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PubMed2006

Restless legs syndrome in hemodialysis patients: health-related quality of life and laboratory data analysis.

AIMS: To compare clinical data, sleep quality and health-related quality of life (HRQOL) with and without RLS in HD patients. MATERIALS AND METHODS: The international RLS study group diagnosis questionnaire was completed by 228 HD patients. The Pittsburg Sleep Quality Index (PSQI) for the evaluation of sleep quality and the Kidney Disease Quality of Life (KDQOL-SF) for the analysis of HRQOL were also used. RESULTS: 53 (23%) patients were diagnosed as RLS. Age and age at the initiation of HD were significantly younger in the RLS group. Serum calcium concentration (Ca) was significantly higher in the RLS group. Sleep quality evaluated by PSQI was significantly lower in the RLS group. In SF-36 domains of KDQOL-SF, bodily pain, general health perceptions, vitality, role functioning emotional, mental health and mental component score were significantly lower in the RLS group. In kidney targeted scales of KDQOL-SF, symptoms/problems, burden of kidney disease, cognitive function, quality of social interaction, sleep and patient satisfaction were significantly lower in the RLS group. CONCLUSION: High Ca was possibly connected to the pathophysiology of RLS which impaired sleep quality as well as HRQOL including mental health and many kidney disease related scales.

Adult↗

PubMedDate not supplied

Sleep-disordered breathing in nondialyzed patients with chronic renal failure.

The prevalence and significance of sleep-disordered breathing (SDB) in dialysis-independent chronic renal failure (CRF) remains unknown. We studied the presence of SDB in nondialyzed CRF patients. Diagnostic polysomnography was performed in consecutive stable nondialyzed CRF patients. Inclusion criteria were age 70% pr, absence of neurologic disease or hypothyroidism, and calculated creatinine clearance <40 ml/min. Thirty-five patients (19 male, 16 female) were studied. An apnea-hypopnea index (AHI) >or=5/h was present in 54.3% (almost exclusively obstructive events). AHI correlated with urea (r = 0.35, p = 0.037), age (r = 0.379, p = 0.025), and body mass index (BMI) (r = 0.351, p = 0.038), but not with creatinine clearance. AHI or SDB were unrelated to gender. In nondiabetics (n = 25), AHI correlated with urea (r = 0.608, p = 0.001) and creatinine clearance (r = -0.50, p = 0.012). Nondiabetics with severe CRF (calculated GFR < 15 ml/min/1.73 m(2)) had a significantly higher AHI compared with less severe CRF. Restless legs syndrome (RLS) was present in 37.1% and periodic limb movements in 28.6%. Daytime sleepiness was not associated with respiratory events, but was more common in patients with RLS. The prevalence of SDB and RLS is high in dialysis-independent CRF. SDB weakly correlates with indices of kidney function and this association becomes stronger in nondiabetics.

Age Factors↗

PubMed2005

CSF iron, ferritin and transferrin levels in restless legs syndrome.

The aim of this study is evaluating iron, ferritin, and transferrin in both serum and CSF in patients of restless legs syndrome (RLS), based on the hypothesis that iron deficiency in the central nervous system (CNS) causes the symptoms as a result of the dysfunction of dopaminergic systems. These parameters, polysomnographic sleep measures, and subjective evaluation of the sleep quality were compared in 10 patients of idiopathic RLS (RLS group) and 10 age-matched patients of psychophysiological insomnia without RLS symptoms (non-RLS group). With sleep patterns, sleep latency was longer and sleep efficiency was lower in the RLS group than those in the non-RLS group. Periodic leg movement index in the RLS group was higher than that of the non-RLS group. With serum examination, there were no significant differences for the iron, ferritin, and transferrin values between the both groups. With CSF examination, the iron and ferritin values were lower and the transferrin values were higher in the RLS group than those in the non-RLS group. There was positive correlation between the serum and CSF ferritin levels in the both groups, but the slope of the regression lines for the RLS group was lower than that for the non-RLS group. These results indicate low brain iron concentration caused by the dysfunction of iron transportation from serum to CNS in patients with idiopathic RLS.

Aged↗

PubMed2005

A phase II trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier Oncology Group study.

In a previous phase I study, olanzapine was demonstrated to be a safe and effective agent for the prevention of delayed emesis in chemotherapy-naïve cancer patients receiving cyclophosphamide, doxorubicin, and/or cisplatin. Using the maximum tolerated dose of olanzapine in the phase I trial, a phase II trial was performed for the prevention of chemotherapy-induced nausea and vomiting in chemotherapy-naïve patients. The regimen was 5 mg/day of oral olanzapine on the 2 days prior to chemotherapy, 10 mg on the day of chemotherapy, day 1, (added to intravenous granisetron, 10 mcg/kg and dexamethasone 20 mg), and 10 mg/day on days 2-4 after chemotherapy (added to dexamethasone, 8 mg p.o. BID days 2 and 3, and 4 mg p.o. BID day 4). Thirty patients (median age 58.5 years, range 25-84; 23 women; ECOG PS 0, 1) consented to the protocol, and all were evaluable. Complete response (CR) (no emesis, no rescue) was 100% for the acute period (24 h postchemotherapy), 80% for the delayed period (days 2-5 postchemotherapy), and 80% for the overall period (0-120 h postchemotherapy) in ten patients receiving highly emetogenic chemotherapy (cisplatin > or =70 mg/m(2)). CR was also 100% for the acute period, 85% for the delayed period, and 85% for the overall period in 20 patients receiving moderately emetogenic chemotherapy (doxorubicin > or =50 mg/m(2)). Nausea was very well controlled in the patients receiving highly emetogenic chemotherapy, with no patient having nausea [0 on scale of 0-10, M.D. Anderson Symptom Inventory (MDASI)] in the acute or delayed periods. Nausea was also well controlled in patients receiving moderately emetogenic chemotherapy, with no nausea in 85% of patients in the acute period and 65% in the delayed and overall periods. There were no grade 3 or 4 toxicities and no significant pain, fatigue, disturbed sleep, memory changes, dyspnea, lack of appetite, drowsiness, dry mouth, mood changes, or restlessness experienced by the patients. Complete response and control of nausea in subsequent cycles of chemotherapy (25 patients, cycle 2; 25 patients, cycle 3; 21 patients, cycle 4) were equal to or greater than cycle 1. Olanzapine is safe and highly effective in controlling acute and delayed chemotherapy-induced nausea and vomiting in patients receiving highly and moderately emetogenic chemotherapy.

Administration, Oral↗

PubMedDate not supplied

The del(2)(q32.2q33) deletion syndrome defined by clinical and molecular characterization of four patients.

We report four patients with an interstitial deletion of chromosome 2q32-->2q33. They presented similar clinical findings including pre- and postnatal growth retardation, distinct facial dysmorphism, thin and sparse hair and fair built, micrognathia, cleft or high palate, relative macroglossia, dacrocystitis, persisting feeding difficulties, inguinal hernia and broad based gait. All were severely mentally retarded. Three patients had a specific behavioral phenotype with hyperactivity and motor restlessness, chaotic behavior, happy-personality but with periods of aggression and anxiety, sleeping problems and self-mutilation. (head-banging). Array CGH and fluorescence in situ hybridization (FISH) allowed us to delineate the deletion size and showed that the four patients share a 8.1 Mb minimal deleted region. Reviewing additional nine case reports of patients with similar deletions showed striking phenotypic similarities which enabled the delineation of the 2q32.2q33 syndrome. Deletion of 2q32 has been also associated with the wrinkly skin syndrome (WWS) and isolated cleft palate. Although the patients presented here shared many aspects of WWS, they did not had the wrinkly skin. All patients had a cleft or high palate, most likely as a result of hemizygosity for SATB2. A potential commonly deleted interval of the three patients with behavioral problems, excluding the deletion in the patient without behavioral problems, is at most 0.5 Mb in size harboring only two genes.

Abnormalities, Multiple↗

PubMedDate not supplied

[Restless leg syndrome. Diagnosis and treatment].

INTRODUCTION: The restless legs syndrome is characterized by an unpleasant sensation in the legs which causes an imperative need to move the legs and is therefore considered to be a disorder of movement. When it appears before going to sleep, it may interfere with falling asleep and lead to a sleep-deficit. DEVELOPMENT AND CONCLUSIONS: It is a clinical condition with a satisfactory treatment, and improvement of the associated sleep disorder. The etiology is unknown, sometimes it is familial. The syndrome is increasingly often diagnosed, particularly in association with iron deficiency, during pregnancy, in chronic renal failure and in patients with peripheral neuropathy. Polysomnography is not necessary, unless one suspects an associated disorder of periodic leg movements. Treatment is by dopaminergic, opiate, benzodiazepine, anticonvulsant drugs or clonidine.

Anticonvulsants↗

PubMed1987

Does the human body produce a substance similar to caffeine?

The idea that the human body probably produces a substance similar to caffeine came to my mind after reviewing the literature on the "restless legs syndrome". This syndrome is a disorder in which the afflicted individual feels an irresistible urge to move the legs, generally when sitting or lying down, and especially in bed, at night, just prior to getting to sleep. The patient has an extremely unpleasant deep discomfort inside the calves, requiring that the legs be moved(1). The "restless legs syndrome" has been described in persons who consume a lot of caffeine(2,3), in patients with iron deficiency anemia(4), and in patients with chronic renal failure(5). Since this syndrome occurs in persons who indulge in caffeine consumption as well as in patients with iron deficiency and patients with chronic renal failure, it is tempting to postulate that the human body- in cases of iron deficiency and chronic renal failure -produces a substance similar to caffeine. The following discussion entertains the hypothetical route that might be involved in the formation of this substance.

Caffeine↗

PubMed2002

Reliability of a questionnaire screening restless legs syndrome in patients on chronic dialysis.

BACKGROUND: The aim of this study is to evaluate the reliability of a self-administered questionnaire on leg discomfort and restlessness as a screening tool for restless legs syndrome (RLS) in a population of chronically dialyzed patients. METHODS: One hundred twenty-seven patients on chronic hemodialysis therapy filled in a self-administered questionnaire including 4 diagnostic questions for RLS and 12 subsequent questions on clinical characteristics of leg discomfort. Two neurologists trained in sleep medicine blinded to questionnaire answers evaluated all patients and diagnosed RLS according to criteria of the International Restless Legs Syndrome Study Group. We compared questionnaire results in terms of RLS diagnosis with direct patient evaluation performed by neurologists used as a gold standard. RESULTS: The questionnaire showed a low sensitivity and specificity and did not prove reliable for screening for RLS in uremic patients. False-positive results seem to be caused by the presence of other leg symptoms and neurological objective signs suggesting peripheral neuropathy; false-negative results may be caused by the moderate severity of leg discomfort and its poor appraisal. CONCLUSION: Our study suggests caution in evaluating results of questionnaires to screen for RLS in patients with chronic renal insufficiency on dialysis therapy.

Adult↗

PubMed1997

Pergolide: treatment of choice in restless legs syndrome (RLS) and nocturnal myoclonus syndrome (NMS). A double-blind randomized crossover trial of pergolide versus L-Dopa.

A double-blind randomized crossover study of 0.125 mg Pergolide (Lilly) at bedtime versus 250mg L-Dopa + Carbidopa (Roche) was conducted in 16-day phases in 11 patients with idiopathic restless legs syndrome. Two patients reported a partial and 9 patients a complete relieve of motor restlessness while receiving Pergolide. Only 1 patient experienced an improvement of restlessness after L-Dopa. The patients showed polysomnographically a mean decrease in NMS cluster disturbed time by 45% from control on L-Dopa (p < 0.025) and by 79% from control on Pergolide (p < 0.001). In addition, Pergolide increased the total sleep time compared to L-Dopa (p < 0.05). In conclusion, the dopamine agonist Pergolide is superior to L-Dopa in the treatment of RLS and NMS.

Aged↗

PubMed2005

The PAM-RL ambulatory device for detection of periodic leg movements: a validation study.

BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) is usually associated with periodic leg movements (PLM) occurring during wakefulness and sleep. The PLM index obtained by the polysomnographic method reflects the degree of motor symptoms and their consequences on sleep structure. Automated analysis of PLM using actigraphy can assess this condition and can therefore be used to assess therapeutic effects in clinical trials. In the current study we assessed the reliability of the PAM-RL, an ambulatory device measuring limb movements and PLM with a high-time resolution. PATIENTS AND METHODS: Forty-three patients consecutively referred to the sleep laboratory for insomnia and/or excessive daytime sleepiness underwent one or two nights of polysomnography (PSG) with simultaneous bilateral recording of limb activity by the PAM-RL device. The PSG recordings were blinded and manually analyzed for PLM, while limb actimetry was scored automatically based on the manufacturer's algorithm. RESULTS: There was a significant correlation between PLM derived from PSG and actimetry (r=0.87, P<0.0001) with good agreement across a wide range of values. The sensitivity and specificity of the PAM-RL device in detecting patients having a polysomnographic PLM index >10 were, respectively, 0.88 and 0.76 with a receiving operating curve having an area under the curve (AUC) of 0.86 for the entire group of patients. All patients with clinically definitive RLS and primary PLM disorder (PLMD) had a PLM index >10 on PSG, but among patients with sleep-related breathing disorders (SRBD) 60% reached this cut-off value. Conversely, only 50% of those patients with an actigraphically assessed PLM index >10 had clinically definitive RLS or PLMD, and 40% had SRBD. CONCLUSIONS: We demonstrate that automatic detection of PLM derived from the PAM-RL device is highly reliable when compared to the 'gold standard' of polysomnography in patients with RLS and PLMD. Therefore, limb actigraphy can be used routinely to assess motor restlessness in patients with RLS and PLMD. The higher discrepancy in patients with SRBD and insomnia may preclude the use of the device in these patients.

Adult↗

PubMed2001

Restless legs syndrome: a review of clinical and pathophysiologic features.

Restless legs syndrome (RLS), although long ignored and still much underdiagnosed, disrupts the life and sleep considerably of those who have it. Recent clinical and basic research provides for better definition and pathophysiologic understanding of the disorder. The body of knowledge about this disorder has been expanding rapidly during the past decade and it has altered our concepts of this disorder. This review of RLS covers history, diagnosis, morbidity of sleep disturbance, relation to periodic limb movements in both sleep and waking, secondary causes, severity assessment methods, phenotypes for possible genetic patterns, epidemiology, pathophysiology, and medical treatment considerations. The emphasis on pathophysiology includes consideration of central nervous system localization, neurotransmitter and other systems involved, and the role of iron metabolism. Studies to date support the authors' recently advanced iron-dopamine model of RLS.

Anemia, Iron-Deficiency↗

PubMed1987

Restless legs syndrome treatment with dopaminergic drugs.

Sixteen patients with symptoms of restless legs syndrome and resulting insomnia are included in this study. They were nine women and seven men with a mean age of 50.8 years and with a mean duration of symptoms of 6.3 years. The purpose of the study is to determine the drugs that are useful for the treatment of restless legs syndrome. In 13 patients L-Dopa plus benserazide, in two patients bromocriptine, and in the remaining one patient piribedil were used orally at night approximately 1 h before bedtime. Compared with placebo these dopaminergic drugs decreased the times of waking up and staying awake periods at a statistically significant level (p changed between 0.025 and 0.01, t test). In this susceptibility of CNS there is dysfunction of the dopamine system triggered by sleep, and resting and dopaminergic potentiation by drugs affect the symptoms.

Adult↗

PubMed2001

Long-term effects of pergolide in the treatment of restless legs syndrome.

An open follow-up of a controlled study in patients with restless legs syndrome (RLS) shows that the beneficial effect of pergolide on RLS symptoms persists throughout at least 1 year. Twenty-two patients of 28 (78.6%) continued to take pergolide. Polysomnographic measurements showed a persistent improvement of PLM index, PLMS arousal index, total sleep time, and sleep efficiency (p = 0.0001). Side effects, in particular nausea, were common but were well controlled by domperidone in most patients.

Adult↗

PubMed1993

Polysomnography in obese children with a history of sleep-associated breathing disorders.

We hypothesized that obese children with a history of breathing difficulty during sleep would demonstrate (1) evidence of complete and partial obstructive sleep apnea (OSA) with hypercarbia and/or hypoxemia; and (2) correlation between symptoms, degree of obesity, adenoid and tonsil size, and polysomnography (PSG) results. We evaluated 32 obese children [% ideal body weight (IBW), 196 +/- 45%] with a sleep history questionnaire, airway radiographs, electrocardiograms (ECG), and PSG. By history, we found snoring (100%), difficulty breathing (59%), sweating (44%), restlessness (53%), arousals (41%), apnea (50%), worsening with upper respiratory infection (URI) (81%), hypersomnolence (59%), and mouth breathing (59%). We found adenoid and/or tonsil enlargement on 75% of airway x-ray pictures. ECGs were abnormal in 5 patients. Among all patients, mean sleep study oxyhemoglobin saturation (SaO2) was 85 +/- 16% and mean end-tidal CO2 (PetCO2) was 51 +/- 7 torr; 84% had paradoxical inward movement of the chest on inspiration, 59% had OSA, and 66% had partial OSA. In those with > or = 200% IBW and adenotonsillar enlargement, elevated PetCO2 and the presence of hypoxemia (SaO2 < 90%) for > or = 5% of the total sleep time (TST) were correlated, unlike in patients of similar weight but without adenotonsillar enlargement. Individuals symptoms did not correlate with the severity of PSG abnormalities. By discriminant analysis, using three variables (IBW, presence of adenotonsillar tissue, and presence of > or = 5 symptoms), we could predict PSG abnormalities with up to 81% reliability. Our findings indicate that in obese children, particularly those with %IBW > or = 200 and adenotonsillar hypertrophy, with sleep-disordered breathing evaluation by polysomnography should be considered.

Adolescent↗

PubMed1987

Sleep apnea in multiinfarct dementia and Alzheimer's disease.

Sleep-related hypopneas and apneas were studied in 19 patients with multiinfarct dementia (MID), in 21 patients with Alzheimer's disease (AD), and in 26 healthy control subjects using the Static Charge-Sensitive Bed (SCSB) method. Demented patients had more apneas or hypopneas and more disturbed sleep than the control subjects. Over 10 apneas/hypopneas per hour of sleep were detected in 47.5% of the demented patients and in 19.2% of the control subjects (p less than 0.05). Restlessness comprised 46.7% of the time in bed in patients with AD and 49.6% in those with MID, but only 102.% in the control subjects (p less than 0.001, controls versus demented). The total duration of apneas and hypopneas calculated from the total sleeping time was greater than 10% in 60.0% of the demented patients and in 15.4% of the control subjects (p less than 0.001). Patients with MID tended to have more apneas/hypopneas than those with AD, and apneas/hypopneas tended to increase in direct proportion to the severity of dementia. Age had no effect on the proportion of apneas and hypopneas among demented patients or control subjects, but male controls had more apneas and hypopneas than did female controls.

Aged↗

PubMedDate not supplied

[Restless legs syndrome].

The restless legs syndrome is restlessness of the extremities, particularly the legs. It occurs mainly during the hours before going to sleep or during the sleep and it frequently causes a refractory insomnia. The patients feel a typical, almost indefinable, particuliar crawling sensation reminiscent of the movement of worms. The intensity of this feeling may vary from time to time. From literature and our experience we concluded that this syndrome is not a disease of itself but an early symptom of an intoxication or auto-intoxication process.

Diagnosis, Differential↗

PubMed2000

Restless legs syndrome: detection and management in primary care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome.

Restless legs syndrome (RLS) is a neurologic movement disorder that is often associated with a sleep complaint. Patients with RLS have an irresistible urge to move their legs, which is usually due to disagreeable sensations that are worse during periods of inactivity and often interfere with sleep. It is estimated that between 2 and 15 percent of the population may experience symptoms of RLS. Primary RLS likely has a genetic origin. Secondary causes of RLS include iron deficiency, neurologic lesions, pregnancy and uremia. RLS also may occur secondarily to the use of certain medications. The diagnosis of RLS is based primarily on the patient's history. A list of questions that may be used as a basis to assess the likelihood of RLS is included in this article. Pharmacologic treatment of RLS includes dopaminergic agents, opioids, benzodiazepines and anticonvulsants. The primary care physician plays a central role in the diagnosis and management of RLS.

Anticonvulsants↗

PubMed2005

Insomnia complaints in patients evaluated for obstructive sleep apnea.

Obstructive sleep apnea (OSA) and insomnia are among the most common sleep diagnoses encountered in the sleep clinic population, however little is known about potential interactions or associations between the two disorders. This retrospective, cross-sectional study was designed to determine the prevalence of insomnia complaints in patients undergoing evaluation for OSA and to ascertain which clinical and polysomnographic features are associated with insomnia. Of 255 consecutive patients who underwent polysomnography for clinically suspected OSA, 54.9% reported a complaint of insomnia: 33.4% reported difficulty initiating sleep, 38.8% difficulty maintaining sleep, and 31.4% early morning awakenings. Insomnia complaints were noted more commonly in patients without significant sleep-disordered breathing [apnea hypopnea index (AHI)<10; 81.5%] vs those with sleep-disordered breathing (AHI> or =10; 51.8%); p=0.01. Clinical factors associated with insomnia included female gender, psychiatric diagnoses, chronic pain, the absence of regular alcohol use, restless leg symptoms, and reports of nocturnal kicking. Polysomnographic factors associated with insomnia included lower AHI and lower desaturation index (DI). In the subgroup of patients with significant sleep-disordered breathing (AHI> or =10, n=228), there was no association between insomnia complaints and AHI or DI. These results suggest that insomnia is a common complaint in patients being evaluated for OSA, but it is not strongly associated with sleep-disordered breathing and may instead reflect other coexisting factors.

Adult↗