Tag: restless legs

Do Pre-existing Sleep Disorders Worsen Long COVID Fatigue and Brain Fog?

Abstract:

Introduction: Long COVID is common after COVID-19 infection and leads to functional limitations with most reporting substantial symptom burden from fatigue. Symptoms in sleep disorders are attributed to inflammatory dysregulation and may predispose to fatigue expression. We hypothesize prior diagnoses of sleep disorders are associated with severity of long COVID fatigue.
Methods: A retrospective EMR review was performed of 210 consecutive adult patients (9/2021 to 2/2022) referred at least 3 months after COVID-19 infection seen in a new community-based long COVID clinic. The intake process collected demographics, past medical history, functional questionnaires, and symptom checklists. Primary outcome was Fatigue Severity Scale (FSS) score. Sleep disorders were evaluated as a composite of self-reported insomnia, sleep disordered breathing, and restless legs syndrome as well as subset analyses of each disorder. Secondary outcome was physical functioning measured by ECOG performance scale. Linear analyses were used for FSS and ECOG analyses. Adjustors included age, sex, body mass index (BMI), and whether patient had COVID-19 hospitalization.
Results: Cohort was female (66.2%), aged 51.6±SD14.4 yrs, BMI 29.8 [IQR 26.2, 37.7]). Prior chronic insomnia was present in 9%, sleep disordered breathing in 23%, and RLS in 4%; the pooled history of sleep disorders was 30%. Fatigue was reported in 76% with mean FSS score of 5.44 [interquartile range, IQR: 4.11,6.44]; 48% reported brain fog. The interval between acute COVID infection and clinic evaluation was 10.4±5.34 months and had no association to FSS severity (r = 0.07, p = 0.30). Sleep disorders in aggregate, insomnia, and restless legs syndrome had no associations with fatigue or functional status. Sleep disordered breathing had an association to fatigue in unadjusted (β = 0.68, 95% confidence interval, [CI]:0.13,1.24), but not adjusted models (β = 0.53, 95%CI: -0.06,1.13). Sleep disorders both in aggregate and evaluated individually had no associations to brain fog.
Conclusion: A prior history of sleep disorders contributed little to post-COVID fatigue reported in those presenting to a community-based Long COVID clinic.

Source: Isabelle Carter and others, 0967 Do Pre-existing Sleep Disorders Worsen Long COVID Fatigue and Brain Fog?, Sleep, Volume 46, Issue Supplement_1, May 2023, Pages A426–A427, https://doi.org/10.1093/sleep/zsad077.0967 (Full text is available as PDF file)

Restless legs syndrome is associated with long-COVID in women

Abstract:

Study Objectives: Sleep disturbance is common in long-COVID (LC). Restless legs syndrome (RLS) is characterized by sleep disturbance and has been reported after viral infections. Therefore, we evaluated RLS symptoms cross-sectionally in individuals with LC at both current and pre-COVID19 timepoints.

Methods: LC-focused Facebook adults were recruited for an online assessment of symptoms before COVID-19 infection and during their present LC state in a cross-sectional manner. The LC group documented baseline symptoms retrospectively. Questions were included about the presence/severity of RLS symptoms and assessments of fatigue, quality of life, and sleep apnea. A control group was recruited and included individuals ≥18 years of age who never had overt symptoms of COVID-19. Pregnancy was exclusion criteria for both groups.

Results: There were 136 LC participants (89.7% females, age 46.9 ±12.9 years) and 136 controls (65.4% females, age 49.2 ±15.5). RLS prevalence in LC-females was 5.7% pre-COVID-19 and 14.8% post-COVID-19 (p<0.01) vs. 6.7% in control-females. Severity of RLS was moderate in both groups. Logistic regression predicting post-COVID-19 RLS among LC-females failed to find significant effects of hospitalization, sleep apnea, neuropathic pain severity or use of antihistamines and antidepressants.

Conclusions: The baseline prevalence of RLS in LC-females was similar to the general population group as well as to patients in epidemiological studies. The prevalence significantly increased in the LC state. Post-infectious immunological mechanisms may be at play in the production for RLS symptoms.

Source: Leonard B. Weinstock, MD, FACG ; Jill B. Brook, MA ; Arthur S. Walters,  MD ;  Ashleigh Goris, RN, BSN, MPH, CIC, FAPIC ; Lawrence B. Afrin, MD ; Gerhard J. Molderings, MD. Restless legs syndrome is associated with long-COVID in women. Journal of Clinical Sleep Medicine. Published Online:January 25, 2022. https://doi.org/10.5664/jcsm.9898 https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.9898 (Full study)

Not what it seems to be: Depression versus periodic limb movement disorder

Abstract:

Sleep disorders often disturb sleep. Daytime symptoms of disturb sleep mimic that of depression, somatoform disorder, fibromyalgia and chronic fatigue syndrome. We are presenting a case of depression who was not responding to antidepressant therapy. Based on clinical history, diagnosis was changed to chronic fatigue syndrome and in view of prominent sleep disturbances, polysomnography was done. Based on sleep study data, diagnosis of periodic limb movement disorder was made and he was started on ropinirole, that improved his symptoms.

Source: Gupta R, Kundu K, Khayyam K, Saini LK. Not what it seems to be: Depression versus periodic limb movement disorder. Indian J Psychiatry. 2020 Jul-Aug;62(4):437-439. doi: 10.4103/psychiatry.IndianJPsychiatry_450_19. Epub 2020 Jul 27. PMID: 33165358; PMCID: PMC7597704. https://pubmed.ncbi.nlm.nih.gov/33165358/

Periodic K-alpha sleep EEG activity and periodic limb movements during sleep: comparisons of clinical features and sleep parameters

Abstract:

The K-alpha sleep electroencephalographic (EEG) phenomenon is characterized by periodic (approximately 20-40 seconds) K-complexes, immediately followed by alpha-EEG activity (7.5-11 Hz) of 0.5- to 5.0-second duration. A group of 14 subjects with the periodic K-alpha anomaly was found to have a similar distribution pattern of interevent intervals as compared with previously published data for sleep-related periodic limb movements during sleep (PLMS). Sleep parameters and somatic symptoms of 30 patients with K-alpha were compared with 30 patients with PLMS. The periodic K-alpha group was predominantly female, younger, exhibiting more slow-wave sleep, gastrointestinal symptoms and muscular complaints and fewer movement arousals on overnight polysomnography. The K-alpha group presented uniformly with complaints of unrefreshing sleep, often associated with fibromyalgia and chronic fatigue syndrome. The PLMS group was predominantly male, showed greater sleep disruption and presented with a variety of sleep-related symptoms.

 

Source: MacFarlane JG, Shahal B, Mously C, Moldofsky H. Periodic K-alpha sleep EEG activity and periodic limb movements during sleep: comparisons of clinical features and sleep parameters. Sleep. 1996 Apr;19(3):200-4. http://www.ncbi.nlm.nih.gov/pubmed/8723376