Original ArticleComparison of impact of insomnia on depression and quality of life in restless legs syndrome/Willis–Ekbom disease and primary insomnia patients
Introduction
Restless legs syndrome/Willis–Ekbom disease (RLS/WED) is a common, sensorimotor, neurological disorder with significant impact on sleep and quality of life (QoL). Sleep disturbance is common in RLS, and both insomnia and RLS symptoms are independently associated with depression [1], [2], which further contributes to impaired QoL [3]. An estimated 50–85% of people with RLS suffer from initial or sleep-maintenance insomnia [4], [5], [6], [7], [8], [9], [10], [11], and insomnia is more common among those with greater symptom severity [11], [12]. In particular, depression is common in RLS, with a prevalence ranging from 10 to 50% [13], [14], [15], and the presence of RLS has been associated with a higher risk of clinical depression, greater severity of depression scores, and lower internal locus of control [13], [16], [17], [18], [19], [20].
In the general population, insomnia is closely associated with depression [21], [22] and impaired QoL [23], [24], [25], but effective insomnia treatment may improve these outcomes [26], [27], [28]. Depression is also closely associated with impaired QoL in several medical conditions [29], [30], [31], [32], [33]. In RLS studies in particular, both insomnia and depression have been associated with fatigue, poor social functioning, and poor QoL [10], [12], [34], [35], and electroencephalographic evidence of sleep fragmentation in RLS predicts poor psychological function at follow-up nearly three years later [36].
The impact of insomnia on depression and QoL in people with RLS, however, remains unclear. Previous findings have been inconsistent. For instance, one longitudinal study of people with RLS was unable to find an association between depression and sleep disturbance [37], whereas in a cohort of patients with chronic kidney disease, insomnia mediated a portion of the association between RLS and depression [38]. Further, using structural equation modeling, sleep disturbances were shown to mediate a significant component of emotional distress among subjects with RLS [39]. It is believed that, to date, no previous study has compared the impact of insomnia symptoms on depression and QoL among people with RLS and primary insomnia.
Following the previous work by Brand et al. [36], it was hypothesized that there is an association between insomnia and both depression and QoL among people with RLS and primary insomnia, and that this association is stronger among subjects with primary insomnia than those with RLS. To test this hypothesis, the impact of insomnia on depression and QoL was compared among people with RLS, primary insomnia, and healthy controls.
Section snippets
Participants
The institutional ethics committee of the regional hospital approved this study. The target population included 263 drug-naïve people – 148 with primary RLS and 115 with primary insomnia – who were evaluated at a tertiary-care sleep center between August 2010 and November 2013. A certified Korean neurologist, who was an expert in sleep medicine (YWC), evaluated each person with RLS or primary insomnia. Each person with RLS met the 2014 Revised International Restless Legs Syndrome Study Group
Comparison of general characteristics and the features of restless legs syndrome
A total of 148 people with RLS, 115 with primary insomnia, and 117 healthy controls were enrolled. There were no significant differences in age, gender, or body-mass index (BMI) among the groups. In the RLS group, 38 (25.7%) participants had a family history of RLS. The RLS group had a mean age of RLS onset of 42.45 years (±12.79), symptom duration of 8.09 years (±8.58), mean ferritin level of 67.22 ng/mL (±65.45), mean K-IRLS of 27.69 (±6.41), and mean K-RLSQol of 59.54 (±22.57) (data not
Discussion
Insomnia is a common comorbidity in people with RLS [7], [9], [12], [20], and depressed mood commonly occurs in people with both RLS and primary insomnia [50]. Insomnia prevalence among the participants with RLS in the present study was 62.2%, which is toward the higher end of the range of previous reports [4], [5], [6], [7], [8], [9], [10], [11]. Also in this study, depression of at least moderate severity (BDI score of ≥20) occurred in 37.8% of participants with RLS, which was higher than the
Conflict of interest
All authors have no conflicts of interest.
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2015.06.019.
Acknowledgements
This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No. 2014R1A5A2010008).
References (58)
- et al.
Assessing health-related quality of life in patients with restless legs syndrome in Korea: comparison with other chronic medical diseases
Sleep Med
(2012) - et al.
Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study
Sleep Med
(2004) - et al.
Prevalence, severity and risk factors of restless legs syndrome in the general adult population in two Scandinavian countries
Sleep Med
(2005) - et al.
Comorbidity in restless legs syndrome among a sample of Swedish adults
Sleep Med
(2007) - et al.
Prevalence and correlates of restless legs syndrome: results from the 2005 National Sleep Foundation Poll
Chest
(2006) - et al.
Physician-diagnosed restless legs syndrome in a large sample of primary medical care patients in western Europe: prevalence and characteristics
Sleep Med
(2010) - et al.
Restless legs syndrome in 218 patients: associated disorders
Sleep Med
(2000) - et al.
Assessing health-related quality of life in patients with restless legs syndrome
Sleep Med
(2009) - et al.
Association of insomnia severity and comorbid medical and psychiatric disorders in a health plan-based sample: insomnia severity and comorbidities
Sleep Med
(2010) - et al.
Chronic insomnia, quality-of-life, and utility scores: comparison with good sleepers in a cross-sectional international survey
Sleep Med
(2012)
Quality of life in older adults receiving medications for anxiety, depression, or insomnia: findings from a community-based study
Am J Geriatr Psychiatry
A study examining depression in restless legs syndrome
Asian J Psychiatr
Association between restless legs syndrome and depression in patients with chronic kidney disease
J Psychosom Res
Modeling the causal relationships between symptoms associated with restless legs syndrome and the patient-reported impact of RLS
Sleep Med
Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance
Sleep Med
Sleep disorders and depressive feelings: a global survey with the Beck depression scale
Sleep Med
Prevalence and correlates of restless legs syndrome symptoms in the Wisconsin Sleep Cohort
Sleep Med
Depression and anxiety complaints; relations with sleep disturbances
Eur Psychiatry
Relationship between quality of life and mood or depression in patients with severe obstructive sleep apnea syndrome
Chest
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
Diagnosis, comorbidities, and management of restless legs syndrome
Curr Med Res Opin
Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria
Mov Disord
Restless legs syndrome: a clinical study of 55 patients
Eur Neurol
Restless legs syndrome prevalence and impact: REST general population study
Arch Intern Med
Restless legs syndrome and its relationship with insomnia symptoms and daytime distress: epidemiological survey in Sweden
Psychiatry Clin Neurosci
Restless legs syndrome in older people: a community-based study on its prevalence and association with major depressive disorder in older Korean adults
Int J Geriatr Psychiatry
Correlation of anxiety and depression symptoms in patients with restless legs syndrome: a population based survey
J Neurol Neurosurg Psychiatry
Restless legs syndrome in a community sample of Korean adults: prevalence, impact on quality of life, and association with DSM-IV psychiatric disorders
Sleep
Restless legs syndrome is associated with DSM-IV major depressive disorder and panic disorder in the community
J Neuropsychiatry Clin Neurosci
Cited by (12)
Quality of life among patients with restless legs syndrome: A systematic review and meta-analysis
2024, Journal of Clinical NeuroscienceCognitive behavioral therapy for insomnia in restless legs syndrome patients
2020, Sleep MedicineCitation Excerpt :RLS patients report having severe insomnia, low sleep efficiency, insufficient total sleep time, long latency to sleep onset, and wake after sleep onset [18]. In addition, depressive mood and anxiety are often reported [19], that is even worse in RLS patients with comorbid insomnia [6]. CBTI has been effective for these variables and has been validated in studies conducted in patients with chronic pain or psychiatric disorders [12].
Depressive Symptoms and Suicidal Thoughts in Restless Legs Syndrome
2022, Movement DisordersTranscranial sonography characteristics and their influencing factors in patients with restless leg syndrome
2022, Chinese Journal of NeuromedicineBehavioral Presentation of Sleep-Related Motor Disorders
2022, Sleep and Neuropsychiatric Disorders