Restless Legs Syndrome in Liver Transplant Recipients

Abstract

Background: The prevalence of restless legs syndrome (RLS) is approximately 10% in general population. This condition is more prevalent in certain diseases and we previously reported the prevalence of RLS in chronic liver disease population to be 62%. Objectives: Our aim was to assess the self-reported prevalence of RLS using an RLS symptom specific questionnaire in liver transplant patients. Methods: Subjects were a convenience sample in transplant clinic. They completed a validated survey for core RLS symptoms and if positive went on to completed a telephone survey using the validated International RLS Severity Scale Questionnaire (IRLS) and the Johns Hopkins RLS QoL survey to measure the effect of RLS symptoms on daily activities. Results: 40 patients surveyed, RLS was found in 16 subjects (40%) with moderate severity {17 (SD + 7.2, high score 31)}. Hepatitis C as indication for liver transplant was more likely associated with RLS (p = 0.05). Calcium channel blockers were protective (p = 0.032) while antidopaminergic agent use was statistically significant for RLS symptom (p = 0.005). On multiple linear regression analysis, diabetes (p = 0.024) and use of antidepressants/antihistamines (p = 0.049) were associated with RLS. Quality of Life (QoL) surveys specific to RLS suggested RLS symptoms resulted in significantly diminished QoL, with an average QoL score of 80 (SD + 11.7). Conclusion: There was a very high prevalence of RLS in our liver transplant patients with majority experiencing moderate or severe symptoms. The explanation for this higher prevalence is likely due to combination of comorbidites as well as medications that can trigger RLS.

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R. Franco, S. Rizvi, J. Franco and F. Rizvi, "Restless Legs Syndrome in Liver Transplant Recipients," International Journal of Clinical Medicine, Vol. 4 No. 3, 2013, pp. 145-151. doi: 10.4236/ijcm.2013.43026.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] G. J. Lavigne and J. Y. Montplaisir, “Restless Legs Syndrome and Sleep Bruxism: Prevalence and Association among Canadians,” Sleep, Vol. 17, No. 8, 1994, pp. 739- 743.
[2] D. A. Nichols, R. P. Allen, J. H. Grauke, J. B. Brown, M. L. Rice, P. R. Hyde, W. C. Dement and C. A. Kushida, “Restless Legs Syndrome Symptoms in Primary Care: A Prevalence study,” Archives of Internal Medicine, Vol. 163, No. 19, 2003, pp. 2323-2329. doi:10.1001/archinte.163.19.2323
[3] B. H?gl, S. Kiechl, J. Willeit, M. Saletu, B. Frauscher, K. Seppi, J. Müller, G. Rungger, A. Gasperi, G. Wenning and W. Poewe, “Restless Legs Syndrome: A Community- Based Study of Prevalence, Severity, and Risk Factors,” Neurology, Vol. 64, No. 11, 2005, pp. 1920-1924. doi:10.1212/01.WNL.0000163996.64461.A3
[4] G. Merlino, L. Fratticci, M. Valente, A. Del Giudice, C. Noacco, P. Dolso, I. Cancelli, A. Scalise and G. L. Gigli, “Association of Restless Legs Syndrome in Type 2 DIA- BETES: A Case-Control Study,” Sleep, Vol. 30, No. 7, 2007, pp. 866-871.
[5] J. A. O’Hare, F. Abuaisha and M. Geoghegan, “Prevalence and Forms of Neuropathic Morbidity in 800 Diabetics,” Irish Journal of Medical Sciences, Vol. 163, No. 3, 1994, pp. 132-135. doi:10.1007/BF02965972
[6] L. A. Lopes, M. Lins Cde, V. G. Adeodato, D. P. Quental, P. F. de Bruin, R. M. Montenegro Jr. and V. M. de Bruin, “Restless Legs Syndrome and Quality of Sleep in Type 2 Diabetes,” Diabetes Care, Vol. 28, No. 11, 2005, pp. 2633-2636. doi:10.2337/diacare.28.11.2633
[7] S. Walker, A. Fine and M. H. Kryger, “Sleep Complaints Are Common in a Dialysis Unit,” American Journal of Kidney Diseases, Vol. 26, No. 5, 1995, pp. 751-756. doi:10.1016/0272-6386(95)90438-7
[8] D. Kavanagh, S. Siddiqui and C. C. Geddes, “Restless Legs Syndrome in Patients on Dialysis,” American Journal of Kidney Diseases, Vol. 43, No. 5, 2004, pp. 763-771. doi:10.1053/j.ajkd.2004.01.007
[9] S. T. O’Keeffe, K. Gavin and J. N. Lavan, “Iron Status and Restless Legs Syndrome in the Elderly,” Age Ageing, Vol. 23, No. 3, 1994, pp. 200-203. doi:10.1093/ageing/23.3.200
[10] C. J. Earley, J. R. Connor, J. L. Beard, E. A. Malecki, D. K. Epstein and R. P. Allen, “Abnormalities in CSF Concentrations of Ferritin and Transferrin in Restless Legs Syndrome,” Neurology, Vol. 54, No. 8, 2000, pp. 1698- 1700. doi:10.1212/WNL.54.8.1698
[11] X. Gao, M. A. Schwarzschild, H. Wang and A. Ascherio, “Obesity and Restless Legs Syndrome in Men and Women,” Neurology, Vol. 72, No. 14, 2009, p. 1255. doi:10.1212/01.wnl.0000345673.35676.1c
[12] Y. A. Rajabally, et al., “Restless Legs Syndrome in Chronic Inflammatory Demyelinating Polyneuropathy,” Muscle & Nerve, Vol. 42, No. 2, 2010, pp. 252-256. doi:10.1002/mus.21684
[13] S. B. Rutkove, J. K. Matheson and E. L. Logigian, “Restless Legs Syndrome Inpatients with Polyneuropathy,” Muscle & Nerve, Vol. 19, No. 5, 1996, pp. 670-672. doi:10.1002/(SICI)1097-4598(199605)19:5<670::AID-MUS20>3.0.CO;2-Q
[14] M I. Botez and B. Lambert, “Folate Deficiency and Restless Legs Syndrome in Pregnancy,” New England Journal of Medicine, Vol. 297, No. 12, 1977, p. 670. doi:10.1056/NEJM197709222971219
[15] R. A. Franco, “The High Prevalence of Restless Legs Syndrome Symptoms in Liver Disease in an Academic- Based Hepatology Practice,” Journal of Clinical Sleep Medicine, Vol. 4, No. 1, 2008, pp. 45-49.
[16] S. A. Azar, R. Hatefi and M. Talebi, “Evaluation of Effect of Renal Transplantation in Treatment of Restless Legs Syndrome,” Transplantation Proceedings, Vol. 39, No. 4, 2007, pp. 1132-1133. doi:10.1016/j.transproceed.2007.03.097
[17] O. A. Minai, “Restless Legs Syndrome in Lung Transplant Recipients,” The Journal of Heart and Lung Transplantation, Vol. 26, No. 1, 2007, pp. 24-29. doi:10.1016/j.healun.2006.10.014
[18] S. Javaheri, “Prevalence of Obstructive Sleep Apnoea and Periodic Limb Movement in 45 Subjects with Heart Transplantation,” European Heart Journal, Vol. 25, No. 3, 2004, pp. 260-266. doi:10.1016/j.ehj.2003.10.032
[19] J. Kirsch, R. P. Allen, T. Washburn and C. J. Earley, “Validation of the Restless Legs Syndrome Quality of Life Questionnaire,” Value in Health, Vol. 8, No. 2, 2005, pp. 157-167. doi:10.1111/j.1524-4733.2005.03010.x
[20] R. P. Allen and C. J. Earley, “Validation of the Johns Hopkins Restless Legs Severity Scale,” Sleep Medicine, Vol. 2, No. 3, 2001, pp. 239-224. doi:10.1016/S1389-9457(00)00080-0
[21] R. P. Allen, C. A. Kushida and M. J. Atkinson, “Factor Analysis of the International Restless Legs Syndrome Study Group’s Scale for Restless Legs Severity,” Sleep Medicine, Vol. 4, No. 2, 2003, pp. 133-135. doi:10.1016/S1389-9457(02)00193-4
[22] J. Winkelmann, A. Stautner, W. Samtleben and C. Trenkwalder, “Long-Term Course of Restless Legs Syndrome in Dialysis Patients after Kidney Transplantation,” Movement Disorders, Vol. 17, No. 5, 2002, pp. 1072-1076. doi:10.1002/mds.10231
[23] M. Z. Molnar, M. Novak, C. Ambrus, et al., “Restless Legs Syndrome in Patients after Renal Transplantation,” American Journal of Kidney Diseases, Vol. 45, No. 2, 2005, pp. 388-396. doi:10.1053/j.ajkd.2004.10.007
[24] T. Kraus, A. Schuld and T. Pollmacher, “Periodic Leg Movements in Sleep and Restless Legs Syndrome Probably Caused by Olanzapine,” Journal of Clinical Psychopharmacology, Vol. 19, No. 5, 1999, pp. 478-479. doi:10.1097/00004714-199910000-00017
[25] R. Hargrave and D. J. Beckley, “Restless Legs Syndrome Exac-erbated by Sertraline,” Psychosomatics, Vol. 39, No. 2, 1998, pp. 177-178. doi:10.1016/S0033-3182(98)71370-2
[26] R. Bakshi, “Fluoxetine and Restless Legs Syndrome,” Journal of the Neurological Sciences, Vol. 142, No. 1-2, 1996, pp. 151-152. doi:10.1016/0022-510X(96)00180-3
[27] M. J. Garvey and G. D. Tollefson, “Occurrence of Myoclonus in Patients Treated with Cyclic Antidepressants,” Archives of General Psychiatry, Vol. 44, No. 3, 1987, pp. 269-272. doi:10.1001/archpsyc.1987.01800150081010
[28] T. Terao, M. Terao, R. Yoshimura and K. Abe, “Restless Legs Syndrome Induced by Lithium,” Biological Psychiatry, Vol. 30, No. 11, 1991, pp. 1167-1170. doi:10.1016/0006-3223(91)90185-O
[29] M. S. Aldrich and J. E. Shipley, “Alcohol Use and Periodic Limb Movements of Sleep,” Alcoholism: Clinical & Experimental Research, Vol. 17, No. 1, 1993, pp. 192- 196. doi:10.1111/j.1530-0277.1993.tb00747.x
[30] F. J. Authier, et al., “Detection of Genomic Viral RNA in Nerve and Muscle of Patients with HCV Neuropathy,” Neurology, Vol. 60, No. 5, 2003, pp. 808-812. doi:10.1212/01.WNL.0000044399.71601.EA
[31] E. Apartis, “Peripheral Neuropathy Associated with Essential Mixed Cryoglobulinaemia: A Role for Hepatitis C Virus Infection?” Journal of Neurology, Neurosurgery & Psychiatry, Vol. 60, No. 6, 1996, pp. 661-666. doi:10.1136/jnnp.60.6.661

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