/day]). There were altogether 120 patients with RLS and 30 controls completed the polysomnography and dCA assessment. PD was lower in the moderate, severe, and very severe RLS groups than that in the controls and mild RLS groups. Periodic limb movement index (PLMI), arousal index, and IRLS all showed a linear correlation with PD in RLS patients. Additionally, PD increased in RLS patients after therapy. The dCA was compromised in moderate, severe, and very severe RLS patients and was negatively correlated with the IRLS, arousal index, and PLMI. After 1 month of therapy, dCA improved in RLS patients.

A Comparative Investigation of Functional Connectivity Utilizing Electroencephalography in Insomnia Patients with and without Restless Leg Syndrome

The current study aimed to identify distinctive functional brain connectivity characteristics that differentiate patients with restless legs syndrome (RLS) from those with primary insomnia. Quantitative electroencephalography (QEEG) was employed to analyze connectivity matrices using the phaselocking value technique. A total of 107 patients with RLS (RLS group) and 17 patients with insomnia without RLS (primary insomnia group) were included in the study. Demographic variables were compared using t tests and chi-square tests, while differences in connectivity were examined through multiple analyses of covariance. Correlation analysis was conducted to explore the relationship between connectivity and the severity of RLS. The results indicated significant differences in the primary somatosensory cortex (F = 4.377, r = 0.039), primary visual cortex (F = 4.215, r = 0.042), and anterior prefrontal cortex (F = 5.439, r = 0.021) between the RLS and primary insomnia groups. Furthermore, the connectivity of the sensory cortex, including the primary somatosensory cortex (r = -0.247, p = 0.014), sensory association cortex (r = -0.238, p = 0.028), retrosplenial region (r = -0.302, p = 0.002), angular gyrus (r = -0.258, p = 0.008), supramarginal gyrus (r = -0.230, p = 0.020), primary visual cortex (r = -0.275, p = 0.005) and secondary visual cortex (r = -0.226, p = 0.025) exhibited an inverse association with RLS symptom severity. The prefrontal cortex, primary somatosensory cortex, and visual cortex showed potential as diagnostic biomarkers for distinguishing RLS from primary insomnia. These findings indicate that QEEG-based functional connectivity analysis shows promise as a valuable diagnostic tool for RLS and provides insights into its underlying mechanisms. Further research is needed to explore this aspect further.

Daytime impulsiveness, attention, and learning in the restless legs syndrome.

Restless legs syndrome (RLS) is a sensorimotor condition characterized by disturbing sensations and the desire to move, often localized in the legs. Cognitive changes and impulsivity can be present in RLS, although the potential effect of commonly co-occurring attention-deficit/hyperactivity disorders (ADHD) or dopamine agonist (DA) use on these are unclear. Twenty-three RLS patients and 22 healthy controls were included. Rey Auditory Verbal Learning Test (RAVLT), Continuous Performance Test (CPT), Beck Depression Inventory (BDI), Epworth Sleepiness Scale (ESS), State and Trait Anxiety Inventory (STAI), and Adult Attention Deficit Self-Evaluation Scale (ASRS) were administered. Performance was compared between RLS patients and controls accounting for the presence of attention-deficit/hyperactivity disorder (ADHD) and DA use. Age, education, BDI, ESS, STAI, and ASRS scores were similar for control and RLS groups. Control and RLS groups performed similarly on auditory verbal learning and general attention tests. In the CPT, commission error was significantly higher and response time was significantly shorter in the RLS group compared to controls (p = .014 and p = .010, respectively). These significant differences persisted after adjusting for ADHD and DA usage. In this study, RLS patients were more impulsive than the healthy individuals independent of ADHD and DA use. However, learning and attention performances of the patients are not affected.

Comparative assessment of choroidal thickness and choroidal vascularity index in patients with restless legs syndrome

BackgroundIncreased sympathetic activity has been emphasized in the pathophysiology of restless legs syndrome (RLS). This study aims to evaluate the choroidal thickness (CT) and choroidal vascularity index (CVI) values of individuals with RLS. MethodsA total of 60 volunteers, 30 individuals with RLS and 30 healthy individuals, were included in the study. The central macular thickness, subfoveal CT, and the CTs 1000 μm away from the fovea in the temporal and nasal regions were measured by optical coherence tomography. Total choroidal area (TCA), luminal area (LA) and stromal area (SA) were calculated using the binarization method. CVI was calculated as the ratio of lumen area to total choroidal area (LA/TCA). ResultsThere was no significant difference between the participants in terms of age, gender, spherical equivalent, intraocular pressure, and axial length (p>0.05). The mean LA/SA was 1.56%±0.05 in RLS group and 1.99%±0.28 in the control group. The mean CVI was 0.64%±0.02% in RLS group and 0.66%±0.03 in the control group. There was no significant difference between the groups in terms of CT, TCA and LA values. There were significant differences between the groups in SA, LA/SA and CVI values (p = 0.017, p<0.001, and p = 0.004, respectively). ConclusionSA values were significantly higher in RLS group than in control group. The LA/SA and CVI values were significantly lower in RLS group than in control group. These findings suggests that there is vascular narrowing due to sympathetic overactivity in RLS patients.

Elevated Cardiovascular Disease Risk in Patients with Restless Legs Syndrome.

There are studies in the literature that link restless legs syndrome with increasing cardiovascular disease risk. The reason for this was that increased sympathomimetic activation in restless legs syndrome causes tachycardia, hypertension, and autonomic instability. We intended to assess the cardiovascular disease risk in patients with restless legs syndrome using electrocardiogram parameters. The present investigation compared the demographic characteristics, electrocardiogram variables, and lab results of 40 patients diagnosed with restless legs syndrome with 43 healthy controls. Restless legs syndrome patients had a higher frontal QRS-T angle than healthy control patients. Restless legs syndrome patients had lower hemoglobin, neutrophil, lymphocyte, basophil, albumin, and high-density lipoprotein cholesterol levels. There was a significant increase in eosinophil, platelet, C-reactive protein, total cholesterol, low-density lipoprotein cholesterol, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and C-reactive protein-to-albumin ratio values in patients with restless legs syndrome. The frontal QRS-T angle is highly correlated with the neutrophil-to-lymphocyte ratio (P = .001). Similarly, monocyte-to-lymphocyte ratio and C-reactive protein-to-albumin ratio values were significantly correlated with frontal QRS-T (P = .011 and P = .24). The fact that frontal QRS-T angle and neutrophil-to-lymphocyte ratio were correlated in the restless legs syndrome group in our study suggests that the inflammatory process may have increased the risk of cardiovascular disease in restless legs syndrome patients. Our findings show that the frontal QRS-T angle is high in restless legs syndrome patients. We conclude that C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio are higher in the restless legs syndrome patient group and are related to cardiovascular disease risk.

The effects of restless legs syndrome on sleep and quality of life during pregnancy: a comparative descriptive study

Objective: The study aimed to identify the effects of restless legs syndrome (RLS) on sleep quality and quality of life in pregnant women.Methods: This comparative and descriptive study was conducted with 109 pregnant women between the 24 and 39 weeks of gestation. The presence and severity of RLS were investigated using the International Restless Legs Syndrome Study Group’s Diagnostic Criteria Scale and Severity Rating Scale, and the effects of the syndrome on sleep and quality of life were evaluated. Results: The prevalence of RLS in pregnant women was found to be 47.7%. In the RLS group, 22.0% of the pregnant women had severe RLS symptoms and 20.2% had moderate RLS symptoms. The mean score for Restless Legs Syndrome Severity Rating Scale was determined 20.75±6.38. The mean score for quality of life scale was determined 17.75±3.73 in RLS group and 26.46±2.67 in non-RLS group. Conclusion: The difference between the mean scores for Pittsburgh Sleep Quality Index of the pregnant women with RLS and those without the syndrome was found to be statistically significant. While the mean score for Quality of Life Scale in pregnant women with RLS was lower in general health, physical health and psychological health sub-dimensions, no statistically significant difference was found in social relations and environment sub-dimensions. It is recommended that nurses investigate RLS complaints of pregnant women and include non-pharmacological methods in their nursing practices.

Restless legs syndrome and cognitive function among adults: a systematic review and meta-analysis.

Changes in the cognitive function of patients with restless legs syndrome is a growing area of research. Although several studies have been performed to investigate the association between restless legs syndrome (RLS) and cognitive function, the outcomes are still controversial. The meta-analysis aimed to elucidate the relationship between RLS and cognition, including global cognition and various cognitive domains including memory, attention, executive function, and spatial cognition. We searched the MEDLINE, EMBASE, and Web of Science databases from inception to November 2022 to screen eligible records. The means and standard deviations of cognitive test scores were obtained to calculate the standard mean difference and 95% confidence intervals. A total of 1437 records were collected from the initial search and 16 records involving 4635 individuals were ultimately included in the systematic review and meta-analysis. Our data suggest negative associations between RLS and global cognition (SMD, -0.42; 95% CI -0.72 to -0.11; I2 = 76.6%) and attention (SMD, -0.43; 95% CI -0.73 to -0.12; I2 = 85.3%). No significant differences in memory (SMD, -0.01; 95% CI -0.31 to 0.28; I2 = 68.0%), executive function (SMD, -0.10; 95% CI, -0.30 to 0.11; I2 = 52.1%), or spatial cognition (SMD, -0.17; 95% CI -0.38 to 0.03; I2 = 58.5%) were observed between the RLS and control groups. Moreover, the strength of the results was modified by age but not by sex or region. Our findings suggest that RLS is negatively correlated with cognitive function, particularly global cognition and attention. However, the causal relationship, considering more confounders, is worthy of further exploration.

Optimal Contact Position of Subthalamic Nucleus Deep Brain Stimulation for Reducing Restless Legs Syndrome in Parkinson's Disease Patients: One-Year Follow-Up with 33 Patients.

Objectives: To determine the short- and medium-term therapeutic effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on restless legs syndrome (RLS) in patients with Parkinson's disease (PD) and to study the optimal position of activated contacts for RLS symptoms. Methods: We preoperatively and postoperatively assessed PD Patients with RLS undergoing STN-DBS. Additionally, we recorded the stimulation parameters that induced RLS or relieved RLS symptoms during a follow-up. Finally, we reconstructed the activated contacts' position that reduced or induced RLS symptoms. Results: 363 PD patients were enrolled. At the 1-year follow-up, we found that the IRLS sum significantly decreased in the RLS group (preoperative 18.758 ± 7.706, postoperative 8.121 ± 7.083, p &lt; 0.05). The results of the CGI score, MOS sleep, and RLS QLQ all showed that the STN-DBS improved RLS symptoms after one year. Furthermore, the activated contacts that relieved RLS were mainly located in the central sensorimotor region of the STN. Activated contacts in the inferior sensorimotor part of the STN or in the substantia nigra might have induced RLS symptoms. Conclusions: STN-DBS improved RLS in patients with PD in one year, which reduced their sleep disorders and increased their quality of life. Furthermore, the central sensorimotor region part of the STN is the optimal stimulation site.

Evaluation of Serum Selenium Level, Quality of Sleep, and Life in Pregnant Women With Restless Legs Syndrome.

Restless legs syndrome (RLS) is a multifactorial disease that patients describe as restlessness in their legs, which creates a desire to move their legs, especially in the evening and at rest. This study aims to investigate serum selenium levels in RLS and document the quality of sleep and life in pregnant women with RLS according to International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria. Thirty-eight moderate to severe RLS patients with pregnancy at 38-41weeks of gestation were determined as the case group, and 38 women with healthy gestational age-matched pregnancies were determined as the control group. Maternal serum selenium levels were compared between the RLS case group and the group of healthy pregnant women at the time of hospitalization for delivery. The Pittsburgh Sleep Quality Index (PSQI) and The Quality of Life Scale (SF-36) were applied to the patients. The mean selenium level (µg/L) was statistically significantly lower in the RLS group (53.24 ± 10.28), compared to the healthy pregnant population (58.95 ± 11.29) (P = 0.024). The PSQI score was significantly higher in the RLS case group (P = 0.033). Especially sleep efficiency (P = 0.018) and daytime dysfunction (P = 0.032) sub-parameters were affected. The SF-36 questionnaire was examined and a significant difference was detected between the two groups in role emotional (P = 0.026), social functioning (P = 0.023), and body pain (P = 0.044) sub-parameters. Serum selenium level was significantly lower, the sleep quality of the RLS group was impaired and their quality of life was affected in pregnant women with RLS. Further studies are needed to determine whether selenium replacement in pregnant women with RLS is feasible or not.

Restless legs syndrome in patients with chronic low back pain.

Based on studies showing that both chronic low back pain (LBP) and restless legs syndrome (RLS) have similar pathophysiological mechanisms, we aimed to investigate the prevalence of RLS in patients with chronic LBP and to define which demographic and clinical features are prominent in those with LBP accompanied by RLS. One hundred and two eligible, volunteer participants with chronic LBP were enrolled in this study. Visual analog scale (VAS), the Oswestry Disability Index (ODI), Pittsburgh Sleep Quality Index, Beck Depression Inventory, and Short Form-36 scales were applied to the patients. All patients were evaluated face-to-face for RLS using the International RLS study group diagnostic criteria. Most of our patients were women (52%). The mean age was 40.96±13.34years and the mean disease duration was 46.16±41.98months. RLS was detected in 36 (35.3%) of the patients with LBP. It was found that the female gender was more dominant in patients with RLS and the difference was statistically significant (p < 0.001). The amount of coffee intake was significantly higher in patients with RLS compared to those without RLS (p = 0.001). The disease duration for LBP was significantly higher in the patients with RLS (p = 0.003). VAS score, ODI score, PUKI score, and Beck depression score were significantly higher in the RLS group (p value were 0.048, 0.040, 0.007, and 0.043, respectively). In the evaluation of quality of life, all parameters except role emotional limitations and mental health were found to be significantly worse in the RLS group.

Possible association between vitamin B12 deficiency and restless legs syndrome

Restless Legs Syndrome (RLS) can be defined as a sleep disorder. However, whether changes in the serum vitamin B12 levels are involved in the pathophysiological mechanism of RLS remains unclear. Our study aimed to determine whether vitamin B12 levels are independently related to the occurrence of RLS. The serum vitamin B12 levels of 80 patients with RLS and 80 age- and gender-matched healthy controls (HC) were retrospectively analyzed. Serum vitamin B12 levels in the RLS group were significantly reduced, while the levels of creatinine, and homocysteine were higher (P<0.05). In addition, multivariate logistic regression revealed serum vitamin B12 to be independently associated with RLS (p<0.05; odds ratio=0.97; 95% confidence interval: 0.96-0.98). Pearson correlation analysis indicated that serum vitamin B12 level was negatively correlated with the International Restless Legs Scales (IRLS) score, and the 24-item Hamilton Depression Rating Scale (HAMD24) score (r=-0.025, P=0.023, r=-0.295, P=0.001). Patients with RLS had significant vitamin B12 deficiency compared to HC. Such deficiency significantly affects severity of symptoms and depression symptoms. In addition, decreased serum vitamin B12 levels are independently associated with the development of RLS, which illustrates the complex relationship between vitamin B12 and RLS. Prospective vitamin B12 treatment studies are needed to confirm this relationship and to evaluate the efficacy of vitamin B12 as a treatment for RLS patients.

Determination of optimal 25-hydroxyvitamin D cutoff values for the evaluation of restless legs syndrome among pregnant women.

Vitamin D deficiency is associated with restless legs syndrome (RLS). However, a cutoff value for serum 25-hydroxyvitamin D (25[OH]D) level associated with RLS has yet to be clearly determined. We evaluated the association between 25(OH)D and RLS in pregnant women. Data from 203 pregnant women were evaluated using blood samples taken in the third trimester. Liquid chromatography-tandem mass spectrometry and ligand binding assays were used to measure 25(OH)D. RLS was diagnosed based on International Classification of Sleep Disorders, third edition, criteria. The cutoff value for serum 25(OH)D associated with RLS was explored using receiver operating characteristic (ROC) curve and classification and regression tree (CART) analyses. The results of liquid chromatography-tandem mass spectrometry (x) and ligand binding assays (y) for serum 25(OH)D in the RLS (n = 35, 17.2%) and non-RLS (n = 168) groups showed a relationship of y = -2.65 + 0.08x . The RLS group showed lower serum 25(OH)D and folate levels. ROC curve and CART analyses revealed cutoff values of 10-12.7 ng/mL and 6.6-7.2 ng/mL for 25(OH)D and folate, respectively. Of the 5 women with RLS symptoms persisting at a moderate-to-severe level after delivery, 4 had 25(OH)D levels < 10 ng/mL and all had folate levels < 6 ng/mL. Vitamin D and folate deficiency were associated with RLS in pregnant women and may be associated with persistent moderate-to-severe postpartum RLS symptomatology; it is essential to examine associations with RLS while accounting for measurement methods and assay systems. Miyazaki A, Takahashi M, Shuo T, Eto H, Kondo H. Determination of optimal 25-hydroxyvitamin D cutoff values for the evaluation of restless legs syndrome among pregnant women. J Clin Sleep Med. 2023;19(1):73-83.

Perioperative outcomes of patients with restless legs syndrome: a single-center retrospective review.

There are multiple stressors in the perioperative period for patients with restless legs syndrome (RLS) that may be implicated in the worsening of symptoms. Our primary objective was to compare the perioperative course of patients with RLS to patients without the diagnosis. This was a single-center, matched-cohort, retrospective chart review of patients with RLS undergoing inpatient procedures from 2015-2019 matched 1:1 with patients without the diagnosis. Patients with RLS had a higher comorbidity burden; specifically, pulmonary, renal, diabetes mellitus, and congestive heart failure. The perioperative course was notable for higher maximum pain scores for patients with RLS in the postanesthesia care unit (odds ratio, 1.29; 95% confidence interval, 1.19-1.40; P < .001). Postoperative patients with RLS also had higher maximum pain scores on postoperative days 0, 1, and 2. The odds of rapid-response calls were higher in patients with RLS (odds ratio, 1.43; 95% confidence interval, 1.18-1.73; P < .001). There were no other significant differences in postoperative complications. The odds of using RLS-triggering medications were lower in the RLS group (odds ratio, 0.85; 95% confidence interval, 0.78-0.92; P < .001). Our single-center retrospective review found that patients with RLS had higher pain scores in the postanesthesia care unit and on the first few postoperative days. Rapid-response team calls were more common in patients with RLS. RLS-triggering medications were significantly less likely to be used in patients with RLS. There were no significant differences in other postoperative events. Gali B, Silber MH, Hanson AC, Portner E, Gay P. Perioperative outcomes of patients with restless legs syndrome: a single-center retrospective review. J Clin Sleep Med. 2022:18(7):1841-1846.

Restless Legs Syndrome Prevalence and Clinical Correlates Among Psychiatric Inpatients: A Multicenter Study.

BackgroundThere are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders. The present study aimed to evaluate the prevalence and clinical correlates in psychiatric inpatients in Germany and Switzerland.MethodsThis is a multicenter cross-sectional study of psychiatric inpatients with an age above 18 years that were diagnosed and evaluated face-to-face using the International RLS Study Group criteria (IRLSSG) and the International RLS severity scale (IRLS). In addition to sociodemographic and biometric data, sleep quality and mood were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). In addition to univariate statistics used to describe and statistically analyze differences in variables of interest between patients with and without RLS, a logistic model was employed to identify predictors for the occurrence of RLS.ResultsThe prevalence of RLS in a sample of 317 psychiatric inpatients was 16.4%, and 76.9% of these were diagnosed with RLS for the first time. RLS severity was moderate to severe (IRLS ± SD: 20.3 ± 8.4). The prevalences in women (p = 0.0036) and in first-degree relatives with RLS (p = 0.0108) as well as the body mass index (BMI, p = 0.0161) were significantly higher among patients with RLS, while alcohol consumption was significantly lower in the RLS group. With the exception of atypical antipsychotics, treatment with psychotropic drugs was not associated with RLS symptoms. Regarding subjective sleep quality and mood, scores of the PSQI (p = 0.0007), ISI (p = 0.0003), and ESS (p = 0.0005) were higher in patients with RLS, while PHQ-9 scores were not different. A logistic regression analysis identified gender (OR 2.67; 95% CI [1.25; 5.72]), first-degree relatives with RLS (OR 3.29; 95% CI [1.11; 9.73], ESS score (OR 1.09; 95% CI [1.01; 1.17]), and rare alcohol consumption (OR 0.45; 95% CI [0.22; 0.94] as predictors for RLS.ConclusionsClinically significant RLS had a high prevalence in psychiatric patients. RLS was associated with higher BMI, impaired sleep quality, and lower alcohol consumption. A systematic assessment of restless legs symptoms might contribute to improve the treatment of psychiatric patients.

Serum 25-Hydroxyvitamin D level in Restless Legs Syndrome: A controlled study

Objective: We aimed to investigate 25-hydroxyvitamin D (25-OHD) level on a group of restless legs syndrome (RLS) patients. Material and Methods: Twenty-one RLS patients and fourteen age and gender healthy controls (non RLS) with similar age and gender were included in the study. All patients underwent a physical examination for the neurologic and musculoskeletal system. The 25-OHD level was measured for all participants. Results: The 25-hydroxyvitamin D levels were higher in the RLS patient group (20.06±8.79 ng/ml) than in the healthy control group (14.75±4.67 ng/ml). In the healthy control group ‘’without the RLS syndrome’’, 25-hydroxyvitamin D levels were below the normal range (&lt;20 ng/ml). However, there were no statistical differences in terms of vitamin D level between the RLS and Control groups (p&gt;0.05). Conclusion: In this study, due to the absence of RLS syndrome in the control group despite low 25-hydroxyvitamin D levels (&lt;20 ng/ml), a relationship could not be established between 25-hydroxyvitamin D levels and RLS syndrome. The cause of RLS syndrome does not seem to depend on a single parameter such as 25-OHD level.

Large body movements on video polysomnography are associated with daytime dysfunction in children with restless sleep disorder.

Restless sleep disorder (RSD) is a newly defined sleep-related movement disorder characterized by large muscle movements (LMM) in sleep. We examined the sleep study, clinical characteristics, and daytime functioning in children with RSD and compared them to children with periodic limb movement disorder (PLMD) or restless legs syndrome (RLS). Video polysomnography from 47 children with restless sleep was retrospectively reviewed for LMM and age- and sex-matched to 34 children with PLMD and 12 children with RLS. Data examined included PSG characteristics, ferritin, Pediatric Quality of Life (PedsQL), and Epworth Sleepiness Scale (ESS). Fourteen children met the clinical criteria for RSD with an LMM index of 5 or more per hour of sleep. Mean ESS was elevated in patients with RSD compared to either the PLMD or RLS groups though the result did not reach statistical significance (RSD = 10.20 ± 6.81, PLMD = 6.19 ± 4.14, RLS = 6.25 ± 4.90). The PedsQL score was significantly decreased in the RLS group compared to RSD and was reduced overall in all three groups (PedsQL Total RSD = 70.76 ± 18.05, PLMD = 57.05 ± 20.33, RLS = 53.24 ± 16.97). Serum ferritin values were similar in all three groups (RSD = 26.89 ± 10.29, PLMD = 33.91 ± 20.31, RLS = 23.69 ± 12.94 ng/mL, p = ns). Children with RSD demonstrate increased daytime sleepiness compared to PLMD or RLS and all three disease groups showed decreased quality of life. Further studies are needed to examine long-term consequences of RSD.

The Effect of Motor Imagery on the Excitability of Spinal Segmentary Reflexes in Restless Legs Syndrome Patients

Context: Restless legs syndrome (RLS) is a neurological sleep disorder which causes an overwhelming urge to move the legs. However, this spinal excitability can be decreased through the use some motor movements such as walking or stretching. Aims: This study aimed to investigate the effect of motor imagery (MI) on spinal excitability in relation to the H reflex (HR). Settings and Design: In this study, 11 patients diagnosed with RLS (3 males and 8 females, mean age: 41.2) and 14 controls (8 males and 7 females, mean age: 38.4) were tested. HR was studied while participants in the supine position were imagining walking and also while imagining both dorsiflexion (DF) and plantar flexion (PF). Results: There was significant decrease in the Hmax/Mmax at 90° DF in both groups (p = 0.002, p = 0.001). There was no significant decrease in the RLS group on imagery; however, there was a significant decrease in the control group with movement imagination compared to the resting state (p = 0.021). There was no significant increase in Hmax/Mmax at 135° PF in both groups on movement and imagery. There was a decrease in the ratio on the imagery of walking in the RLS group (p = 0.038), but the same ratio increased in the control group (p = 0.010). Conclusion: As motor movements decrease corticospinal excitability in RLS, the imagery of movement mimicking the actmovement can relieve the symptoms of RLS. As a conclusion, further electrophysiological studies can be useful to gauge the effects of MI on spinal excitability in RLS.