Management of Restless Legs Syndrome/Willis-Ekbom Disease in Hospitalized and Perioperative Patients

Goldstein, Cathy

doi:10.1016/j.jsmc.2015.05.003

Cited by 10 publications

(17 citation statements)

References 76 publications

(81 reference statements)

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“…For example, obstructive sleep apnea (OSA) is common and often goes untreated during hospital admissions ( 60 – 62 ). Similarly, preexisting sleep problems such as insomnia and restless legs syndrome can be exacerbated or unmasked by factors associated with critical illness, including blood loss, anxiety, immobility, sleep deprivation, provoking drugs, or cessation of therapeutic medications ( 63 ). Furthermore, preexisting disrupted sleep and undiagnosed OSA disproportionately affect racial and ethnic minorities ( 64 , 65 ).…”

Section: Subtopic 1: Prevalence Incidence and Risk Factorsmentioning

confidence: 99%

Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement

Knauert¹,

Ayas²,

Bosma³

et al. 2023

Am J Respir Crit Care Med

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Background Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.

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Section: Subtopic 1: Prevalence Incidence and Risk Factorsmentioning

confidence: 99%

Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement

Knauert¹,

Ayas²,

Bosma³

et al. 2023

Am J Respir Crit Care Med

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“…Perioperative Management of Sleep Disorders postoperative outcomes. 27,33 Sleep disruption and sleep loss are common preceding and following surgery, 11 and this can aggravate RLS. 26,27 Forced immobility, either via bedrest or casting/splinting, is often required following surgery and can worsen RLS symptoms.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

“…Abrupt cessation of these medications can lead to significant rebound RLS symptoms. 27 The perioperative addition of medications known to aggravate RLS can precipitate RLS in patients previously under control. 27,36 Finally, there is controversy about whether or not the use of spinal anesthesia can promote RLS or not.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

“…27 The perioperative addition of medications known to aggravate RLS can precipitate RLS in patients previously under control. 27,36 Finally, there is controversy about whether or not the use of spinal anesthesia can promote RLS or not. 37,38 An early study found 9% of patients undergoing spinal anesthesia developed new-onset "transient RLS; 37 " however, a follow-up study did not find any new cases of RLS following spinal anesthesia.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

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Perioperative Management of Insomnia, Restless Legs, Narcolepsy, and Parasomnias

Hershner

Auckley

2021

Anesthesia &Amp; Analgesia

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Obstructive sleep apnea (OSA) has been shown to increase risk of adverse perioperative events. More recently, investigators have begun to examine other common sleep disorders to assess how they may be impacted by the perioperative environment, as well as influence postoperative outcomes. There are a number of mechanisms by which such common sleep disorders (eg, insomnia, restless legs syndrome, narcolepsy, and parasomnias) may have consequences in the perioperative setting, both related to the underlying pathophysiology of the diseases as well as their treatments. This review will highlight the current state of the literature and offer recommendations for management of these conditions during the perioperative journey.

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“…This finding was not replicated in a second study (Crozier et al, 2008 ), albeit with a study population with very different composition. The perioperative period may be a time of heightened vulnerability to worsening RLS symptoms, because of prolonged immobility, blood loss, iatrogenic sleep loss, temporary cessation of symptomatic treatment, and use of medications such as metoclopramide that can worsen RLS (Högl et al, 2012 ; Goldstein, 2015 ). However, the possibility of acute or chronic effects of general anesthesia has not been well-defined in RLS patients.…”

Section: Introductionmentioning

confidence: 99%

Central Disorders of Hypersomnolence, Restless Legs Syndrome, and Surgery With General Anesthesia: Patient Perceptions

LaBarbera

García

Bliwise

et al. 2018

Front. Hum. Neurosci.

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Introduction: The importance of obstructive sleep apnea in patients undergoing surgery with general anesthesia is well-defined, but the surgical and anesthetic implications of other sleep disorders are less clear. We sought to evaluate response to surgery with general anesthesia in patients with central disorders of hypersomnolence or restless legs syndrome.Methods: We surveyed patients on their most recent surgical procedure with general anesthesia, querying about procedure, recovery, and any changes in sleep disorder symptomatology following the procedure.Results: Forty-five patients with restless legs syndrome and 57 patients with central disorders of hypersomnolence (15 narcolepsy type 2, 1 narcolepsy type 1, 30 idiopathic hypersomnia, 1 Kleine-Levin syndrome, and 10 subjective sleepiness) completed the survey, with response rates of 45.5 and 53.8%, respectively. While patients in both groups were equally likely to report surgical complications and difficulty awakening from anesthesia, hypersomnolent patients were more likely to report worsened sleepiness (40% of the hypersomnolent group vs. 11% of the RLS group, p = 0.001) and worsening of their sleep disorder symptoms (40% of the hypersomnolent group vs. 9% of the RLS group, p = 0.0001).Conclusion: Patients with sleep disorders other than sleep apnea frequently report surgical or anesthetic complications. Patients with hypersomnolence disorders commonly perceive that their sleep disorder worsened following a procedure; whether this might be related to long term effects of general anesthesia in a particularly vulnerable clinical population requires further study.

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Management of Restless Legs Syndrome/Willis-Ekbom Disease in Hospitalized and Perioperative Patients

Cited by 10 publications

References 76 publications

Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement

Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement

Perioperative Management of Insomnia, Restless Legs, Narcolepsy, and Parasomnias

Central Disorders of Hypersomnolence, Restless Legs Syndrome, and Surgery With General Anesthesia: Patient Perceptions

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