Restless legs syndrome linked with risk for suicidal thoughts

Suicidal thoughts are more likely to be prevalent in people with restless legs syndrome (RLS), suggests a new study published in the journal Sleep Medicine.

Brian Koo, an associate professor of neurology at the Yale Medical School, and colleagues conducted the study to determine the frequency of suicidal ideation and behavior in RLS.

Typically, people with restless legs syndrome say that when they're lying down, "they have a creepy-crawly feeling in their legs plus an irresistible urge to move," explained Dr. Koo."That urge to move prevents them from staying in bed."

And that often means that patients with restless legs syndrome can't get a good night's sleep. It's entirely possible that the poor sleep is leading to depression and suicidality, Koo said.

Koo's team can't say for sure that the syndrome causes people to think about suicide; they can only say there's a correlation.

"Restless legs syndrome is associated with very serious psychiatric consequences, including thoughts of suicide and/or attempts at suicide," said Koo.

Also Read: AAN’s Practice Guideline of treatment of restless legs syndrome in adults

For the study, the researchers recruited 192 patients and a comparison group of 158 people without restless legs. The study volunteers ranged in age from 18 to 89. Both groups filled out questionnaires on the syndrome, sleep, depression, and suicidal thoughts and behavior. They were also queried about a host of demographic and health factors.

Key Findings:

• Significantly more RLS than control participants had lifetime suicidal ideation or behavior (27.1% vs. 7.0%; p<0.00001) or lifetime depression history (65.6%% vs. 22.8%).


• The odds of having a lifetime suicidal ideation or behavior was higher in those with RLS (2.80 [1.29,6.11]), even after accounting for depression and other confounders.


• In RLS, the odds of lifetime suicidal ideation or behavior was increased if there was lifetime depression (7.37 [2.65,20.47]) or if RLS in the past was severe or very severe (2.36 [1.03,5.40]).

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While the study only shows an association, Koo suspects that restless legs syndrome causes suicidality. "Having treated hundreds of patients I think it is causing depression and likely the suicidality," he said. "Whether it works through a mechanism of sleep loss or something else I don't know."

The new study "is consistent with the literature showing various types of sleep disturbances are associated with suicidality," said Peter Franzen, an assistant professor in the Department of Psychiatry at the University of Pittsburgh. "We see it with all kinds of sleep complaints, including people with insomnia, short sleep, and long sleep. This is showing it's also true with restless legs syndrome."

And that's not surprising, said Franzen, who was not involved with the new research. "People with disrupted sleep don't function as well," he explained. "Sleep is important when it comes to regulating emotions. And there are cognitive deficits when you don't get good sleep. You have trouble with decision-making and you're more apt to make impulsive decisions."

"Lifetime suicidal ideation or behavior is prevalent in RLS sufferers, and its likelihood is dependent on RLS severity and depression history," concluded the study authors.