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ABSTRACT
Year : 2018  |  Volume : 3  |  Issue : 1  |  Page : 14

Restless leg syndrome


1 Post-Doctoral Fellow, Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA
2 PhD Scholar, Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA
3 Associate Professor, Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA

Date of Web Publication16-May-2018

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-1540.232544

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How to cite this article:
Kaur D, Tallman D, Khosla P. Restless leg syndrome. J Renal Nutr Metab 2018;3:14

How to cite this URL:
Kaur D, Tallman D, Khosla P. Restless leg syndrome. J Renal Nutr Metab [serial online] 2018 [cited 2019 Sep 18];3:14. Available from: http://www.jrnm.in/text.asp?2018/3/1/14/232544


  Definition and Causes Top


Restless Leg Syndrome(RLS) is defined as a sensorimotor disorder characterized by an urge to move the limbs, which may or may not be accompanied by unpleasant sensations. This disorder usually affects the lower limbs and worsens during periods of rest or inactivity predominantly in the later part of the day, hence resulting in sleep disturbances. An increase in severity is associated with lower sleep quality and quality of life and increased depression[1],[2]. There are two forms of RLS which are characteristically similar (1) Primary – Generally starts at a younger age and is believed to have genetic predisposition. (2) Secondary – Diagnosed concomitant with another disorder that has association with RLS (iron deficiency, pregnancy, peripheral neuropathy). When the associated disorder is End Stage Renal Disease (ESRD), the diagnosis is termed Uremic RLS. The prevalence of RLS is estimated to be about 62% in ESRD which is significantly higher than general population (5-15%)[3],[4]


  Factors Affecting RLS and Diagnostic Criteria Top


Hypertension, female gender, increased body weight and dialysis vintage are associated with increase in RLS severity additionally with age and diabetes status. International Restless Leg Syndrome Study Group (IRLSSG) identified five essential criteria to diagnose RLS. (1) An urge to move the legs - may or may not be accompanied by uncomfortable sensations in the legs. (2) The urge to move the legs and any unpleasant sensations either begin or worsen during rest or inactivity. (3) The urge to move the legs and any unpleasant sensations improve partially or totally with movement, even if temporarily. (4) The urge to move the legs and any unpleasant sensations worsen in the later part of the day. (5) All above features are not solely attributed to symptoms primary to another medical or behavioral conditions such as myalgia, leg edema, venous stasis, arthritis, leg cramps, positional discomfort, habitual foot tapping – also referred to as RLS mimics[4],[5]. To help clinicians better understand the condition and diagnosis for a patient, questions have been suggested by National Sleep Foundation and RLS foundation along with an International RLS severity scale for better assessment[1].


  Clinical Implicationsand Management of Uremic RLS Top


Uremic RLS has been associated with Sleep Related Disorders – Affects both quality and quantity of sleep and is in turn associated withincreased insulin resistance such as fatty liver, central adiposity and physical inactivity. Inadequate sleep also affects Quality of Life as assessed by the QoL scores. Uremic RLS is also associated with higher muscle atrophy compared to their idiopathic counterparts. There are also implications suggested on cardiovascular disease and mortality though the results are not conclusive. No specific guidelines have been published for treating uremic RLS, therefore, the general approach is to use published instructions for idiopathic RLS. (1) Check for iron deficiency anemia. (2) to improve sleep habits (3) Changing shift timings to earlier in the day (4) Incorporation of intradialytic aerobic exercise.

 
  References Top

1.
Giannaki, C.D., et al., Epidemiology, impact, and treatment options of restless legs syndrome in end-stage renal disease patients: an evidence-based review. Kidney Int, 2014. 85(6): p. 1275-82.  Back to cited text no. 1
    
2.
Gkizlis, V., et al., Uremic versus idiopathic restless legs syndrome: impact on aspects related to quality of life. ASAIO J, 2012. 58(6): p. 607-11.  Back to cited text no. 2
    
3.
Lee, J., et al., The prevalence of restless legs syndrome across the full spectrum of kidney disease. J Clin Sleep Med, 2013. 9(5): p. 455-9.  Back to cited text no. 3
    
4.
Novak, M., J.W. Winkelman, and M. Unruh, Restless Legs Syndrome in Patients With Chronic Kidney Disease. Semin Nephrol, 2015. 35(4): p. 347-58.  Back to cited text no. 4
    
5.
2012 revised IRLSSG diagnostic criteria for RLS. International Restless Legs Syndrome Study Group., 2013.  Back to cited text no. 5
    




 

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