Restless Leg Syndrome: Pathophysiology, Diagnostic Criteria, and Treatment

Role of vitamins in the pathogenesis and treatment of restless leg syndrome: A systematic review and meta-analysis

We performed a meta-analysis to assess the role of vitamins in the possible pathogenesis and treatment of RLS (Restless Leg Syndrome). A systematic search of the PubMed, Cochrane, Embase, and Web of Science databases was conducted. Fifty-nine studies on the relationship between vitamins and RLS were included, as well as four randomized controlled trials (RCTs) on vitamin treatment of RLS. Compared with non-RLS patients, serum vitamin D levels were significantly lower both in primary (P =  0.009) and secondary (P =  0.003) RLS patients, and appeared to be positively correlated with disease severity. Serum folate levels were lower in pregnant RLS patients than in pregnant non-RLS patients (P =  0.007), but this phenomenon was not seen in non-pregnant RLS patients (P =  0.65). Vitamin B12 (P =  0.59) and B1 (P =  0.362) deficiencies were not found in RLS patients. Oral vitamin B6 significantly improved primary RLS (P < 0.0001), while vitamin D did not (P =  0.05). Oral vitamin C (P < 0.00001), E (P < 0.0001), and vitamin C +  E (P < 0.00001) all significantly improved hemodialysis-associated RLS with equal efficacy. Vitamin C is equivalent to 0.18 mg of pramipexole for the treatment of RLS (P =  0.81). In this meta-analysis, low vitamin D levels were found in patients with RLS, low folate levels were associated with RLS only in pregnant women, and vitamin C/E/B6 may improved symptoms in patients with RLS. These results suggest that vitamin deficiency or insufficiency may be related to the pathogenesis of RLS.

Simultaneous evaluation of restless leg syndrome, neuropathic pain, disease activity, and quality of life in patients with Takayasu arteritis: a cross-sectional study

We aimed to investigate the frequency of restless legs syndrome (RLS) and neuropathic pain (NeP) in patients with Takayasu arteritis (TAK), and their relationship with disease activity, and quality of life (QoL). In this prospective case-control study, we evaluated 30 patients with TAK and 28 healthy subjects. Demographic, clinical, and current treatment-related data were also recorded. RLS diagnosis was confirmed in both groups according to the International Restless Legs Study Group criteria. The Douleur neuropathic-4 questionnaire (DN4) confirmed the frequency of neuropathic pain, and the quality of life was confirmed by the Short Form 36 (SF-36) health survey questionnaire. Univariate logistic regression analyses were performed to estimate the odds ratio (OR) for factors associated with NeP in patients with TAK. There was no statistically significant difference in the diagnosis of RLS between the TAK group and the control group (p = 0.195). The prevalence of NeP was significantly higher in TAK patients than in healthy controls (p = 0.011). The SF-36 subscale scores for physical functioning (p = 0.01) and general health (p = 0.002) were significantly lower in the TAK group than in the control group. Vasculitis Damage Index (VDI) scores were considerably higher in patients with NeP (p = 0.004). In univariate analyses, VDI decreased unbound iron-binding capacity, and SF36 mental component summary were predictors associated with NeP. This study revealed that the frequency of NeP was higher in patients with TAK than in the healthy population, and the patients with TAK were negatively affected in terms of NeP and QoL rather than RLS.

Association between obesity and sleep disorder in the elderly: evidence from NHANES 2005-2018

Background

The available data exhibit inconsistent findings regarding the association between obesity and sleep problems among older adults. The objective of this study was to assess the potential association between obesity and sleep disorders in the older population.

Methods

The data utilised in this cross-sectional investigation was obtained from the National Health and Nutritional Examination Survey (NHANES) conducted between 2005 and 2018. The study employed a multivariate logistic regression model and conducted subgroup analysis to evaluate the association between obesity and sleep disturbance.

Results

The investigation consisted of 2,570 older people who provided complete information, out of which 324 individuals satisfied the criteria for sleep disturbance. The findings from the multivariable adjusted logistic regression model indicate that individuals in the overweight and normal weight groups exhibited decreased odds of experiencing sleep disorder, as evidenced by the adjusted odds ratios (AOR) of 0.46 (95% confidence interval [CI] = 0.34-0.61) and 0.33 (95% CI = 0.22-0.47), respectively. These results were statistically significant (p < 0.001) when compared to individuals in the obese group. The investigation of age and gender subgroups demonstrated similar associations between various BMI categories and sleep disorders in the older population.

Conclusion

In summary, there exists a correlation between obesity and sleep disorders in the senior population. A significant association was observed between BMI and the likelihood of experiencing sleep disorders, indicating a dose-response relationship. Individuals with a higher BMI demonstrated a heightened likelihood of experiencing sleep disorders compared to those with a lower BMI.

Longitudinal Cognitive Trajectories in Older Adults with Restless Legs Syndrome or Willis-Ekbom Disease

Background: Restless legs syndrome/Willis-Ekbom disease (RLS/WED) has occasionally but not consistently been associated with cognitive and most notably language and executive impairment. The present study was conducted to investigate the cognitive trajectories of older individuals with RLS/WED. Methods: Participants were drawn from the randomly selected, older (>64 years), population-based HELIAD cohort. Individuals without dementia and with available neuropsychological evaluations at baseline and follow-up were considered for potential eligibility. A comprehensive assessment examining five principal components of cognition (memory, visuo-spatial ability, attention, executive function, and language) was administered to the participants. Generalized estimating equation analyses were used to examine the unadjusted and adjusted (for critical factors and covariates) effects of RLS/WED on cognition over time. Results: A total of 1003 predominantly female (59.5%), older (72.9 ± 4.9 years) participants with follow-up evaluations after a mean of 3.09 ± 0.85 years and without dementia at baseline and follow-up were included in the present study. Among them, 81 were diagnosed with RLS/WED at baseline. Global cognition, memory, attention, and executive and visuo-perceptual skills did not differ between those with and without RLS/WED. However, the RLS/WED group performed worse on language at baseline by a standard deviation of 0.249, while demonstrating a mitigated language decline over time, by a standard deviation of 0.063. The unadjusted models yielded similar results. Conclusions: Our findings were indicative of a baseline language disadvantage among older individuals with RLS/WED, but the initial discrepancy tends to dissolve over time.

An Unusual Case of an Acute Episode of Restless Leg Syndrome Following Oral Metoclopramide Therapy

Restless leg syndrome (RLS) is a chronic disorder characterized by a compulsive urge to move the legs, accompanied by various subjective symptoms and a distinctive nyctimeral pattern. A negligent entity is drug-induced RLS, which may be challenging to recognize by practitioners due to its rarity. Among various drugs that can induce or exacerbate RLS, metoclopramide is notable; however, the literature primarily describes cases related to its intravenous forms. In this case presentation, a 33-year-old male experienced drug-related gastrointestinal (GI) symptoms after starting semaglutide for weight loss. Semaglutide was discontinued, and oral metoclopramide was administered to manage the GI symptoms. Subsequently, he developed RLS-like symptoms, which resolved within 48 hours of stopping metoclopramide. His family history included chronic RLS. Laboratory tests were normal. The case highlights a potential link between drug administration and transient RLS symptoms. This case suggests that RLS can be a rare, reversible side effect of oral metoclopramide. It emphasizes the need for careful monitoring of RLS symptoms in patients using this drug and highlights the variability of side effects depending on the method of drug administration. The case serves as a reminder of the unpredictable nature of drug reactions and the importance of vigilance in pharmacotherapy.

The Obesity-Related Dietary Pattern Is Associated with Higher Risk of Sleep Disorders: A Cross-Sectional Study from NHANES

Evidence on the association between dietary patterns and sleep disorders is limited and controversial. In addition, studies evaluating the effect of dietary patterns on sleep disorders have seldom considered the critical role of obesity. We aimed to explore obesity-related dietary patterns and evaluate their impact on sleep disorders using data from the National Health and Nutrition Examination Survey 2005–2014. In total, 19,892 participants aged over 20 years with two-day dietary recalls were enrolled. Obesity-related dietary patterns explaining most variance in waist circumference and BMI simultaneously were extracted from twenty-six food groups by the using partial least squares method. Sleep disorder and sleep duration, which were defined by self-reported questions, were the primary and the secondary outcome, respectively. Generalized linear models were performed to estimate the association of sleep disorders and sleep duration with dietary patterns. Two types of dietary patterns were identified. The “high fats, refined grains, and meat” pattern was characterized by high intakes of solid fats, cured meat, potatoes, refined grains, meat, cheese, and added sugars. The “low whole grains, vegetables, and fruits” pattern was characterized by low intakes of oils, whole grains, nuts and seeds, milk, fruits, and several vegetables. Participants with the highest adherence to the “high fats, refined grains, and meat” pattern had a higher risk for sleep disorders (OR (95%CI): 1.43 (1.12, 1.84)) and shorter sleep duration (β (95%CI): −0.17 (−0.26, −0.08)) compared to those with the lowest adherence. The corresponding associations for the “low whole grains, vegetables, and fruits” pattern were only significant for sleep duration (β (95%CI): −0.26 (−0.37, −0.15)). Our results found that the dietary pattern characterized by high solid fats, cured meat, potatoes, refined grains, meat, cheese, and added sugars, was associated with a higher risk for sleep disorders and shorter sleep duration.