Mandal Tugba, Aydın Şenay, Kanmaz Dilek, Karasulu Ahmet Levent, Aras Gülfidan, Tuncay Esin
Department of Chest Diseases, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, 34020, Zeytinburnu, Istanbul, Turkey.
Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu, Istanbul, Turkey.
Sleep Breath. 2016 Sep;20(3):1021-7. doi: 10.1007/s11325-016-1359-3. Epub 2016 May 30.
Willis-Ekbom disease (RLS/WED) is common in chronic obstructive pulmonary disease (COPD). Patients with RLS/WED have poorer quality of sleep and more fatigue and depressive symptoms. The prevalence of RLS/WED in patients with COPD has been reported to vary between 29.1 and 36.8 %. However, during exacerbation, the prevalence can increase up to 54 %. These rates are higher than those seen in general population. We have not enough knowledge regarding the association between RLS and COPD. In this study, we aimed to determine the frequency of RLS in patients with stable COPD without comorbid conditions. In addition, we also aimed to determine possible related causative factors.
We included 80 COPD patients without comorbid conditions who presented to our outpatient clinic between April 2013 and September 2013 for RLS/WED evaluation. Three cases that have polyneuropathy and one case that refused undergoing electromyography (EMG) examination were excluded from the study. Demographic data, P-A chest X-rays, pulmonary function tests (PFT), biochemical parameters (including hemogram), and dyspnea scales were evaluated for each patient. In addition, the RLS/WED rating scale and Epworth Sleep Scale (ESS) were applied. Further, each patient diagnosed with RLS/WED underwent a detailed neurological examination (performed by a neurologist) and an EMG examination to rule out polyneuropathy.
Out of 76 COPD cases included in our study, 26.3 % (n = 20) were diagnosed with RLS/WED (mean age 60.4 ± 7.5 years, 20 males). The cases with RLS/WED had significantly lower body mass index (BMI) than cases without RLS/WED (p = 0.009). There were no significant differences between cases with and without RLS/WED with respect to PFT, dyspnea scales, and arterial blood gas values. However, ESS was significantly different (p = 0.016). There were no significant differences in RLS/WED scores and mean hs-CRP levels between COPD stages (p = 0.424; p = 0.518, respectively), while ESS was significantly different (p = 0.016). ESS was significantly higher in stage B COPD than in stages A and D (p = 0.005, p = 0.008, respectively). Based on our model, we found that exacerbations and iron binding capacity (UIBC) were predictive factors for RLS/WED (p < 0.100) CONCLUSION: RLS/WED is a common disease in cases with stable COPD. Despite our hypothesis suggesting that the prevalence of RLS/WED in COPD is related with systemic inflammation, we did not find a significant association between hs-CRP and COPD cases with RLS/WED. However, we did find that UIBC is a predictive factor for the development of RLS/WED. Nonetheless, further studies are needed to understand the relationships between UIBC, low BMI, and the development of RLS/WED in COPD.
不安腿综合征（RLS/WED）在慢性阻塞性肺疾病（COPD）中很常见。RLS/WED患者的睡眠质量较差，且更易出现疲劳和抑郁症状。据报道，COPD患者中RLS/WED的患病率在29.1%至36.8%之间。然而，在病情加重期间，患病率可增至54%。这些比率高于普通人群中的比率。我们对RLS与COPD之间的关联了解不足。在本研究中，我们旨在确定无合并症的稳定期COPD患者中RLS的发生率。此外，我们还旨在确定可能的相关致病因素。
我们纳入了80例无合并症的COPD患者，这些患者于2013年4月至2013年9月到我们的门诊进行RLS/WED评估。3例患有多发性神经病的患者和1例拒绝接受肌电图（EMG）检查的患者被排除在研究之外。对每位患者评估人口统计学数据、胸部正侧位X线片、肺功能测试（PFT）、生化参数（包括血常规）和呼吸困难量表。此外，应用RLS/WED评定量表和爱泼华嗜睡量表（ESS）。此外，每位被诊断为RLS/WED的患者均接受了详细的神经系统检查（由神经科医生进行）和EMG检查以排除多发性神经病。
在我们研究纳入的76例COPD病例中，26.3%（n = 20）被诊断为RLS/WED（平均年龄60.4±7.5岁，20例男性）。RLS/WED患者的体重指数（BMI）显著低于无RLS/WED的患者（p = 0.009）。在PFT、呼吸困难量表和动脉血气值方面，有RLS/WED和无RLS/WED的患者之间无显著差异。然而，ESS有显著差异（p = 0.016）。COPD各阶段之间的RLS/WED评分和平均高敏C反应蛋白（hs-CRP）水平无显著差异（分别为p = 0.424；p = 0.518），而ESS有显著差异（p = 0.016）。B期COPD患者的ESS显著高于A期和D期（分别为p = 0.005，p = 0.008）。基于我们的模型，我们发现病情加重和未饱和铁结合力（UIBC）是RLS/WED的预测因素（p < 0.100）
RLS/WED在稳定期COPD患者中是一种常见疾病。尽管我们的假设表明COPD中RLS/WED的患病率与全身炎症有关，但我们未发现hs-CRP与患有RLS/WED的COPD病例之间存在显著关联。然而，我们确实发现UIBC是RLS/WED发生的一个预测因素。尽管如此，仍需要进一步研究以了解UIBC、低BMI与COPD中RLS/WED发生之间的关系。
