Polysomnographic sleep measures in patients with uremic and idiopathic restless legs syndrome
Corresponding Author
Thomas C. Wetter MD
Max Planck Institute of Psychiatry, Munich, Germany
Max Planck Institute of Psychiatry, Kraepelinstraße 2–10, D-80804 Munich, GermanySearch for more papers by this authorKarin Stiasny MD
Department of Neurology, Philipps University, Marburg, Germany
Search for more papers by this authorRalf Kohnen PhD
Institute for Medical Research Management and Biometrics, Nuernberg, Germany
Search for more papers by this authorWolfgang H. Oertel MD
Department of Neurology, Philipps University, Marburg, Germany
Search for more papers by this authorClaudia Trenkwalder MD
Max Planck Institute of Psychiatry, Munich, Germany
Search for more papers by this authorCorresponding Author
Thomas C. Wetter MD
Max Planck Institute of Psychiatry, Munich, Germany
Max Planck Institute of Psychiatry, Kraepelinstraße 2–10, D-80804 Munich, GermanySearch for more papers by this authorKarin Stiasny MD
Department of Neurology, Philipps University, Marburg, Germany
Search for more papers by this authorRalf Kohnen PhD
Institute for Medical Research Management and Biometrics, Nuernberg, Germany
Search for more papers by this authorWolfgang H. Oertel MD
Department of Neurology, Philipps University, Marburg, Germany
Search for more papers by this authorClaudia Trenkwalder MD
Max Planck Institute of Psychiatry, Munich, Germany
Search for more papers by this authorAbstract
In the present study, the nocturnal electroencephalographic sleep pattern, the number of periodic leg movements (PLM) during sleep and wakefulness, and the subjective sleep parameters of patients with uremic (n = 10) and idiopathic (n = 17) restless legs syndrome (RLS) were compared. The main finding was that the total number of PLM (p = 0.019), the PLM index (p = 0.018), and the PLM index while awake (p = 0.003) were significantly higher in patients with uremic RLS compared with patients who had idiopathic RLS. Additionally, both groups showed a distinct time-of-night pattern of PLM activity. Polysomnographic measures of sleep continuity (total sleep time, sleep efficiency, sleep onset latency, time awake) and sleep architecture (amount of nonrapid eye movement sleep stages 1, 2, 3, and 4 and the amount of rapid eye movement sleep) did not differ between uremic and idiopathic RLS patients. With regard to subjective paramaters, sleep quality was estimated to be worse in uremic RLS (p = 0.033), whereas other paramaters (for example, severity of RLS, quality of life) did not differ between the two groups. It is suggested that uremia itself worsens the motor symptoms of RLS, probably as a result of increased excitability.
References
- 1 Ekbom KA. Restless legs. Acta Med Scand 1945; 158(suppl): 1–123.
- 2 Lavigne GJ, Montplaisir JY. Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep 1994; 17: 739–743.
- 3 Walters AS, International Restless Legs Syndrome Study Group. Toward a better definition of the restless legs syndrome. Mov Disord 1995; 10: 634–642.
- 4 Montplaisir J, Boucher S, Poirier G, Lavigne G, Lapierre O, Lespérance P. Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria. Mov Disord 1997; 12: 61–65.
- 5 Coleman R. Periodic movements in sleep (nocturnal myoclonus) and restless legs syndrome. In: C Guilleminault, ed. Sleeping and Waking Disorders: Indications and Techniques. Menlo Park, CA: Addison-Wesley, 1982: 265–295.
- 6 Pollmächer T, Schulz H. Periodic leg movements (PLM)–their relationship to sleep stages. Sleep 1993; 16: 572–577.
- 7 Montplaisir J, Godbout R, Boghen D, DeChamplain J, Young SN, Lapierre G. Familial restless legs with periodic movements in sleep: electrophysiologic, biochemical, and pharmacologic study. Neurology 1985; 35: 130–134.
- 8 Walters AS, Hickey K, Maltzman J, et al. A questionnaire study of 138 patients with restless legs syndrome: the ‘night walkers’ survey. Neurology 1996; 46: 92–95.
- 9 Callaghan N. Restless legs syndrome in uremic neuropathy. Neurology 1966; 16: 359–361.
- 10 Nordlander NB. Therapy in restless legs. Acta Med Scand 1953; 116: 453–457.
- 11 Goodman JDS, Brodie C, Ayida GA. Restless leg syndrome in pregnancy. BMJ 1988; 297: 1101–1102.
- 12 Reynolds G, Blake DR, Pall HS, Williams A. Restless legs and rheumatoid arthritis. BMJ 1986; 292: 659–660.
- 13 Salvi F, Montagna P, Plasmati R. Restless legs syndrome and nocturnal myoclonus: initial clinical manifestation of familial amyloid polyneuropathy. J Neurol Neurosurg Psychiatry 1990; 53: 522–525.
- 14 Collado-Seidel V, Kohnen R, Samtleben W, Hillebrand G, Oertel WH, Trenkwalder C. Clinical and biochemical findings in uremic patients with and without restless legs syndrome. Am J Kidney Dis 1998; 31: 324–328.
- 15 Winkelman JW, Chertow GM, Lazarus JM. Restless legs syndrome in end-stage renal disease. Am J Kidney Dis 1996; 28: 372–378.
- 16 Walker S, Fine A, Kryger MH. Sleep complaints in a dialysis unit. Am J Kidney Dis 1995; 26: 751–756.
- 17 Holley JL, Nespor S, Rault R. A comparison of reported sleep disorders in patients on chronic hemodialysis and continuous peritoneal dialysis. Am J Kidney Dis 1992; 19: 156–161.
- 18 Trenkwalder C, Stiasny K, Pollmächer T, et al. l-dopa therapy of uremic and idiopathic restless legs syndrome: a double-blind crossover trial. Sleep 1995; 18: 681–688.
- 19 National Institute of Mental Health. Clinical global impressions. In: W Guy, RR Bonato, eds. Manual for the EC-DEU Assessment Battery, 2nd rev ed. Chevy Chase, MD: National Institute of Mental Health, 1970: 1–6.
- 20 Jasper HH. The 10-20 electrode system of the International Federation. Electroencephalogr Clin Neurophysiol 1958; 10: 371–375.
- 21 A Rechtschaffen, A Kales, eds. A Manual of Standardized Terminology, Technique and Scoring System for Sleep Stages of Human Subjects. Los Angeles, CA: Brain Information Service/Brain Research Institute, UCLA, 1968.
- 22 Lauer CJ, Riemann D, Wiegand M, Berger M. From early to late adulthood: changes in EEG sleep of depressed patients and healthy volunteers. Biol Psychiatry 1991; 29: 979–993.
- 23 Diagnostic Classification Steering Commitee, Thorpy MJ Chairman. International Classification of Sleep Disorders: Diagnostic and Coding Manual. Rochester, MN: American Sleep Disorders Association, 1990: 65–68.
- 24 Williams RL, Karacan I, Hursch CJ. Electroencephalography (EEG) of Human Sleep: Clinical Applications. New York, NY: John Wiley & Sons, 1974.
- 25 Walker SL, Fine A, Kryger MH. l-dopa/carbidopa for nocturnal movement disorders in uremia. Sleep 1996; 19: 214–218.
- 26 Kimmel PL, Miller G, Mendelson WB. Sleep apnea syndrome in chronic renal disease. Am J Med 1989; 86: 308–314.
- 27 Mendelson WB, Wadhwa NK, Greenberg HE, Gujavarty K, Bergofsky E. Effects of hemodialysis on sleep apnea syndrome in end-stage renal disease. Clin Nephrol 1990; 33: 247–251.
- 28 Stepanski E, Faber M, Zorick F, Basner R, Roth T. Sleep disorders in patients on continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 1995; 6: 192–197.
- 29 Mendelson WB. Are periodic leg movements associated with clinical sleep disturbance? Sleep 1996; 19: 219–223.
- 30 Culpepper WJ, Badia P, Shaffer JI. Time-of-night patterns in PLMS activity. Sleep 1992; 15: 306–311.
- 31 Trenkwalder C, Walters AS, Hening W, Campbell S, Rahman K, Chokroverty S. Circadian rhythm of patients with the idiopathic restless legs syndrome. 9th Meeting of the American Sleep Disorders Association, APSS abstract book 1995: 406.
- 32 Guilleminault C, Cetel M, Philip P. Dopaminergic treatment of restless legs and rebound phenomenon. Neurology 1993; 43: 445–447.
