Dados do Trabalho

Título

RESTLESS LEGS SYNDROME IN A TERTIARY OUTPATIENT SLEEP MEDICINE SERVICE: CASE REPORT

Introdução

Restless legs syndrome (RLS), also known as Willis-Ekbon disease, is a movement disorder associated with sleep, characterized by an urgency to move the legs and unpleasant sensations when resting. In Brazil, the prevalence is 6.4%, increasing with age and predominating in females. It may be associated with iron deficiency, pregnancy, inflammatory processes and chronic kidney disease.

Objetivo

The objective of this case report is to provide descriptive information about the presentation, management and evolution of three cases of RLS in a brazilian Sleep Medicine service.

Métodos

Descriptive report of three clinical cases of patients diagnosed with RLS treated at a Sleep Medicine service in the state of São Paulo.

Resultados

CASE 1: Patient I.C.S., female, 60 years old, with fibromyalgia and spondyloarthritis. She complains of snoring and sleep apnea, as well as leg pain that worsens at rest and with contact between her legs, making it difficult to sleep. Her BMI is 32 kg/m² and her waist circumference is 104 cm. Her ferritin is 81 ng/dL. She received guidance on sleep hygiene and parenteral iron replacement (1000 mg) for 3 weeks. She is awaiting polysomnography and medical reevaluation.
 
CASE 2: Patient M.I.I.S.C., female, 55 years old, with diabetes, hypertension, obesity and moderate OSA, who has been using CPAP for 5 years. She reports an uncontrollable urge to move her legs for 10 years. Her BMI is 47 kg/m², and she doesn´t have iron deficiency. She received behavioral measures and gabapentin 600 mg/day. She reports partial improvement of symptoms and restful sleep.
 
CASE 3: Patient A.M.A., a 57-year-old female, with an ischemic stroke in 2006 and severe OSA. She reported an uncontrollable urge to move her legs since the stroke. She was initially treated with pramipexole, which proved ineffective. She presented iron deficiency (ferritin 42.7 ng/dL) and a corrected gastric ulcer. Gabapentin 800 mg/day was introduced with significant improvement, but she still had non-restorative sleep, because inadequate treatment of OSA.

Conclusões

Despite the lack of definitive therapy for RLS, first-line treatment includes alpha-2-delta ligands, such as gabapentin and pregabalin. Iron supplementation has shown improvement in the severity of RLS when compared to placebo. However, the management of the disease must be individualized and  it is a great challenge, requiring the expansion of the bibliographic substrate on the subject.

Palavras -chave

restless legs syndrome; case report; iron deficiency