Influence of Obesity Surgery on Restless Leg Syndrome

Abstract

Restless leg syndrome (RLS), which is a chronic neurosensory-motor disorder, is a disease which is usually accompanied by disturbing or unpleasant sensations, characterised by an irresistible impulse for moving the legs. This sensation which may be as a severe pain may temporarily relieve with movements.Prevalence of RLS varies between 4% and 10% in the general population. 1 RLS, which is characterised by delay in starting sleep, difficulty to maintain sleep, decreased total sleeping time and impairment in slow-wave sleep, leads to an impairment in quality of life. 2 Depression, anxiety and pain disorders are common co-morbid conditions which accompany RLS. 3 Diabetes, cardiovascular disease and stroke risk may also increase in RLS patients. 4 While early-onset RLS (before 45 years) is usually idiopathic, 5 secondary RLS (after 45 years) mainly occurs due to iron deficiency, pregnancy and end stage renal disease (ESRD). Although patho-physiology of RLS is not clear yet, it is considered to be associated with cerebral iron metabolism dysfunction, which leads to abnormal dopaminergic outcomes, 6,7 together with an underlying genetic predisposition. 1,6 Obesity is an important community health problem which is responsible for an important part of sleep-related complaints. 8 It is directly related with sleep disorders like obstructive sleep apnea syndrome and insomnia. 9 The association between RLS and obesity has been investigated in many studies as RLS is also a sleep disorder. RLS patients were reported to have higher BMI values compared to the patients without RLS. 10 RLS prevalence was reported to be higher in obese individuals compared to the non-obese. 11 Similar changes in dopamine metabolism in RLS and obesity have shown a potential relationship between them. 12,13 The factor like iron deficiency having an important role in etio-pathogenesis of RLS, 6 the relationship between obesity and iron deficiency, 14 increase the importance of obesity as a risk factor for RLS.Given the close relationship between obesity and RLS, the aim of this study was to investigate whether RLS symptoms improved and treatment requirement decreased through weight loss on postoperative followups of the patients who underwent LSG due to obesity and who were started medical therapy due to RLS.

Obesity and sleep disturbances: The “chicken or the egg” question

“…Supporting the correlation between obesity and RLS, a study by Ozdas et al has demonstrated that weight loss obtained with bariatric surgery lead to an improvement of RLS symptoms, with around 86% of patients that discontinued medications after 12 months from bariatric surgery [69].…”