Liver disease severity is poorly related to the presence of restless leg syndrome in patients with cirrhosis

Abstract

Context: Restless leg syndrome (RLS) has been reported to be common in patients with cirrhosis. The relation of RLS with severity of liver disease is, however, unclear. Aim: We studied the association between occurrence of RLS and severity of cirrhosis. Setting and Design: Single centre, prospective, observational study. Materials and Methods: Adult patients with cirrhosis and relatively stable clinical condition and no associated neurological condition were prospectively studied. Severity of liver disease was graded as Child-Turcotte-Pugh (CTP) class A, B or C; using Model for End-Stage Liver Disease (MELD) score; and as a binary variable (compensated or decompensated disease). Each subject underwent an initial screening for RLS, followed by a re-evaluation by an independent neurologist to confirm the diagnosis, using the International RLS Diagnostic Criteria. In patients with RLS, its severity was assessed using a validated Hindi translation of the International RLS severity (IRLS) scoring system. Statistical Analysis Used: Data for categorical variables were expressed as proportions and compared using chi-squared test, and those for numerical variables were expressed as median and range, and compared using Wilcoxon rank sum test. Results: Among the 356 patients with cirrhosis studied (median [range] age: 48 [18-83] years; 241 [67.7%] male; CTP A/163, B/172, C/21; MELD 11 [6-41]; decompensated 51.7%), 36 (10.1%) had RLS. RLS severity was mild (1), moderate (15), severe (19) or very severe (1). Compared to those without RLS, patient with RLS had a lower MELD score (9 [6-25] versus 11 [6-41], P = 0.04), and a comparable distribution of CTP classes and frequency of decompensated liver disease. The prevalence and severity of RLS were not different between those with compensated and those with decompensated cirrhosis. Conclusion: In the Indian population, RLS is common in patients with cirrhosis. Its occurrence did not show any increase with the severity of liver disease.