The Author: Francoise Roux, MD, PhD is an Associate Professor of Medicine at Yale University School of Medicine in the Section of Pulmonary, Critical Care and Sleep Medicine. She is also the Medical Director of the Yale Center for Sleep Medicine and Program Director of the Sleep Fellowship at Yale University School of Medicine. Her main interests include the link between sleep-disordered breathing and adverse cardiovascular outcomes.
INVITED REVIEW SERIES: TRANSLATING RESEARCH INTO PRACTICE†
Restless legs syndrome: Impact on sleep-related breathing disorders
Article first published online: 25 JAN 2013
© 2012 The Author. Respirology © 2012 Asian Pacific Society of Respirology
Volume 18, Issue 2, pages 238–245, February 2013
How to Cite
ROUX, F. J. (2013), Restless legs syndrome: Impact on sleep-related breathing disorders. Respirology, 18: 238–245. doi: 10.1111/j.1440-1843.2012.02249.x
SERIES EDITORS: JOHN E HEFFNER AND DAVID CL LAM
- Issue published online: 25 JAN 2013
- Article first published online: 25 JAN 2013
- Accepted manuscript online: 13 AUG 2012 02:38AM EST
- Received 1 April 2012; invited to revise 15 April 2012; revised 18 May 2012; accepted 4 June 2012.
- continuous positive airway pressure therapy;
- obstructive sleep apnoea;
- periodic leg movements in sleep;
- restless leg syndrome.
Restless legs syndrome (RLS) is a common chronic sensory-motor neurological disorder that remains a clinical diagnosis. Most RLS patients present with sleep complaints in the form of initiation and/or maintenance insomnia as RLS has a circadian rhythmicity. An increased number of periodic leg movements during sleep (PLMS) is a supportive criterion in the diagnosis of RLS. Abnormalities in the central dopaminergic and iron systems are involved in the physiopathology of RLS. There is a higher prevalence of RLS and PLMS in sleep-disordered breathing patients, particularly those with obstructive sleep apnoea (OSA), the most common sleep disorder in western societies. The complex mechanisms underlying the association between OSA, RLS and PLMS remain unclear. Untreated OSA can lead to adverse cardiovascular consequences due to cardio-metabolic dysfunction. It remains controversial whether RLS could further adversely impact the cardiovascular consequences of OSA. The PLMS do not have an additive effect on the hypersomnia experienced by some sleep-disordered breathing patients. Continuous positive airway pressure (CPAP) therapy is the most effective therapy for OSA. The presence of PLMS during CPAP treatment could be a marker of an incomplete resolution of sleep-disordered breathing in the form of increased upper airway resistance syndrome, despite treatment. Dopaminergic agonists are the preferred agent for the treatment of RLS, and are indicated when RLS symptoms are frequent and affect quality of life. PLMS and RLS do not seem to contribute to the residual hypersomnia that can be observed in some sleep-disordered breathing patients despite adequate compliance and effective CPAP therapy.