Sleep Apnea And Associated Restless Leg Syndrome

In this blog, we will look into restless leg syndrome in conjunction with sleep apnea and sleep interruption and its association.

Sleep apnea is a medical condition characterized by complete or partial cessation of the breath, generally 10 seconds or longer, and has associated symptoms of snoring, fatigue, daytime sleepiness, and cognitive impairment.  Generally, to evaluate sleep apnea, an index is used called the Apnea Hypopnea Index during the diagnostic sleep study.  When associated symptoms are present an Apnea Hypopnea Index of 5/hour or higher, is generally considered positive although an index of 15/hour or higher is needed in many cases when symptoms are minimal.  An Apnea Hypopnea Index of 30/hour or higher is generally considered severe sleep apnea that if untreated has clinical consequences in the long run such as increase risk of heart attack, stroke, worsening of diabetes, and low blood oxygen level (hypoxia).  The treatment is generally a continuous positive airway pressure (CPAP) and in many cases may need BiPAP (bi-level positive airway pressure), especially if the person is unable to tolerate the CPAP.

Restless leg syndrome is a condition where there is an urge to move the legs due to an unpleasant sensation or feeling.  The person feels comfortable after the movement, but the symptoms recur.  In many cases, there are associated causes such as iron deficiency anemia, diabetes, kidney disease, high caffeine intake, and drug related side effects that are especially common in antidepressants that may cause restless leg symptoms.

There is clinical association with sleep apnea and restless leg syndrome.  In many cases, when sleep apnea is acutely treated, the restless leg symptoms improve.  Conversely, there are cases where restless leg symptoms are absent but because severe sleep apnea symptoms are more predominant that once the sleep apnea is treated with the CPAP or BiPAP, in the coming months there is sleep interruption that may be in association with restless leg syndrome.  In that situation, treatment of restless leg syndrome needs to be initiated.

There are pharmacological and non-pharmacological treatment options.  The most commonly used drugs for treatment are Ropinirole (Requip) and Pramipexole (Mirapex).  There are non-pharmacological treatments like regular exercise, improvement in constipation, taking warm baths, leg massage, cutting down caffeine, breathing exercises of yoga or pranayama that may help.

Sleep apnea and restless leg syndrome may both be present in some cases.  By managing both diseases, this may further help improve associated sleep interruption and quality of sleep, which may provide a more restful sleep at night with decrease in fatigue.

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