Prevalence of RLS among subjects with chronic liver disease and its effect on sleep and mood.

BACKGROUND

Earlier studies have shown that prevalence of RLS among patients with chronic liver disease (CLD) ranges between 6.6% and 100%. However, most of these studies had used questionnaires to diagnose RLS reported contradictory findings regarding risk factors for RLS. This study was planned to assess prevalence, severity and correlates of RLS among patients with CLD. We also intend to assess effect of RLS on sleep and mood in this population.

METHODS

Adult population with CLD was included after excluding potential confounders. Etiology of CLD was investigated. Severity of liver disease was assessed using three variables- Child-Turcotte-Pugh (CTP) grade; Model for end-stage liver disease (MELD) score, and as presence of compensated or decompensated liver disease. Acute on chronic liver failure was also defined as per APASL criteria. RLS was diagnosed on clinical interview and examination. To assess the severity of RLS international RLS severity rating scale was used. Diagnosis of insomnia and depression was made using insomnia severity index and patient health questionnaire (PHQ-9) along with clinical examination, respectively. Sleep quality was assessed by Pittsburg Sleep Quality Index- Hindi version.

RESULTS

This sample had predominance of males (78.6%), average age of subjects was 48.70 + 12.31 years and 98.5% subjects had decompensated liver disease. RLS was reported by 19.1% subjects and 2.3% had positive family history of RLS. Subjects with RLS had lower serum iron and serum ferritin compared to subjects without RLS. Among subjects having RLS, 60% had moderately severe symptoms, 32% had severe symptoms and 4% had very severe RLS. Subjects with RLS had greater chances of having depression and poor sleep quality.

CONCLUSION

Present study shows that prevalence of RLS among patients with CLD is greater than population prevalence. Iron deficiency increased risk for having RLS. Subjects with RLS had poorer sleep quality and RLS increased chances of having insomnia and depression.