Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
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Clinical Significance of Restless Legs Syndrome in Patients with Late Life Depression

노년기 우울증 환자의 하지불안증후군의 임상적 중요성

  • Song, Jae Min (Department of Psychiatry, Jeju National University Hospital, School of Medicine, Jeju National University) ;
  • Park, Joon Hyuk (Department of Psychiatry, Jeju National University Hospital, School of Medicine, Jeju National University) ;
  • Kang, Ji Eon (Department of Psychiatry, Jeju YeonKang Hospital) ;
  • Lee, Chang In (Department of Psychiatry, Jeju National University Hospital, School of Medicine, Jeju National University)
  • 송재민 (제주대학교 의학전문대학원 제주대학교병원 정신건강의학교실) ;
  • 박준혁 (제주대학교 의학전문대학원 제주대학교병원 정신건강의학교실) ;
  • 강지언 (제주 연강병원 정신건강의학과) ;
  • 이창인 (제주대학교 의학전문대학원 제주대학교병원 정신건강의학교실)
  • Received : 2014.06.21
  • Accepted : 2014.07.24
  • Published : 2014.08.28
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Abstract

Objectives Restless legs syndrome (RLS) is a sleep disorder characterized by uncomfortable and unpleasant sensations in the legs and an urge to move the legs, usually at night. The aim of this study is to investigate the incidence of RLS in patients with late life depression and its influence on various clinical outcomes such as severity of depression, sleep quality, cognitive function, and quality of life and accordingly, to elucidate the clinical significance of RLS in patients with late life depression (LLD). Methods This study enlisted 170 depressive patients aged 65 years or older from an outpatient clinic. Structured diagnostic interviews were performed using the Korean version of the Mini-International Neuropsychiatric Interview. All patients completed the questionnaires, including the International RLS Severity Scale, the Korean version of Short-Form 36-Item Health Survey (SF-36), and the Pittsburgh Sleep Quality Index (PSQI). The severity of depression was evaluated by the Korean form of the Geriatric Depression Scale (KGDS) and the level of global cognition was assessed by the Mini-Mental State Examination in the Korean version of The Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (MMSE-KC). Results The incidence of RLS was 17.6% in LLD patients. RLS was more prevalent among the subjects with major depressive disorder (MDD) than those with minor depressive disorder or subsyndromal depressive disorder. The RLS group showed higher score in the KGDS than the Non-RLS group but the difference did not reach the statistical significance (p = 0.095, Student t-test). The mean PSQI score was significantly higher in the RLS group than in the Non-RLS group (p = 0.001, Student t-test). The MMSE-KC score was also lower in the RLS group than in Non-RLS group (p = 0.009, analysis of covariance). But, there was no difference in the score of SF-36 between the RLS group and the Non-RLS group. Conclusions RLS is common in LLD patients, especially in the patients with MDD and is associated with poor sleep quality and cognitive dysfunction, indicating that RLS is clinically significant in patients with LLD. Therefore, RLS should be considered as an important clinical issue in the management of LLD.

Keywords

References

  1. Ekbom KA. [Restless legs]. Lakartidningen 1965;62:2376-2382.
  2. Abetz L, Allen R, Follet A, Washburn T, Earley C, Kirsch J, et al. Evaluating the quality of life of patients with restless legs syndrome. Clin Ther 2004;26:925-935. https://doi.org/10.1016/S0149-2918(04)90136-1
  3. Cho YW, Kim do H, Allen RP, Earley CJ. Assessing health-related quality of life in patients with restless legs syndrome in Korea: comparison with other chronic medical diseases. Sleep Med 2012;13:1158-1163. https://doi.org/10.1016/j.sleep.2012.05.005
  4. Lee DY, Sagong JK, Kwak KP, Han YH, Son YP, Park CJ, et al. Restless legs syndrome in depressed psychiatric outpatients. J Korean Soc Biol Ther Psychiatry 2011;17:38-46.
  5. Kim KW, Yoon IY, Chung S, Shin YK, Lee SB, Choi EA, et al. Prevalence, comorbidities and risk factors of restless legs syndrome in the Korean elderly population - results from the Korean Longitudinal Study on Health and Aging. J Sleep Res 2010;19(1 Pt 1):87-92. https://doi.org/10.1111/j.1365-2869.2009.00739.x
  6. Hening WA, Caivano CK. Restless legs syndrome: a common disorder in patients with rheumatologic conditions. Semin Arthritis Rheum 2008;38:55-62. https://doi.org/10.1016/j.semarthrit.2007.09.001
  7. Kim J, Choi C, Shin K, Yi H, Park M, Cho N, et al. Prevalence of restless legs syndrome and associated factors in the Korean adult population: the Korean Health and Genome Study. Psychiatry Clin Neurosci 2005;59:350-353. https://doi.org/10.1111/j.1440-1819.2005.01381.x
  8. Cho YW, Shin WC, Yun CH, Hong SB, Kim JH, Allen RP, et al. Epidemiology of restless legs syndrome in Korean adults. Sleep 2008;31:219-223. https://doi.org/10.1093/sleep/31.2.219
  9. Lee KA, Zaffke ME, Baratte-Beebe K. Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron. J Womens Health Gend Based Med 2001;10:335-341. https://doi.org/10.1089/152460901750269652
  10. Banno K, Delaive K, Walld R, Kryger MH. Restless legs syndrome in 218 patients: associated disorders. Sleep Med 2000;1:221-229. https://doi.org/10.1016/S1389-9457(00)00023-X
  11. Anand S, Johansen KL, Grimes B, Kaysen GA, Dalrymple LS, Kutner NG, et al. Physical activity and self-reported symptoms of insomnia, restless legs syndrome, and depression: the comprehensive dialysis study. Hemodial Int 2013;17:50-58. https://doi.org/10.1111/j.1542-4758.2012.00726.x
  12. Wesstrom J, Skalkidou A, Manconi M, Fulda S, Sundstrom-Poromaa I. Pre-pregnancy restless legs syndrome (Willis-Ekbom Disease) is associated with perinatal depression. J Clin Sleep Med 2014;10:527-533.
  13. Gupta R, Lahan V, Goel D. A study examining depression in restless legs syndrome. Asian J Psychiatr 2013;6:308-312. https://doi.org/10.1016/j.ajp.2013.01.011
  14. Becker PM, Novak M. Diagnosis, comorbidities, and management of restless legs syndrome. Curr Med Res Opin 2014;30:1441-1460. https://doi.org/10.1185/03007995.2014.918029
  15. Hornyak M, Kopasz M, Berger M, Riemann D, Voderholzer U. Impact of sleep-related complaints on depressive symptoms in patients with restless legs syndrome. J Clin Psychiatry 2005;66:1139-1145. https://doi.org/10.4088/JCP.v66n0909
  16. Li Y, Mirzaei F, O'Reilly EJ, Winkelman J, Malhotra A, Okereke OI, et al. Prospective study of restless legs syndrome and risk of depression in women. Am J Epidemiol 2012;176:279-288. https://doi.org/10.1093/aje/kws016
  17. Wesstrom J, Nilsson S, Sundstrom-Poromaa I, Ulfberg J. Health-related quality of life and restless legs syndrome among women in Sweden. Psychiatry Clin Neurosci 2010;64:574-579. https://doi.org/10.1111/j.1440-1819.2010.02116.x
  18. Happe S, Reese JP, Stiasny-Kolster K, Peglau I, Mayer G, Klotsche J, et al. Assessing health-related quality of life in patients with restless legs syndrome. Sleep Med 2009;10:295-305. https://doi.org/10.1016/j.sleep.2008.01.002
  19. Gupta R, Lahan V, Goel D. Prevalence of restless leg syndrome in subjects with depressive disorder. Indian J Psychiatry 2013;55:70-73. https://doi.org/10.4103/0019-5545.105515
  20. Szentkiralyi A, Volzke H, Hoffmann W, Baune BT, Berger K. The relationship between depressive symptoms and restless legs syndrome in two prospective cohort studies. Psychosom Med 2013;75:359-365. https://doi.org/10.1097/PSY.0b013e31828bbbf1
  21. Yoo SW, Kim YS, Noh JS, Oh KS, Kim CH, Namkoong K, et al. Validity of Korean Version of the MINI international neuropsychiatric interview. Anxiety Mood 2006;2:50-55.
  22. Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003;4:121-132. https://doi.org/10.1016/S1389-9457(02)00258-7
  23. Bae JN, Cho MJ. Development of the Korean version of the Geriatric Depression Scale and its short form among elderly psychiatric patients. J Psychosom Res 2004;57:297-305. https://doi.org/10.1016/j.jpsychores.2004.01.004
  24. Lee DY, Lee JH, Ju YS, Lee KU, Kim KW, Jhoo JH, et al. The prevalence of dementia in older people in an urban population of Korea: the Seoul study. J Am Geriatr Soc 2002;50:1233-1239. https://doi.org/10.1046/j.1532-5415.2002.50310.x
  25. Han CW, Lee EJ, Iwaya T, Kataoka H, Kohzuki M. Development of the Korean version of Short-Form 36-Item Health Survey: health related QOL of healthy elderly people and elderly patients in Korea. Tohoku J Exp Med 2004;203:189-194. https://doi.org/10.1620/tjem.203.189
  26. Nam BH. Testing the validity of the Korean SF-36 health survey [dissertation]. Seoul: Seoul National University;2003.
  27. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  28. Kaplan PW, Allen RP, Buchholz DW, Walters JK. A double-blind, placebo-controlled study of the treatment of periodic limb movements in sleep using carbidopa/levodopa and propoxyphene. Sleep 1993;16:717-723. https://doi.org/10.1093/sleep/16.8.717
  29. Jung KY, Koo YS, Kim BJ, Ko D, Lee GT, Kim KH, et al. Electrophysiologic disturbances during daytime in patients with restless legs syndrome: further evidence of cognitive dysfunction? Sleep Med 2011;12:416-421. https://doi.org/10.1016/j.sleep.2010.08.018
  30. Lee HB, Ramsey CM, Spira AP, Vachon J, Allen R, Munro CA. Comparison of cognitive functioning among individuals with treated restless legs syndrome (RLS), untreated RLS, and no RLS. J Neuropsychiatry Clin Neurosci 2014;26:87-91. https://doi.org/10.1176/appi.neuropsych.12120394