Skip to main content
Top
Published in: Sleep and Breathing 3/2020

Open Access 01-09-2020 | Insomnia | Psychiatrics • Original Article

Sleep apnea syndrome comorbid with and without restless legs syndrome: differences in insomnia specific symptoms

Authors: Franziska Pistorius, Peter Geisler, Thomas C. Wetter, Tatjana Crönlein

Published in: Sleep and Breathing | Issue 3/2020

Login to get access

Abstract

Objective

Sleep Apnea Syndrome (SAS) is frequently comorbid with Restless Legs Syndrome (RLS). Both disorders are associated with disturbed sleep. However, data about insomnia specific symptoms in patients suffering from both sleep disorders (SAS-RLS) are rare.

Methods

In a restrospective design, we investigated 202 patients suffering from SAS and SAS-RLS. All patients underwent polysomnography, performed a vigilance test (Quatember-Maly), and completed the Regensburg Insomnia Scale (RIS), Epworth Sleepiness Scale (ESS), Beck Depression Inventory-II (BDI-II), and a Morning Questionnaire (FZN). Differences in insomnia specific symptoms between SAS and SAS-RLS were calculated using ANOVA. In a secondary analysis, the differences in daytime sleepiness and depression were analyzed.

Results

Of 202 patients, 42 (21%) had SAS-RLS. The proportion of women (60%) with SASRLS was higher than for men (40%) while men had had a higher proportion (71%) of SAS alone compared to women (29%), p < 0.0005. The RIS score was higher in SAS-RLS than in SAS. No differences were found in PSG data, ESS, BDI-II, or vigilance tests.

Conclusions

Patients with both disorders SAS and RLS show a higher degree of insomnia-specific symptoms than for SAS alone and may profit from additional insomnia specific treatment.
Literature
1.
go back to reference Bjornsdottir E, Janson C, Gislason T, Sigurdsson JF, Pack AI, Gehrman P et al (2012) Insomnia in untreated sleep apnea patients compared to controls. J Sleep Res 21:131–138CrossRef Bjornsdottir E, Janson C, Gislason T, Sigurdsson JF, Pack AI, Gehrman P et al (2012) Insomnia in untreated sleep apnea patients compared to controls. J Sleep Res 21:131–138CrossRef
2.
go back to reference Wickwire EM, Collop NA (2010) Insomnia and sleep-related breathing disorders. Chest 137:1449–1463CrossRef Wickwire EM, Collop NA (2010) Insomnia and sleep-related breathing disorders. Chest 137:1449–1463CrossRef
3.
go back to reference Bianchi MT, Goparaju B, Moro M (2016) Sleep apnea in patients reporting insomnia or restless legs symptoms. Acta Neurol Scand 133:61–67CrossRef Bianchi MT, Goparaju B, Moro M (2016) Sleep apnea in patients reporting insomnia or restless legs symptoms. Acta Neurol Scand 133:61–67CrossRef
4.
go back to reference Appleton SL, Gill TK, Lang CJ, Taylor AW, McEvoy RD, Stocks NP, González-Chica DA, Adams RJ (2018) Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep Health 4:13–19CrossRef Appleton SL, Gill TK, Lang CJ, Taylor AW, McEvoy RD, Stocks NP, González-Chica DA, Adams RJ (2018) Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep Health 4:13–19CrossRef
5.
go back to reference Beneto A, Gomez-Siurana E, Rubio-Sanchez P (2009) Comorbidity between sleep apnea and insomnia. Sleep Med Rev 13:287–293CrossRef Beneto A, Gomez-Siurana E, Rubio-Sanchez P (2009) Comorbidity between sleep apnea and insomnia. Sleep Med Rev 13:287–293CrossRef
6.
go back to reference Lakshminarayanan S, Paramasivan KD, Walters AS, Wagner ML, Patel S, Passi V (2005) Clinically significant but unsuspected restless legs syndrome in patients with sleep apnea. Mov Disord 20:501–503CrossRef Lakshminarayanan S, Paramasivan KD, Walters AS, Wagner ML, Patel S, Passi V (2005) Clinically significant but unsuspected restless legs syndrome in patients with sleep apnea. Mov Disord 20:501–503CrossRef
7.
go back to reference Benediktsdottir B, Arnardottir ES, Jansson C, Pack A, Juliusson S, Gislason T (2012) Prevalence of restless legs syndrome among patients with obstructive sleep apnea before and after CPAP treatment, compared to general population. The Icelandic Sleep Apnea Cohort (ISAC). Eur Respir J 40:436CrossRef Benediktsdottir B, Arnardottir ES, Jansson C, Pack A, Juliusson S, Gislason T (2012) Prevalence of restless legs syndrome among patients with obstructive sleep apnea before and after CPAP treatment, compared to general population. The Icelandic Sleep Apnea Cohort (ISAC). Eur Respir J 40:436CrossRef
8.
go back to reference Ohayon MM, O'Hara R, Vitiello MV (2012) Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 16:283–295CrossRef Ohayon MM, O'Hara R, Vitiello MV (2012) Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 16:283–295CrossRef
9.
go back to reference Hornyak M, Feige B, Voderholzer U, Philipsen A, Riemann D (2007) Polysomnography findings in patients with restless legs syndrome and in healthy controls: a comparative observational study. Sleep 30:861–865CrossRef Hornyak M, Feige B, Voderholzer U, Philipsen A, Riemann D (2007) Polysomnography findings in patients with restless legs syndrome and in healthy controls: a comparative observational study. Sleep 30:861–865CrossRef
10.
go back to reference Acker J, Richter K, Piehl A, Herold J, Ficker JH, Niklewski G (2017) Obstructive sleep apnea (OSA) and clinical depression-prevalence in a sleep center. Sleep Breath 21:311–318CrossRef Acker J, Richter K, Piehl A, Herold J, Ficker JH, Niklewski G (2017) Obstructive sleep apnea (OSA) and clinical depression-prevalence in a sleep center. Sleep Breath 21:311–318CrossRef
11.
go back to reference Happe S, Reese JP, Stiasny-Kolster K, Peglau I, Mayer G, Klotsche J, Giani G, Geraedts M, Trenkwalder C, Dodel R (2009) Assessing health-related quality of life in patients with restless legs syndrome. Sleep Med 10:295–305CrossRef Happe S, Reese JP, Stiasny-Kolster K, Peglau I, Mayer G, Klotsche J, Giani G, Geraedts M, Trenkwalder C, Dodel R (2009) Assessing health-related quality of life in patients with restless legs syndrome. Sleep Med 10:295–305CrossRef
12.
go back to reference Edinger JD (2003) Cognitive and behavioral anomalies among insomnia patients with mixed restless legs and periodic limb movement disorder. Behav Sleep Med 1:37–53CrossRef Edinger JD (2003) Cognitive and behavioral anomalies among insomnia patients with mixed restless legs and periodic limb movement disorder. Behav Sleep Med 1:37–53CrossRef
13.
go back to reference Choi SJ, Joo EY, Lee YJ, Hong SB (2015) Suicidal ideation and insomnia symptoms in subjects with obstructive sleep apnea syndrome. Sleep Med 16:1146–1150CrossRef Choi SJ, Joo EY, Lee YJ, Hong SB (2015) Suicidal ideation and insomnia symptoms in subjects with obstructive sleep apnea syndrome. Sleep Med 16:1146–1150CrossRef
14.
go back to reference Harvey AG (2002) A cognitive model of insomnia. Behav Res Ther 40:869–893CrossRef Harvey AG (2002) A cognitive model of insomnia. Behav Res Ther 40:869–893CrossRef
15.
go back to reference Delgado Rodrigues RN, de Abreu e Silva Rodrigues AA, Pratesi R, Gomes MM, Vasconcelos AM, Erhardt C et al (2007) Outcome of sleepiness and fatigue scores in obstructive sleep apnea syndrome patients with and without restless legs syndrome after nasal CPAP. Arq Neuropsiquiatr 65:54–58CrossRef Delgado Rodrigues RN, de Abreu e Silva Rodrigues AA, Pratesi R, Gomes MM, Vasconcelos AM, Erhardt C et al (2007) Outcome of sleepiness and fatigue scores in obstructive sleep apnea syndrome patients with and without restless legs syndrome after nasal CPAP. Arq Neuropsiquiatr 65:54–58CrossRef
16.
go back to reference Manber R, Bernert RA, Suh S, Nowakowski S, Siebern AT, Ong JC (2011) CBT for insomnia in patients with high and low depressive symptom severity: adherence and clinical outcomes. J Clin Sleep Med 7:645–652CrossRef Manber R, Bernert RA, Suh S, Nowakowski S, Siebern AT, Ong JC (2011) CBT for insomnia in patients with high and low depressive symptom severity: adherence and clinical outcomes. J Clin Sleep Med 7:645–652CrossRef
17.
go back to reference Shekleton JA, Rogers NL, Rajaratnam SM (2010) Searching for the daytime impairments of primary insomnia. Sleep Med Rev 14:47–60CrossRef Shekleton JA, Rogers NL, Rajaratnam SM (2010) Searching for the daytime impairments of primary insomnia. Sleep Med Rev 14:47–60CrossRef
18.
go back to reference Cronlein T, Langguth B, Popp R, Lukesch H, Pieh C, Hajak G et al (2013) Regensburg Insomnia Scale (RIS): a new short rating scale for the assessment of psychological symptoms and sleep in insomnia; study design: development and validation of a new short self-rating scale in a sample of 218 patients suffering from insomnia and 94 healthy controls. Health Qual Life Outcomes 11:65CrossRef Cronlein T, Langguth B, Popp R, Lukesch H, Pieh C, Hajak G et al (2013) Regensburg Insomnia Scale (RIS): a new short rating scale for the assessment of psychological symptoms and sleep in insomnia; study design: development and validation of a new short self-rating scale in a sample of 218 patients suffering from insomnia and 94 healthy controls. Health Qual Life Outcomes 11:65CrossRef
19.
go back to reference Berger K, Kurth T (2007) RLS epidemiology – frequencies, risk factors and methods in population studies. Mov Disord 22:420–423CrossRef Berger K, Kurth T (2007) RLS epidemiology – frequencies, risk factors and methods in population studies. Mov Disord 22:420–423CrossRef
20.
go back to reference Berger K, Luedemann J, Trenkwalder C, John U, Kessler C (2004) Sex and the risk of restless legs syndrome in the general population. Arch Intern Med 164:196–202CrossRef Berger K, Luedemann J, Trenkwalder C, John U, Kessler C (2004) Sex and the risk of restless legs syndrome in the general population. Arch Intern Med 164:196–202CrossRef
21.
go back to reference Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C (2000) Epidemiology of restless legs symptoms in adults. Arch Intern Med 160:2137–2141CrossRef Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C (2000) Epidemiology of restless legs symptoms in adults. Arch Intern Med 160:2137–2141CrossRef
22.
go back to reference Roth T (2009) Comorbid insomnia: current directions and future challenges. Am J Manag Care 1:S6–S13 Roth T (2009) Comorbid insomnia: current directions and future challenges. Am J Manag Care 1:S6–S13
23.
go back to reference Saskin P, Moldofsky H, Lue FA (1985) Periodic movements in sleep and sleep-wake complaint. Sleep 8:319–324CrossRef Saskin P, Moldofsky H, Lue FA (1985) Periodic movements in sleep and sleep-wake complaint. Sleep 8:319–324CrossRef
24.
go back to reference Karadeniz D, Ondze B, Besset A, Billiard M (2000) Are periodic leg movements during sleep (PLMS) responsible for sleep disruption in insomnia patients? Eur J Neurol 7:331–336CrossRef Karadeniz D, Ondze B, Besset A, Billiard M (2000) Are periodic leg movements during sleep (PLMS) responsible for sleep disruption in insomnia patients? Eur J Neurol 7:331–336CrossRef
25.
go back to reference Fulda S, Heinzer R, Haba-Rubio J (2018) Characteristics and determinants of respiratory event-associated leg movements. Sleep 41:zsx206 Fulda S, Heinzer R, Haba-Rubio J (2018) Characteristics and determinants of respiratory event-associated leg movements. Sleep 41:zsx206
26.
go back to reference Huang CY, Yu CC (2019) Different diagnostic criteria for periodic leg movements in patients with obstructive sleep apnea after continuous positive airway pressure titration. Neuropsychiatr Dis Treat 15:2129–2136CrossRef Huang CY, Yu CC (2019) Different diagnostic criteria for periodic leg movements in patients with obstructive sleep apnea after continuous positive airway pressure titration. Neuropsychiatr Dis Treat 15:2129–2136CrossRef
27.
go back to reference Means MK, Lichstein KL, Edinger JD, Taylor DJ, Durrence HH, Husain AM, Aguillard RN, Radtke RA (2003) Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea. Sleep Breath 7:31–42CrossRef Means MK, Lichstein KL, Edinger JD, Taylor DJ, Durrence HH, Husain AM, Aguillard RN, Radtke RA (2003) Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea. Sleep Breath 7:31–42CrossRef
28.
go back to reference Picchietti D, Winkelman JW (2005) Restless legs syndrome, periodic limb movements in sleep, and depression. Sleep 28:891–898PubMed Picchietti D, Winkelman JW (2005) Restless legs syndrome, periodic limb movements in sleep, and depression. Sleep 28:891–898PubMed
Metadata
Title
Sleep apnea syndrome comorbid with and without restless legs syndrome: differences in insomnia specific symptoms
Authors
Franziska Pistorius
Peter Geisler
Thomas C. Wetter
Tatjana Crönlein
Publication date
01-09-2020
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 3/2020
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-020-02063-8

Other articles of this Issue 3/2020

Sleep and Breathing 3/2020 Go to the issue

Sleep Breathing Physiology and Disorders • Original Article

Association between the ADAMTS proteinases and obstructive sleep apnea

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine