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PubMed2001

Dream recall frequency and sleep quality of patients with restless legs syndrome.

The present study investigated the dream recall frequency and the pattern of influencing factors of patients with restless legs syndrome in comparison with healthy controls. The patients' dream recall frequency did not differ from that of healthy controls. Dream recall, however, was negatively associated with the number of periodic leg movements with arousal (PLMAI). Subjective estimates of sleep quality or feeling of being refreshed in the morning, on the other hand, did not correlate with the PLMAI index. Whereas subjective sleep parameters were related to dream recall frequency in healthy controls, no substantial relationships were found in the patient group, except for the positive correlation between sleep latency and dream recall frequency. The results of the present study can not be interpreted as clear evidence for the arousal-retrieval model of dream recall; it seems plausible that other factors, e.g. the functional state of the brain, are of importance in explaining dream recall in this patient group.

Adult↗

PubMed2005

Clinically significant but unsuspected restless legs syndrome in patients with sleep apnea.

In this prospective study, the prevalence of clinically significant restless legs syndrome (RLS) with symptoms at least 2 to 3 days per week was 8.3% in 60 sequentially polysomnographically studied patients with clinically significant sleep apnea (Apnea Index score > 5 or Respiratory Disturbance Index score > 10). Age-matched spouses were used as a control group and showed a comparable prevalence of RLS at 2.5% (not significant). Although RLS appears to be only slightly more common in sleep apnea patients than in controls, the importance of this study lies in the fact that clinically significant RLS occurred in 1 of every 12 patients with sleep apnea and, in every case, the RLS was unsuspected before polysomnography. We recommend that all patients undergoing polysomnography to rule out sleep apnea be screened for the symptoms of RLS. We have found the MEMO-NIH consensus conference questionnaire administered at the time of polysomnography to be useful in this regard.

Adult↗

PubMed2005

Restless legs syndrome, periodic limb movements in sleep, and depression.

STUDY OBJECTIVES: To review the literature on restless legs syndrome (RLS), periodic limb movements in sleep, and depression. DESIGN: Literature review. SETTING, PARTICIPANTS, AND INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We conducted a comprehensive review of the literature searching for publications that included data on depression or antidepressants and RLS or periodic limb movements in sleep. Sixty-two relevant literature references were found and reviewed. Four population-based studies and 9 clinical studies reported significantly higher rates of depression symptoms in individuals with RLS than in controls. Conversely, the prevalence of RLS in patients presenting with depression was reported as elevated in 2 studies. Conflicting data were found regarding the effect of antidepressants on the sensory symptoms of RLS. In contrast, several studies have found that selective serotonin reuptake inhibitor antidepressant use is associated with increased periodic limb movements in sleep. CONCLUSIONS: Depression symptoms are common in adults with RLS. However, the relationship appears complex, with overlap between RLS- and depression-related symptoms confounding the issue. Given what is known at this time, we propose a specific treatment approach to patients with RLS and depression symptoms.

Depression↗

PubMed2004

Sleep assessment in a population-based study of chronic fatigue syndrome.

BACKGROUND: Chronic fatigue syndrome (CFS) is a disabling condition that affects approximately 800,000 adult Americans. The pathophysiology remains unknown and there are no diagnostic markers or characteristic physical signs or laboratory abnormalities. Most CFS patients complain of unrefreshing sleep and many of the postulated etiologies of CFS affect sleep. Conversely, many sleep disorders present similarly to CFS. Few studies characterizing sleep in unselected CFS subjects have been published and none have been performed in cases identified from population-based studies. METHODS: The study included 339 subjects (mean age 45.8 years, 77% female, 94.1% white) identified through telephone screen in a previously described population-based study of CFS in Wichita, Kansas. They completed questionnaires to assess fatigue and wellness and 2 self-administered sleep questionnaires. Scores for five of the six sleep factors (insomnia/hypersomnia, non-restorative sleep, excessive daytime somnolence, sleep apnea, and restlessness) in the Centre for Sleep and Chronobiology's Sleep Assessment Questionnaire (SAQ) were dichotomized based on threshold. The Epworth Sleepiness Scale score was used as a continuous variable. RESULTS: 81.4% of subjects had an abnormality in at least one SAQ sleep factor. Subjects with sleep factor abnormalities had significantly lower wellness scores but statistically unchanged fatigue severity scores compared to those without SAQ abnormality. CFS subjects had significantly increased risk of abnormal scores in the non-restorative (adjusted odds ratio [OR] = 28.1; 95% confidence interval [CI]= 7.4-107.0) and restlessness (OR = 16.0; 95% CI = 4.2-61.6) SAQ factors compared to non-fatigued, but not for factors of sleep apnea or excessive daytime somnolence. This is consistent with studies finding that, while fatigued, CFS subjects are not sleepy. A strong correlation (0.78) of Epworth score was found only for the excessive daytime somnolence factor. CONCLUSIONS: SAQ factors describe sleep abnormalities associated with CFS and provide more information than the Epworth score. Validation of these promising results will require formal polysomnographic sleep studies.

Adult↗

PubMed1998

Immobilization tests and periodic leg movements in sleep for the diagnosis of restless leg syndrome.

Patients with restless leg syndrome (RLS) complain of motor restlessness, usually occurring while they rest in the evening. Two immobilization tests have been described to assess leg restlessness in these patients. In the first test, the patient sits in bed with his or her legs outstretched while electromyograms are recorded from right and left anterior tibialis muscles for an hour (Suggested Immobilization Test [SIT]); in the second test, the legs are immobilized in a stretcher (Forced Immobilization Test [FIT]). In the current study, the SIT and the FIT were compared in patients with RLS and normal control subjects matched for age and sex. More leg movements were seen in patients than in controls during immobilization tests, especially the SIT. These movements were periodic, occurring at a frequency of approximately one every 12 seconds. The SIT (index > 40) was found to discriminate between RLS and control subjects better than the FIT (index > 25). Patients were also recorded during two consecutive nights to measure periodic leg movements in sleep (PLMS). A SIT index greater than 40 and a PLMS index greater than 11 (highest PLMS index of 2 consecutive nights) were found to discriminate patients with RLS from control subjects with similar power. With each of these two measures, the clinical diagnosis was correctly predicted in 81% of patients and 81% of the control subjects. The SIT has several advantages over the measure of the PLMS index; it does not require an all-night polygraphic recording and can be administered several times a day to measure circadian fluctuation of motor restlessness.

Adult↗

PubMed1989

24 hour polysomnographic evaluation in a patient with sleeping sickness.

A 24 h polysomnographic recording was performed in a patient with sleeping sickness presenting an atypical neurological syndrome. Trypanosoma gambiense was found in a lymph gland puncture and the CSF, and a serologic immunofluorescence test was positive. The scoring technique of the polygraphic traces had to be adapted because of the presence of a permanent EEG delta wave activity during the NREM sleep stages, and the method used by Schwartz and Escande (1970) was applied. REM sleep and wakefulness presented normal polygraphic characteristics. The patient had 8 sleep episodes throughout the recording period, occurring during the daytime and at night, forming the classical diurnal sleepiness and nocturnal restlessness of sleeping sickness. All but one episode represented 1-3 complete REM-NREM sleep cycles. On all occasions, REM latency was short and 2 SOREM episodes were observed. The nychthemeral organization of the stages of vigilance differed from one state to another. Wakefulness and REM sleep had a circadian rhythmicity, while NREM sleep, total sleep time and deep sleep (corresponding to stages 3 and 4) had an ultradian periodicity. The concordance between the higher pressure for wakefulness and lower pressure for sleep around 20.00 h defined the time of occurrence of a 'forbidden zone' for sleep.

Animals↗

PubMed1986

Dominantly inherited restless legs with myoclonus and periodic movements of sleep: a syndrome related to the endogenous opiates?

The restless legs syndrome is a sensory and motor disorder of evening, repose, and sleep. The cardinal features include (a) restlessness, which is frequently associated with (b) dysesthesias, (c) myoclonic jerks and other dyskinesias while awake, (d) periodic movements of sleep, and (e) sleep disturbances. We have recently had the opportunity to study two patients severely affected by this syndrome whose family histories are consistent with dominant inheritance. Both patients serendipitously discovered that their symptoms responded uniquely well to opiate medication. Both patients were studied extensively with electrophysiological and videotape monitoring, and their movements were characterized. In both patients, all elements of the syndrome responded to opiates, with marked relief of symptoms and without any significant side effects. The specific opiate antagonist naloxone blocked the therapeutic benefit of the opiates. Our findings support the involvement of the endogenous opiate system in the pathogenesis of restless legs and related dyskinesias and suggest that opiate therapy may be a potentially valuable treatment for this sometimes disabling syndrome.

Aged↗

PubMed2004

Normal striatal D2 receptor binding in idiopathic restless legs syndrome with periodic leg movements in sleep.

Dopaminergic treatment is very effective in restless legs syndrome (RLS) and periodic leg movements in sleep (PLMS). However, neuroreceptor imaging studies that addressed altered striatal dopaminergic function have given controversial results. In this present study, 14 patients with idiopathic RLS (iRLS) and PLMS with a good response to dopaminergic and non-dopaminergic treatment and ten healthy sex- and age-matched controls were investigated off-medication by using 123I-IBZM and SPECT. RLS symptoms and sleep disturbances were evaluated using three nights of polysomnography, the Pittsburgh Sleep Quality Index, and the International RLS Study Group (IRLSSG) rating scale. The patients presented with sleep disturbances, a high PLMS index (56.2 +/- 33.1 per h), and severe RLS symptoms during SPECT (IRLSSG rating scale 23.1 +/- 8.0), and showed no significant differences in striatal to frontal IBZM binding to D2 receptors compared to controls (ratio striatum/frontal cortex, right side 1.60 +/- 0.10 vs 1.63 +/- 0.08, P = 0.35, NS; left side 1.61 +/- 0.11 vs 1.63 +/- 0.08, P = 0.51, NS). These findings show normal function of striatal D2 receptors in successfully treated patients with iRLS and PLMS. Dopaminergic and non-dopaminergic pretreatment does not appear to change striatal D2 receptor binding as compared to healthy controls. Structures other than striatal D2 receptors are discussed as possible causes of the treatment effects in RLS.

Adult↗

PubMed2005

Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy.

BACKGROUND: Many patients with end stage renal disease (ESRD) undergoing dialysis therapy suffer from sleep disturbances. The aim of this study was to investigate the prevalence of sleep disorders in a large population of uraemic patients recruited from 20 different dialytic centres in Triveneto. METHODS: 883 patients on maintenance dialysis were enrolled in the study. Demographic, lifestyle, renal and dialysis data were recorded. Renal parameters were compared with the database of the Veneto Dialysis Register. Using a self-administered questionnaire we assessed the presence of the following sleep disorders: insomnia, restless leg syndrome (RLS), obstructive sleep apnoea syndrome (OSAS), excessive daytime sleepiness (EDS), possible narcolepsy, sleepwalking, nightmares and possible rapid eye movement behaviour disorders (RBD). Moreover, in order to determine the prevalence of sleep disturbances and the possible effect of demographic or clinical data on sleep, we divided our population into two groups: with (SLEEP+) and without (SLEEP-) sleep disorders. RESULTS: The questionnaire revealed the presence of insomnia (69.1%), RLS (18.4%), OSAS (23.6%), EDS (11.8%), possible narcolepsy (1.4%), sleepwalking (2.1%), nightmares (13.3%) and possible RBD (2.3%). Eighty percent demonstrated SLEEP+, having at least one sleep disorder. Independent risk factors for sleep disorders were advanced age (P<0.001), excessive alcohol intake (P<0.04), cigarette smoking (P<0.006), polyneuropathy (P<0.05) and dialysis shift in the morning (P<0.001). CONCLUSIONS: The questionnaire showed a high presence of sleep disruption in dialytic populations. Awareness by Italian nephrologists regarding sleep disruption seems to be insufficient. Our data might help nephrologists to deal with uraemic patients with possible sleep disorders. Concerning the high prevalence of possible narcolepsy, further studies using polysomnographic records are necessary to confirm our results.

Adolescent↗

PubMed2000

Importance of sleep restoration in co-morbid disease: effect of anticonvulsants.

Over the past two to three decades, sleep medicine has emerged as an important discipline as it strives to meet the challenges of some of the most prevalent disorders among humans. Among the 110 disorders listed in the International Classification of Sleep Disorders, two of the most prevalent and treatable have only recently begun to receive significant attention: sleep apnea and restless legs syndrome with sleep-related periodic limb movements disorder. It is becoming clear that the sleep disruption caused by such disorders has ramifications beyond the usually associated daytime sleepiness, and may include: exacerbation of seizures, headaches, short-term memory deficits, and other cognitive problems. Sleep apnea has also been correlated with hypertension and cardiovascular/cerebrovascular disease. Animal studies have taken this one step further by demonstrating that total sleep deprivation is consistently fatal, usually within 1 month, although the precise mechanism remains to be discovered. The most compelling finding in the animal studies is that "rescuing" the animals with sleep, before the irreversible stage, is associated with rebound amounts of deep sleep and rapid eye movement (REM) sleep ("dream sleep"). This same response is seen after initiating treatment of sleep apnea with nasal continuous positive airway pressure (CPAP), and can also occur in patients with other sleep disorders in response to particular medications, such as valproate or gabapentin.

Anticonvulsants↗

PubMed2003

Arm restlessness as the initial symptom in restless legs syndrome.

BACKGROUND: Upper extremity symptoms can develop in restless legs syndrome, but are rarely the initial symptom. OBJECTIVES: To report a case of restless legs syndrome with restless arms as the initial symptom, and to review the literature. DESIGN: Case report and literature review. PATIENT: A 78-year-old man had arm restlessness and sleep disturbance. A polysomnogram demonstrated subclinical periodic leg movements 1 year after the onset of his symptoms. RESULTS: Two years later, he developed lower extremity symptoms that fit the criteria for restless legs syndrome. To our knowledge, this is the first case of restless legs syndrome with arm restlessness as the initial symptom in an otherwise neurologically normal person. CONCLUSION: Restless legs syndrome may initially exhibit upper extremity symptoms.

Aged↗

PubMed2006

Sudden onset of sleep and dopaminergic therapy in patients with restless legs syndrome.

BACKGROUND AND PURPOSE: Sudden onset of sleep (SOS) was recently reported in patients with Parkinson's disease (PD) under dopaminergic treatment. Here, we investigated as to what extent SOS is found in patients with restless legs syndrome (RLS), who are frequently treated with dopaminergic drugs, and controls. PATIENTS AND METHODS: A questionnaire survey on SOS was administered to 156 RLS patients and 126 controls. RESULTS: While no significant difference between RLS patients and controls was detected in Epworth sleepiness scale (ESS) scores (P=0.76), the prevalence of SOS was higher in RLS patients (32.7%) than in controls (19.8%) (P=0.02). Significant predictors of SOS in RLS were ESS score (odds ratio (OR) 16.4), male sex (OR 4.6), duration of night-time sleep (OR 3.0), and age (OR 2.9), while no association was observed for duration or severity of the disease. Patients on dopaminergic therapy usually featured a lower risk of SOS than untreated patients. Falling asleep while driving was reported by 14.6% of all RLS patients with a driver's license and associated with increased risk of accident (OR 7.1). CONCLUSIONS: RLS patients who are untreated, male, and elderly should be assessed for the presence of SOS. In contrast to PD, dopaminergic drugs may reduce the risk of SOS in RLS. The possible benefit of the drugs should be investigated particularly in male patients.

Accidents, Traffic↗

PubMed1986

Restless legs syndrome and periodic movements in sleep: physiopathology and treatment with L-dopa.

Seven patients suffering from restless legs syndrome (RLS) and periodic movements in sleep (PMS) were investigated before and after treatment with L-Dopa. The effect of treatment was evaluated by polysomnography, structured interviews, and daily questionnaires. Sleep organization and subjective complaints improved during treatment with 100 to 200 mg of L-Dopa. Polysomnographic recordings also revealed a significant decrease of periodic leg movements during the first third of the night and a rebound during the last third. These results and previous biochemical findings raise the hypothesis that RLS and PMS may both result from reduced dopaminergic activity in the CNS, perhaps resulting from decreased sensibility of postsynaptic receptors.

Adult↗

PubMed1993

Dopaminergic agents in restless legs syndrome and periodic limb movements of sleep: response and complications of extended treatment in 49 cases.

Restless legs syndrome (RLS) is a common neurosensorimotor disorder that presents with paresthesias, sleep disturbances and, in most cases, periodic limb movements of sleep (PLMS). Although many treatments have been described, interest has recently been focused on dopaminergic mechanisms of etiology and treatment. The dopamine agonists L-dopa/carbidopa, bromocriptine mesylate or both were initiated in 49 patients with RLS/PLMS who sought consultation at a sleep disorders center. This retrospective study describes the symptoms, time course of response and complications in 36 men and 13 women with a mean age of 53.9 years. Only 47 of the patients were available for extended follow-up. The most common presenting complaints were the sensation of restless legs and sleep maintenance insomnia lasting over 20 years. In the extended follow-up group of 47, four failed to respond to L-dopa or bromocriptine, five discontinued treatment because of side effects and two reported loss of therapeutic effect within the first month. Between month one and six, only three additional subjects discontinued treatment. At a mean follow-up of 283 days (SD 316), 33 patients continued on L-dopa/carbidopa at a mean bedtime dose of 160 mg L-dopa (SD 300). Treatment-emergent morning leg restlessness developed in eight patients, seven of whom required daytime medication for relief. Other side effects, generally nausea, occurred in only eight of 43 patients. Psychiatric side effects of dyskinesia were not seen. The > 70% long-term response is comparable to other studies in the literature.

Adult↗

PubMed1991

The action of clenbuterol on sleep and symptomatology in depressives.

Five female inpatients with major depression (melancholic type, DMS-III-R) were treated with the beta-adrenergic agonist clenbuterol for three weeks, with doses ranging from 100 micrograms to 150 micrograms. Remission of depressive symptomatology during treatment was observed in only one patient. All patients complained of side effects, especially tremor, agitation and restlessness. The sleep EEG showed no consistent effects on sleep parameters, including REM latency and percentage of REM sleep. Thus, the impact of clenbuterol on sleep clearly differs from that of most classical antidepressants. Regarding the lack of therapeutic efficacy, the data are compatible with the hypothesis of a relationship between REM sleep suppression and an antidepressant drug effect. Despite the small sample size, it can be concluded that clenbuterol is not likely to be a promising alternative to proven antidepressants in the treatment of major depression.

Adult↗

PubMed2005

Dopamine agonists for the treatment of restless legs syndrome.

The restless legs syndrome is a neurological disorder characterised by the urge to move the extremities associated with paraesthesias, which are partially or totally relieved by movement, a worsening of symptoms at rest and in the evening or at night and, as a consequence, sleep disturbances. Restless legs syndrome is common and affects 1-10% of the population. The aetiology of restless legs syndrome is unknown, but, beside genetic factors, the dopaminergic system may play a crucial role. Current treatment strategies are not curative, but may nevertheless produce an effective and lasting relief of symptoms. Evidence-based and clinical guidelines identify dopamine agonists as a first-line treatment for daily restless legs symptoms, and such substances are in the process of registration for this indication. In May 2005, the first dopamine agonist, ropinirole, was approved by the FDA. This review discusses treatment studies of dopamine agonists in patients with restless legs syndrome and focuses on long-term treatment with dopamine agonists.

Dopamine Agonists↗

PubMed2006

Restless legs syndrome and motor activity during sleep in spinocerebellar ataxia type 6.

BACKGROUND AND PURPOSE: We investigated the frequency of restless legs syndrome (RLS) and sleep disturbance in spinocerebellar ataxia type 6 (SCA6). PATIENTS AND METHODS: Five patients out of three multigenerational SCA6 families underwent a standardized investigation protocol including clinical interview for RLS, neurophysiological evaluation as well as the clinical assessment of ataxia. Polysomnography (PSG) was performed during two consecutive nights. RESULTS: Two out of five patients fulfilled the clinical criteria for RLS. A periodic leg movements in sleep (PLMS) index>15/h was present in four of the five patients; a PLMS index>5/h was present in all patients. Significant disturbance of rapid eye movement (REM) sleep was not found. None of the patients had REM sleep behaviour disorder. Only one patient had mild REM sleep without atonia. CONCLUSIONS: Our pilot study suggests only minor sleep abnormalities in SCA6.

Adult↗

PubMed2004

[Sleep disorders in elderly].

Insomnia affects 20% of the adult population in western countries and its prevalence increases with age. There is a controversy regarding the origin of sleep disorders in elderly. Are they only due to a senile process of sleep functioning or due to other associated comorbidities? Considering the objective assessment of sleep in elderly (by polysomnography), it has been shown an increasing sleep latency, decreasing total sleep time and sleep efficiency, a lower percentage of slow wave sleep. The circadian clock is also modified by age with phase advance and a decreased amplitude of the circadian rhythms. The most relevant comorbidities found in older people are: sleep apneas, restless leg syndrome, psychiatric disorders (anxiety and depression) and the use of drugs.

Aged↗