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To what extent and why are COPD and Willis-Ekbom disease associated?

  • Neurology • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Aim

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.

Method

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.

Results

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.

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Authors and Affiliations

  1. Department of Chest Diseases, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, 34020, Zeytinburnu, Istanbul, Turkey

    Tugba Mandal, Dilek Kanmaz, Ahmet Levent Karasulu, Gülfidan Aras & Esin Tuncay

  2. Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu, Istanbul, Turkey

    Şenay Aydın

Authors
  1. Tugba Mandal
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  2. Şenay Aydın
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  3. Dilek Kanmaz
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  4. Ahmet Levent Karasulu
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  5. Gülfidan Aras
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  6. Esin Tuncay
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Corresponding author

Correspondence to Tugba Mandal.

Ethics declarations

Study funding

This study was not any financially supported.

Conflict of interest

The investigation was performed at the sleep laboratory of the Department of Chest Diseases, Yedikule Chest Diseases, and Chest Surgery Training and Research Hospital. The work has been seen and approved by all co-authors. The authors have no proprietary, financial, professional, or other personal interest of any nature or kind in any product, service, and/or company that could be construed as influencing the position presented in, or the review of, the manuscript.

Ethical approval

Local Ethics Committee approval was taken for the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

The manuscript entitled “To What Extent and Why Are COPD and Willis-Ekbom Disease Associated?” which we submit for consideration to be published in Journal of Sleep and Breathing is not under consideration for publication or published elsewhere.

Comment

This is the first study looking into detail at the predictors of restless legs syndrome in stable COPD patients without comorbidities. They confirm a very high prevalence of restless legs although a rather young study population. Iron reserve, but not inflammation is contributing to its genesis, in the absence of traditional organic risk factors.

Johan Verbraecken

Antwerp, Belgium

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Mandal, T., Aydın, Ş., Kanmaz, D. et al. To what extent and why are COPD and Willis-Ekbom disease associated?. Sleep Breath 20, 1021–1027 (2016). https://doi.org/10.1007/s11325-016-1359-3

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  • DOI: https://doi.org/10.1007/s11325-016-1359-3

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