Restless Leg Syndrome, Insomnia, and Depression in Hemodialysis Patients: Three Sides of a Triangle?

Abstract

Background: Restless leg syndrome (RLS) is a sensorimotor neurological disorder with high prevalence among patients with end-stage renal disease (ESRD) and is associated with sleep and mood disturbances. The current study evaluated the associations between RLS, depression and insomnia in patients undergoing hemodialysis. Methods: The current cross sectional study collected sociodemographic, laboratory data, and medical history of 235 patients undergoing hemodialysis. RLS was assessed by a questionnaire designed by national institutes of health/international RLS study group (IRLSSG), depression by hospital anxiety depression scale (HADS), and insomnia by Pittsburgh sleep quality index (PSQI). Results: The prevalence of RLS in patients undergoing hemodialysis was 23.4%; out of which 43.6% had severe and very severe RLS. Patients with RLS had a positive family history of RLS (P value < 0.001). There was no difference between the demographic and laboratory findings of the patients. In comparison to the patients without RLS, the patients with RLS had a higher prevalence of depression (63.6% vs. 42.2%, P value = 0.005), and more severe insomnia score (mean PSQI-score = 8.2 ± 4.9 vs. 6.2 ± 4 (P value = 0.009). The PSQI score were correlated with HADS score (P value < 0.001). In multivariate analysis, the link between RLS and depression depended on insomnia. Conclusions: RLS is prevalent among patients undergoing dialysis and could lead to depression, even in the absence of insomnia. Thus, it seems that appropriate diagnosis and management of RLS would make a difference in quality of life of patients undergoing hemodialysis.