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Research ArticleOriginal Article
Open Access

Inflammatory bowel disease and restless leg syndrome

Mahmoud H. Mosli, Lujain M. Bukhari, Alya A. Khoja, Nuha A. Ashour, Hadeel R. Aljahdali, Ohood A. Khoja, Faris F. Alhejaili and Omar I. Saadah
Neurosciences Journal August 2020, 25 (4) 301-307; DOI: https://doi.org/10.17712/nsj.2020.4.20200021
Mahmoud H. Mosli
From the Department of Medicine (Mosli, Bukhari, Khoja A, Ashour, Aljahdali, Khoja O, Alhejaili), Inflammatory Bowel Disease Research Group (Mosli, Saadah), Sleep Medicine and Research Center (SMRC) (Alhejaili) and from the Department of Pediatrics (Saadah), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
MBBS, MSc
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Lujain M. Bukhari
From the Department of Medicine (Mosli, Bukhari, Khoja A, Ashour, Aljahdali, Khoja O, Alhejaili), Inflammatory Bowel Disease Research Group (Mosli, Saadah), Sleep Medicine and Research Center (SMRC) (Alhejaili) and from the Department of Pediatrics (Saadah), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
MBBS
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Alya A. Khoja
From the Department of Medicine (Mosli, Bukhari, Khoja A, Ashour, Aljahdali, Khoja O, Alhejaili), Inflammatory Bowel Disease Research Group (Mosli, Saadah), Sleep Medicine and Research Center (SMRC) (Alhejaili) and from the Department of Pediatrics (Saadah), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
MBBS
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Nuha A. Ashour
From the Department of Medicine (Mosli, Bukhari, Khoja A, Ashour, Aljahdali, Khoja O, Alhejaili), Inflammatory Bowel Disease Research Group (Mosli, Saadah), Sleep Medicine and Research Center (SMRC) (Alhejaili) and from the Department of Pediatrics (Saadah), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
MBBS
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Hadeel R. Aljahdali
From the Department of Medicine (Mosli, Bukhari, Khoja A, Ashour, Aljahdali, Khoja O, Alhejaili), Inflammatory Bowel Disease Research Group (Mosli, Saadah), Sleep Medicine and Research Center (SMRC) (Alhejaili) and from the Department of Pediatrics (Saadah), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
MBBS
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Ohood A. Khoja
From the Department of Medicine (Mosli, Bukhari, Khoja A, Ashour, Aljahdali, Khoja O, Alhejaili), Inflammatory Bowel Disease Research Group (Mosli, Saadah), Sleep Medicine and Research Center (SMRC) (Alhejaili) and from the Department of Pediatrics (Saadah), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
MBBS
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Faris F. Alhejaili
From the Department of Medicine (Mosli, Bukhari, Khoja A, Ashour, Aljahdali, Khoja O, Alhejaili), Inflammatory Bowel Disease Research Group (Mosli, Saadah), Sleep Medicine and Research Center (SMRC) (Alhejaili) and from the Department of Pediatrics (Saadah), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
MBBS, MSc
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Omar I. Saadah
From the Department of Medicine (Mosli, Bukhari, Khoja A, Ashour, Aljahdali, Khoja O, Alhejaili), Inflammatory Bowel Disease Research Group (Mosli, Saadah), Sleep Medicine and Research Center (SMRC) (Alhejaili) and from the Department of Pediatrics (Saadah), Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
MBBS, MRCP
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    Table 1

    The restless leg syndrome diagnostic criteria. shall we add

    1. Do you experience an urge to move the legs that is usually accompanied by an uncomfortable and unpleasant sensation in the legs?
    2. Do you experience an urge to move your legs or an unpleasant sensation that begins or worsens during periods of rest or inactivity, such as lying or sitting?
    3. The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as that activity continues.
    4. Do you experience an urge to move your legs or an unpleasant sensation that is worse in the evening or at night than during the day or only occurs in the evening or night?.
    *All 4 criteria must be fulfilled for the diagnosis of restless leg to be made. **Adapted from Allen et al, official journal of the Movement Disorder Society. 2011;26(1):114-20.
    • View popup
    Table 2

    Baseline characteristics of the study cohort.

    CharacteristicsIBD (N=218)Controls (N=211)P-value
    Mean age in years+-SD30.90±120029.70±11.580.29
    Female gender (%)112165<0.001
    Smoking status:0.001
    Never1611700.07
    Current cigarette27190.15
    X cigarette3200.001
    Current water pipe17100.15
    X water pipe200.15
    Family history of IBD17190.68
    Comorbidities:
    No chronic illness1781720.36
    DM660.99
    Hypertension770.97
    Rheumatoid arthritis440.97
    Vitamin B12 deficiency7120.22
    Varicose veins710.04
    COPD510.11
    Hypothyroidism470.34
    Durations of RLS in years1.36+-0.691.45+-0.790.20
    • View popup
    Table 3

    Results of the RLS screening questionnaire for the study cohort.

    QuestionsIBD(N=218)No IBD(N=211)P-value
    Do you experience an urge to move your legs that is usually accompanied or caused by uncomfortable and unpleasant sensations in the legs?47510.52
    Do you experience an urge to move or an unpleasant sensation that begins or worsens during periods of rest or inactivity such as lying or sitting?34530.01
    Do you experience an urge to move or unpleasant sensations that are partially or totally relieved by movement, such as by walking or stretching, at least as long as the activity continues?41600.02
    Do you experience an urge to move or unpleasant sensations that are worse in the evening or at night than during the day or only occur in the evening or at night?25270.67
    • View popup
    Table 4

    The study outcome comparing the odds ratio of IBD in patients with and without RLS.

    IBD(Exposure) (N=218)Controls(No exposure) (N=211)TotalCohort (N=429)Statistics
    Restless leg syndrome (Case)161733OR=0.90
    No restless leg syndrome (Control)20219439695% CI=0.44 - 1.84
    Total218211429p=0.78
    • View popup
    Table 5

    Responses to the restless leg syndrome questionnaire comparing IBD patients and controls and a comparison of severity scores between the 2 cohorts.

    Questionnaire itemsIBDN=218No IBDN=211P-value
    Mean±SD
    Overall, how would you rate The RLS discomfort in your legs or arms?0.34±0.550.34±0.780.98
    How would you rate the need to move around because of your RLS symptoms?0.31±0.740.36±0.840.53
    How severe was your sleep disturbance due to your RLS symptoms?0.22±0.730.21±0.680.92
    How severe was your tiredness or sleepiness during the day due to your RLS symptoms?0.21±0.690.16±0.560.41
    Overall, how severe was the impact of your RLS symptoms on your ability to carry out your daily affairs, for example carrying out a satisfactory family, home, social, school or work obligation?0.27±0.960.16±0.520.14
    How severe was your mood disturbance due to your RLS symptoms, for example feeling angry, depressed, sad, anxious or irritable?0.28±0.790.26±0.740.75
    Overall, how much relief of your RLS arm or leg discomfort did you get from moving around?0.31±0.760.28±0.710.70
    How often do you get RLS symptoms?0.43±1.010.42±0.860.88
    When you had RLS symptoms, how severe were they on average?0.32±0.740.27±0.640.41
    Total RLS severity score (RLSSS)2.69±6.042.45±5.390.67
    Severity category according to RLSSSn (%)P-value
    Mild RLS (Total RLSSS=1-10)660.94
    Moderate RLS (Total RLSSS=11-20)670.80
    Severe RLS (Total RLSSS=21-30)430.82
    Very severe RLS (Total RLSSS=31-40)01-----
    Pearson chi2 (3)=1.19060.76
    Total number of RLS cases161733
    • View popup
    Table 6

    Predictors of restless leg syndrome and severe restless leg syndrome among IBD patients according to multiple logistic and linear regression analysis, respectively.

    ???Odds ratioP-value95% CI
    RLS
    Age in years1.050.090.99-1.09
    Sex1.060.940.26-4.27
    Cigarette smoker0.500.560.05-5.10
    X-cigarette smoker0.810.860.08-7.92
    DM3.200.300.35-29.08
    Rheumatoid Arthritis7.720.120.60-99.95
    Vitamin B12 deficiency10.200.021.40-74.08
    Varicose veins5.010.110.68-36.92
    COPD5.470.160.51-59.00
    RLSSSCoefP-value95% CI
    Age in years0.050.21-0.03-0.12
    Male gender-2.730.002-4.47--0.98
    Cigarette smoker-0.510.69-3.02-2.01
    X-cigarette smoker-0.470.74-3.29-2.34
    Water pipe smoker-1.610.39-5.29-2.07
    DM5.740.030.60-10.87
    Hypertension0.830.73-3.86-5.51
    Rheumatoid Arthritis5.480.06-0.23-11.20
    Vitamin B12 deficiency3.460.12-0.94-7.85
    Varicose veins0.960.66-3.44-5.53
    COPD5.920.020.86-10.99
    Hypothyroidism0.640.83-5.08-6
    COPD - Chronic obstructive pulmonary disease
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Neurosciences Journal: 25 (4)
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Inflammatory bowel disease and restless leg syndrome
Mahmoud H. Mosli, Lujain M. Bukhari, Alya A. Khoja, Nuha A. Ashour, Hadeel R. Aljahdali, Ohood A. Khoja, Faris F. Alhejaili, Omar I. Saadah
Neurosciences Journal Aug 2020, 25 (4) 301-307; DOI: 10.17712/nsj.2020.4.20200021

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Inflammatory bowel disease and restless leg syndrome
Mahmoud H. Mosli, Lujain M. Bukhari, Alya A. Khoja, Nuha A. Ashour, Hadeel R. Aljahdali, Ohood A. Khoja, Faris F. Alhejaili, Omar I. Saadah
Neurosciences Journal Aug 2020, 25 (4) 301-307; DOI: 10.17712/nsj.2020.4.20200021
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