Sleep Board Review Question: Restless Legs

Monday, February 5, 2018 at 8:00AM
Rick Robbins, M.D. in circadian rhythm, diagnosis, dopamine, ferritin, iron, iron deficiency, periodic leg movements, polysomnogram, restless leg syndrome, tyrosine hydroxylase

Olabimpe Omobomi, MD MPH

Rohit Budhiraja, MD

Division of Sleep Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA USA

 

Ms. Jones (not her real name) is a 63-year-old woman who states that she gets very fidgety when sitting in a theater, watching a movie or when flying long distances on a plane. She is unable to find words to describe the sensation but she states that moving her legs make them feel better. Lately, she has been getting this feeling almost every night. She reports no leg discomfort in the daytime. 

She denies muscle cramps her legs. She had some recent investigations done by her primary care physician because of complaints of fatigue.

Which of the following will be helpful in the diagnosis and management in this patient? (Click on the correct answer for an explanation-no penalty for guessing, you can go back and try again)

1. An overnight polysomnogram showing apnea hypopnea index of 1.6 events per hour and no periodic limb movements (PLMs)
2. Ferritin level of 18 ng/ml (normal range 20-200 ng/ml) 
3. Serum Bicarbonate of 29 mEq/L (normal range 23-29 mEq/L)
4. Thyroid Stimulating hormone (TSH) 6 mIU/ml (normal range 0.4-4.8 mIU/ml)

Cite as: Omobomi O, Budhiraja R. Sleep board review question: restless legs. Southwest J Pulm Crit Care. 2018;16(2):81-2. doi: https://doi.org/10.13175/swjpcc028-18 PDF

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).