Clinical Characteristics and Associated Comorbidities in Diabetic Patients with Restless Legs Syndrome

Abstract

Aim: RLS, despite being a common entity, is often underdiagnosed and appears to be a serious problem from a diagnostic and therapeutic point of view. There have been few studies primarily concerned with the clinical characteristics of RLS in diabetic subjects. Those published have emanated largely from neurological referral centres rather than metabolic departments. The objective of this study was to determine the clinical characteristics and risk factors associated with RLS among persons with diabetes.

Methods: We have performed a retrospective study of all diabetic inpatients with RLS who were seen in the Metabolic Division at “S. Biagio” Hospital, Marsala, over a 18 months period. A detailed history, blood laboratory profile and an electrophysiological evaluation were obtained for each patient.

Results: During the period of the survey RLS was identified in 23 patients. These patients were found to have a poorly controlled diabetes and had increased associated comorbidities: they showed an high prevalence of diabetic neuropathy (96%) and metabolic syndrome (74%). Moreover, median duration of RLS symptoms onset was 2.8 years.

Conclusions: RLS is a serious and not uncommon problem among patients with diabetes mellitus. This syndrome is closely related to diabetic neuropathy and probably to metabolic factors in its pathogenesis. Diagnosis of RLS is often delayed and because it can be effectively treated, a better education of the general medical community toward greater awareness of the syndrome is necessary.

Key words

restless legs syndrome - diabetes mellitus - metabolic syndrome - peripheral neuropathy - hypertension

References

• 1 Allen RP, Picchietti D, Hening WA. et al . Restless legs syndrome: diagnostic criteria, special considerations and epidemiology; a report from the restless legs syndrome diagnosis and epidemiology Workshop at the National Institutes of Health.  Sleep Med. 2003;  4 101-119
• 2 Allen R, Walters AS, Montplaisir J. et al . Restless legs syndrome. Prevalence and impact. REST general population study.  Arch Intern Med. 2005;  165 1286-1292
• 3 Berger K, Luedemann J, Trenkwalder C. et al . Sex and the risk of restless legs syndrome in the general population.  Arch Intern Med. 2004;  164 196-202
• 4 Boulton AJM, Arezzo JC, Lamik RA. et al . Diabetic somatic neuropathies.  Diabetes Care. 2004;  27 1458-1486
• 5 Cuellar NG, Ratcliffe SJ. A comparison of glycemic control, sleep, fatigue and depression in type 2 diabetes with and without restless legs syndrome.  J Clin Sleep Med. 2008;  4 50-56
• 6 Expert Panel on Detection and Evaluation and Treatment of High Blood Cholesterol in Adults. . Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III).  JAMA. 2001;  285 2486-2497
• 7 Gamaldo CE, Earley CJ. Restless legs syndrome.  A clinical update. Chest. 2006;  130 1596-1604
• 8 Gemignani F, Brindani F, Vitetta F. et al . Restless legs sindrome in diabetic neuropathy: a frequent manifestation of small fiber neuropathy.  J Peripher Nerv Syst. 2007;  12 50-53
• 9 Lopes LA, Lins CMM, Adeodato VG. et al . Restless legs syndrome and quality of sleep in type 2 diabetes.  Diabetes Care. 2005;  28 2633-2636
• 10 Medcalf P, Bhatia KP. Restless legs syndrome. Is treatable but under-recognised.  BMJ. 2006;  333 457-458
• 11 Meijer JW, Bosma E, Lefrandt JD. et al . Clinical diagnosis of diabetic polyneuropathy with the diabetic neuropathy symptom and Diabetic Neuropathy Examination score.  Diabetes Care. 2003;  26 697-701
• 12 Merlino G, Fratticci L, Valente M. et al . Association of restless legs syndrome in type 2 diabetes: a case-control study.  Sleep. 2007;  30 866-871
• 13 National Heart and Lung and Blood Institute Working Group on Restless Legs Syndrome. . Restless legs syndrome: detection and management in primary care.  Am Fam Physician. 2000;  62 108-114
• 14 Nilsson PM, Roost M, Engstrom G. et al . Incidence of diabetes in middle-aged men is related to sleep disturbance.  Diabetes Care. 2004;  27 2464-2469
• 15 Phillips B, Young T, Finn L. et al . Epidemiology of restless legs symptoms in adults.  Arch Intern Med. 2000;  160 2137-2141
• 16 Phillips B, Hening W, Britz P. et al . Prevalence and correlates of restless legs syndrome.  Chest. 2006;  129 76-80
• 17 Rutkove SB, Matheson JK, Logigian EL. Rest legs syndrome in patients with polyneuropathy.  Muscle Nerve. 1996;  19 670-672
• 18 Skomro RP, Ludwig S, Salamon E. et al . Sleep complaints and restless legs syndrome in adult type 2 diabetics.  Sleep Med. 2001;  2 417-422
• 19 Spiegel K, Knutson K, Leproult R. et al . Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes.  J Appl Physiol. 2005;  99 2008-2015
• 20 Tison F, Crochard A, Leger D. et al . Epidemiology of restless legs syndrome in french adults: a nationwide survey: the INSTANT study.  Neurology. 2005;  26 239-246
• 21 Ulfberg J, Nystrom B, Carter N. et al . Prevalence of restless legs syndrome among men aged 18 to 64 years: an association with somatic disease and neuropsychiatric symptoms.  Mov Disord. 2001;  16 1159-1163
• 22 Winkelman JW, Finn L, Young T. Prevalence and correlates of restless legs syndrome symptoms in the Wisconsin Sleep Cohort.  Sleep Med. 2006;  7 545-552
• 23 Winkelman JW, Shahar E, Sharief I. et al . Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study.  Neurology. 2008;  70 35-42

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