Syftet med denna systematiska litteraturstudie var att beskriva hur restless legs inverkar på individens sömn och livskvalitet. Syftet var även att granska vilka olika former av behandlingar som finns att tillgå vid restless legs. För att finna information om detta ämne har endast vetenskapliga artiklar använts. Datainsamlingen har skett via databaser, internet samt Högskolans bibliotek, och artiklar från år 1995 och framåt har valts ut. Inklusionskriterier för denna studie var att de valda artiklarna skulle vara internationella vetenskapliga artiklar i fulltext. De funna artiklarna granskades med avseende på vetenskaplig kvalitet och poängsattes utifrån för ändamålet avsedda granskningsmallar. Denna bedömning resulterade i 21 artiklar. Resultatet visade att restless legs patienter upplever sömnbristen som det största problemet. För flertalet individer som drabbas av restless legs försämrades livskvaliteten och patienterna drabbades vanligtvis av psykologiska och fysiologiska besvär. Det vanligaste sättet att behandla restless legs var att använda dopaminerga läkemedel samt bensodiazepiner, antiepileptika och opioider. Andra former av behandlingar var järn, homeopatiska läkemedel, hypnos samt fysisk aktivitet. Det förekom även att restless legs patienter på eget initiativ använde hasch eftersom det ansågs lindra symtomen.

It is known that sleep problems affect people’s wellbeing and has great consequences for public health. Restless legs syndrome (RLS) gives uncomfortable sensations in the legs at rest, leading to an irresistible need for activity. It aggravates in evening and at night. Therefore, RLS provides poorer sleep and can affect quality of life through fatigue, family life and social activities, work, and comorbidity. It is demonstrated a dysfunction of the dopaminergic system in the brain with low levels of dopamine and / or less sensitive dopamine receptors. RLS is more common in women and the prevalence increases with age and during pregnancy. Periodic limb movements are characterized by uncontrolled stretching movements of the legs, especially the toes, ankles, knees and hips during sleep. They last between 0.5 and 5 seconds, and can cause brief awakenings leading to daytime sleepiness. The clinical significance of PLM is rather controversial and PLM is sometimes seen in healthy people with no daytime symptoms. RLS is a subjective diagnosis and translated with the help of questionnaires. PLM however, can objectively be evaluated by polysomnography. Depression is common during and after pregnancy. It is not known whether women with RLS during pregnancy have a higher risk of prenatal or postpartum depression. The aims of this thesis was to  to examine the prevalence, associated symptoms and comorbidities, in particular, vasomotor symptoms, menopause, and hormone replacement therapy (HRT) use, among women who suffer from RLS and PLMs. We also evaluated the impact of RLS and PLMs on health related quality of life (HRQoL), and if RLS before and during pregnancy increases the risk of antenatal or postpartum depressive symptoms. Three different poulations were used.  Paper 1-3 were cross-sectional and included 5000 resp. 10000 randomly selected women from the general populations of Dalarna and Uppsala County. Questionnaires, polysomnographic recordings, blodtests etc. were used. Paper 4 was a longitudinal cohort study where 1428 pregnant women in Uppsala County were followed. In summary, data included in this thesis points out that RLS and PLMs are more common in women with estrogendeficiency-related symptoms of menopause. RLS-positive women had an impaired mental HRQoL compared to RLS-negative women and more often suffered from comorbidities. Data also revealed that women with RLS before and during pregnancy are at increased risk for depression during and after pregnancy.

Freiburg i. Br., Univ., Diss., 2007.

Universidade Federal do Cearà / ESPI e HemodiÃlise. O estudo compreendeu duas fases, transversal em uma primeira fase e prospectivamente durante os dois anos seguintes (2007-2009) para avaliar as alteraÃÃes do sono, sintomas depressivos e a mortalidade em pacientes em hemodiÃlise (HD). Dos 400 pacientes estudados 59% eram homens, idade=51,6Â15,5, em HD hà 5,9Â5,5 anos. SÃndrome de pernas inquietas (SPI) presente em 21,5% predominou em mulheres (p< 0,005); 55,8% apresentavam SPI moderada/grave (International Restless Legs Syndrome (IRLS)>15),e 44,2% sintomas leves. Pacientes com SPI apresentavam reduÃÃo da hemoglobina (p < 0,005) e tendÃncia a hipoalbuminemia (p=0,06). Mà qualidade do sono (Ãndice de Qualidade do Sono de Pittsburgh, IQSP>5) foi mais comum nos indivÃduos com SPI tinham quando comparados aos que nÃo tinham SPI (69,8% vs 56,8%, p=0,002). O risco de SAOS foi maior nos casos com SPI (todos os casos p = 0,01 e casos com SPI moderada/grave, p=0,007, respectivamente). Os casos com SPI moderada/grave associaram-se com hipertensÃo arterial (p=0,01) que permaneceu apÃs o controle para o risco de SAOS (p=0,02). Os turnos de diÃlise nÃo se relacionaram com transtornos do sono nem com sintomas depressivos e outras variÃveis clÃnicas e laboratoriais. AlteraÃÃes do sono e sintomas depressivos na HD. Foram utilizados os questionÃrios IQSP, a Escala de SonolÃncia de Epworth (ESE), o questionÃrio de Berlin, o IDB-II e o Ãndice de Comorbidades de Charlson (ICC). Os fatores de risco independentes associados com a mà qualidade do sono (56,8%) foram insuficiÃncia cardÃaca (OR=1,99, p=0,006), envelhecimento (OR=1,01, p=0,009). Os fatores de risco independentes para depressÃo (BDI-II>16, 19,3%) foram diabetes (OR=2,96, p=0,001], gÃnero feminino (OR=1,96, p=0,007), e hipoalbuminemia (OR=1,86, p=0,024). Mortalidade. O teste mÃltiplo de regressÃo mostrou que, em ambos os gÃneros, o aumento das comorbidades (p<0,005) e idade avanÃada (p<0,005) associaram-se com a mortalidade. Nas mulheres, o Ãndice de comorbidades determinou a mortalidade (p<0,005). Em homens, hipoalbuminemia (p=0,007), idade mais avanÃada(p<0,005), paratormÃnio reduzido (p=0,001) e sonolÃncia excessiva (p=0,03) diurna constituem fatores de risco para mortalidade. ConclusÃes. A prevalÃncia de depressÃo nos pacientes em HD à maior que na populaÃÃo geral. GÃnero feminino, diabetes, insuficiÃncia cardÃaca, hipoalbuminemia e idade sÃo condiÃÃes importantes associadas com depressÃo nos pacientes de HD e constituem caracterÃsticas Ãteis para identificar com prioridade os pacientes que podem se beneficiar com o tratamento da depressÃo apÃs o seu rastreamento. As mulheres e indivÃduos com anemia tÃm risco maior de SPI e SPI revelou-se importante nesse estudo pela sua associaÃÃo nas formas moderada/grave com hipertensÃo arterial, alÃm de depressÃo e mà qualidade do sono. BenefÃcios do tratamento adequado com possÃvel impacto nesses parÃmetros devem ser avaliados. SonolÃncia excessiva diurna associada com doenÃa cerebrovascular e anemia instiga a possibilidade de que a correÃÃo da anemia pode melhorar a sonolÃncia um conhecido fator de risco para DCV e mortalidade. A influÃncia de fatores distintos na mortalidade de homens e mulheres nesses pacientes merece ser explorada. . / SPI and Hemodialysis. The study comprised two phases, first phase in a cross-sectional and prospectively over the next two years (2007-2009) to evaluate sleep disturbances, depressive symptoms and mortality in patients on hemodialysis (HD). Of the 400 patients studied 59% were men, mean age = 51.6  15.5 in HD for 5.9  5.5 years. Restless Leg Syndrome (RLS) present in 21.5% predominated in women (p <0.005), 55.8% had RLS impairment (International Restless Legs Syndrome (IRLS)> 15) and 44.2% mild symptoms. RLS patients had a reduction in hemoglobin (p <0.005) and tendency to hypoalbuminemia (p = 0.06). Poor quality of sleep (Sleep Quality Index in Pittsburgh, PSQI> 5) was more common in individuals with RLS were compared to those without RLS (69.8% vs 56.8%, p = 0.002). The risk of OSA was higher in patients with RLS (all cases p = 0.01 and RLS cases with moderate / severe, p = 0.007, respectively). Cases with SPI moderate / severe were associated with hypertension (p = 0.01) that remained after controlling for risk of OSA (p = 0.02). The shifts of dialysis were not related to sleep disorders or depression symptoms and other clinical and laboratory findings. Sleep disturbances and depressive symptoms in HD. We used the PSQI questionnaire, the Epworth Sleepiness Scale (ESS), the Berlin questionnaire, the BDI-II and Charlson Comorbidity Index (CCI). The independent risk factors associated with poor sleep quality (56.8%) were heart failure (OR = 1.99, p = 0.006), age (OR = 1.01, p = 0.009). The independent risk factors for depression (BDI-II> 16, 19.3%) were diabetes (OR = 2.96, p = 0.001), female gender (OR = 1.96, p = 0.007), and hypoalbuminemia (OR = 1.86, p = 0.024). Mortality. The multiple regression test showed that in both genders, increasing age and comorbidities were associated with mortality. In women, the comorbidity rates determined mortality (p<005). In men, hypoalbuminemia ((p=0.007), older age (p<005), parathyroid hormone (p=0.001) and reduced excessive daytime sleepiness (p=0.03) were associated with mortality. Conclusion. The prevalence of depression in HD patients is higher than the general population. Female gender, diabetes, heart failure, hypoalbuminemia and age are important conditions associated with depression in HD patients and are useful features to identify priority patients who may benefit from the treatment of depression after his screening. Women and individuals with anemia are at greater risk of SPI and SPI has proved important in this study by its association forms moderate / severe arterial hypertension, and depression and poor sleep quality. Benefits of treatment and a possible impact on these parameters must be evaluated. Somnolence excessive daytime sleepiness associated with cerebrovascular disease and anemia instigates the possibility that correction of anemia may improve sleepiness a known risk factor for CVD and mortality. The influence of different factors on mortality in men and women in these patients deserves to be explored.

RLS är ett neurologiskt tillstånd. Karakteristiska symtom är känselförnimmelser framförallt lokaliserade till de nedre extremiteterna. Besvären upplevs sitta djupt inne i benen och framkalla ett oemotståndligt behov att röra på sig. Beskrivningen av symtomen, dess intensitet och förekomst varierar och är mycket individuell. RLS delas in i primär och sekundär form, beroende på symtomens ursprungliga orsak. Med tanke på att orsaken till RLS ännu är oklar finns inte någon kurativ behandling, men däremot goda möjligheter att lindra symtom och obehag. Syftet med denna systematiska litteraturstudie var att kartlägga hur livskvalitén påverkas hos personer med Restless legs syndrom (RLS). Granskning och kvalitetsbedömning av artiklarna gjordes med hjälp av triangulering utefter ett modifierat granskningsprotokoll. Totalt inkluderades 10 vetenskapliga artiklar av varierande kvalité i litteraturstudien efter litteratursökning i databaserna CINAHL, PubMed, PsycINFO samt via Cochrane Library. Samtliga studier visade signifikant resultat avseende sänkt livskvalité hos personer med RLS. Resultatet påvisar att personer med RLS har en sänkt livskvalité på grund av begränsningar i fysiska och psykiska funktioner. Personer med RLS upplever låg vitalitet, försämrad psykisk hälsa, lågt emotionellt välbefinnande, upplevelser av depressiva symtom samt begränsningar i sociala funktioner. Vidare faktorer som bidrar till sänkt livskvalité hos personer med RLS är sömnproblem, besvärande symtom, nedsatt fysisk funktion, försämrad fysisk rollfunktion, samt en upplevd sämre generell hälsa och daglig funktion. / RLS is a neurological condition. Characteristic symptoms are tactile sensations especially localized to the lower extremities. The disorder is perceived deep in the legs and provokes an irresistible need to move. Description of symptoms, its intensity and incidence vary and are highly individual. RLS is divided into primary and secondary form depending on the symptom’s original cause. Given that the cause of the RLS still is unclear, there is no curative treatment but good opportunities to alleviate symptoms and discomfort. The aim of this systematic literature review was to identify how the quality of life in people with Restless legs syndrome (RLS) is affected. Review and quality assessment of the articles was made with triangulation along a modified audit protocol. There were totally 10 scientific articles of varying quality included in the literature survey, after literature search in the databases PubMed, CINAHL, PsycINFO and the Cochrane Library. All studies showed significant results for lower quality of life in people with RLS. The result showed that people with RLS had a reduced quality of life because of limitations in the physical and mental functions. People with RLS were experiencing low vitality, deterioration of mental health, low emotional well-being, experiences of depressive symptoms and restrictions in social functions. Moreover factors affecting the low quality of life in people with RLS were sleeping problems, bothersome symptoms, impaired physical function, loss of physical role functioning and a perceived poor general health and daily function.

No description available.

Background: Symptoms of anxiety and depression in patients with restless legs syndrome (RLS) have been observed. However, it is unclear whether rates of threshold depression and anxiety disorders according to DSM-IV criteria in such patients are also elevated. Methods: 238 RLS patients were assessed with a standardized diagnostic interview (Munich- Composite International Diagnostic Interview for DSM-IV) validated for subjects aged 18–65 years. Rates of anxiety and depressive disorders were compared between 130 RLS patients within this age range and 2265 community respondents from a nationally representative sample with somatic morbidity of other types. Results: RLS patients revealed an increased risk of having 12-month anxiety and depressive disorders with particularly strong associations with panic disorder (OR=4.7; 95% CI=2.1–10.1), generalized anxiety disorder (OR=3.5; 95% CI= 1.7–7.1), and major depression (OR=2.6; 95% CI=1.5–4.4). In addition, lifetime rates of panic disorder and most depressive disorders as well as comorbid depression and anxiety disorders were considerably increased among RLS patients compared with controls. Conclusions: The results suggest that RLS patients are at increased risk of having specific anxiety and depressive disorders. Causal attributions of patients suggest that a considerable proportion of the excess morbidity for depression and panic disorder might be due to RLS symptomatology.

No description available.

Introduction: The Restless Legs Syndrome (RLS) is a frequent neurological disorder with a prevalence ranging from 5 - 10%. RLS is characterized by an urge to move the lower extremities during the night, thus RLS causes sleep disturbance. It presents as both idiopathic and secondary form. Idiopathic RLS is associated with common genetic variants in MEIS1, BTBD9, PTPRD and MAP2K5/SCOR1. Recently, multiple sclerosis (MS) was identified as a common cause for secondary RLS, the prevalence of RLS in patients with MS ranges from 13.3 to 37.5%. The aim of our study was to analyse the clinical and genetic aspects of this disorder, especially in patients with multiple sclerosis. In the clinical part, we evaluated the prevalence of RLS among Czech patients with MS and we compared the extent of brain damage between patients with and without RLS using magnetic resonance imaging (MRI). In the genetic part, we further analysed the impact of known genetic variants (MEIS1, BTBD9, MAP2K5/SCOR1, PTPRD) for RLS in other European populations and in patients with MS. Methods: Clinical part: Each patient with MS underwent a semi-structured interview. A patient was considered to be affected by RLS if he/she met all four standard criteria at life- long interval. Lesion load (LL - T2), brain atrophy - T1 and brain...

Dans cette thèse, nous abordons le problème fondamental de l'accès au spectre opportuniste dans un système de communication multi-canal. Plus précisément, nous considérons un système de communication dans lequel un utilisateur a accès à de multiples canaux, tout en étant limité à la détection et la transmission sur un sous-ensemble de canaux. Nous explorons comment l'utilisateur intelligent exploite ses observations passées et les propriétés stochastiques de ces canaux afin de maximiser son débit. Formellement, nous fournissons une analyse générique sur le problème d'accès au spectre opportuniste en nous basant sur le problème de `restless multi-bandit’ (RMAB), l'une des généralisations les plus connues du problème classique de multi-armed bandit (MAB), un problème fondamental dans la théorie de décision stochastique. Malgré les importants efforts de la communauté de recherche dans ce domaine, le problème RMAB dans sa forme générique reste encore ouvert. Jusqu'à aujourd'hui, très peu de résultats sont connus sur la structure de la politique optimale. L'obtention de la politique optimale pour un problème RMAB général est intraçable dû la complexité de calcul exponentiel. Par conséquent, une alternative naturelle est de se focaliser sur la politique myopique qui maximise la récompense à immédiate, tout en ignorant celles du futur. Donc, nous développons trois axiomes caractérisant une famille de fonctions que nous appelons fonctions régulières, qui sont génériques et pratiquement importantes. Nous établissons ensuite l'optimalité de la politique myopique lorsque la fonction de récompense peut être exprimée comme une fonction régulière et le facteur de discount est borné par un seuil déterminé par la fonction de récompense. Nous illustrons également l'application des résultats pour analyser une classe de problèmes RMAB dans l'accès opportuniste. Ensuite, nous étudions un problème plus difficile, où l'utilisateur doit configurer le nombre de canaux à accéder afin de maximiser son utilité (par exemple, le débit). Après avoir montré la complexité exponentielle du problème, nous développons une stratégie heuristique v-step look-ahead. Dans la stratégie développée, le paramètre v permet de parvenir à un compromis souhaité entre l'efficacité sociale et de la complexité de calcul. Nous démontrons les avantages de la stratégie proposée via des simulations numériques sur plusieurs scénarios typiques. / In the thesis, we address the fundamental problem of opportunistic spectrum access in a multi-channel communication system. Specifically, we consider a communication system in which a user has access to multiple channels, but is limited to sensing and transmitting only on one at a given time. We explore how the smart user should exploit past observations and the knowledge of the stochastic properties of these channels to maximize its transmission rate by switching channels opportunistically. Formally, we provide a generic analysis on the opportunistic spectrum access problem by casting the problem into the restless multi-armed bandit (RMAB) problem, one of the most well-known generalizations of the classic multi-armed bandit (MAB) problem, which is of fundamental importance in stochastic decision theory. Despite the significant research efforts in the field, the RMAB problem in its generic form still remains open. Until today, very little result is reported on the structure of the optimal policy. Obtaining the optimal policy for a general RMAB problem is often intractable due to the exponential computation complexity. Hence, a natural alternative is to seek a simple myopic policy maximizing the short-term reward. Therefore, we develop three axioms characterizing a family of functions which we refer to as regular functions, which are generic and practically important. We then establish the optimality of the myopic policy when the reward function can be expressed as a regular function and the discount factor is bounded by a closed-form threshold determined by the reward function. We also illustrate how the derived results, generic in nature, are applied to analyze a class of RMAB problems arising from multi-channel opportunistic access. Next, we further investigate the more challenging problem where the user has to decide the number of channels to sense in each slot in order to maximize its utility (e.g., throughput). After showing the exponential complexity of the problem, we develop a heuristic v-step look-ahead strategy. In the developed strategy, the parameter v allows to achieve a desired tradeoff between social efficiency and computation complexity. We demonstrate the benefits of the proposed strategy via numerical experiments on several typical settings.