title: Restless Legs Syndrome Following Lung Transplantation: Prevalence and Relationship With Tacrolimus Exposure.
abstract: BACKGROUND
  Complications following lung transplantation are common and significantly reduce quality of life, and increase morbidity and mortality. Increasing evidence suggests sleep disorders are prevalent following lung transplantation, but factors associated with their development are not known.
  
  
  OBJECTIVE
  We sought to evaluate the prevalence of restless legs syndrome (RLS) in a lung transplant population and determine if a relationship exists between RLS and exposure to immunosuppressant medications.
  
  
  METHODS
  Subjects were recruited through the University of Wisconsin Hospital and Clinics Lung Transplant Clinic (N = 125). Participants (N = 81) completed sleep questionnaires, including the four RLS diagnostic criteria, insomnia severity index, and Sheehan disability scale. Cumulative tacrolimus exposure was determined in 62 subjects by calculating an area under the curve (AUC) to assess for a relationship with restless legs syndrome.
  
  
  RESULTS
  Prevalence of RLS was 35 percent. Cumulative mean ± SEM tacrolimus exposure was similar in patients with RLS versus those without RLS (17446 ± 1855 ng days/mL vs. 15303 ± 1643 ng days/mL, respectively; p = 0.42). Insomnia severity index scores (12.5 ± 1.0 vs 6.8 ± 0.7, p < 0.0001) and Sheehan disability scores (7.8 ± 1.3 vs 3.6 ± 0.6, p = 0.003) were significantly higher in those with vs those without RLS symptoms, respectively.
  
  
  CONCLUSIONS
  Our data confirms increased prevalence of RLS following lung transplantation reported by previous studies. RLS symptoms were not related to estimated tacrolimus exposure. Predictors of RLS following lung transplantation need to be further investigated to better identify and control RLS symptoms and reduce associated insomnia and disability.
authors.affiliation: Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Menninga
authors.affiliation: Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Kalynn A
authors.initials: KA
authors.lastname: Rohde
authors.affiliation: Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Zachary W
authors.initials: ZW
authors.lastname: Schlei
authors.affiliation: Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Krista M
authors.initials: KM
authors.lastname: Katers
authors.affiliation: Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Ashley K
authors.initials: AK
authors.lastname: Weber
authors.affiliation: University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Marissa M
authors.initials: MM
authors.lastname: Brokhof
authors.affiliation: University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Hawes
authors.affiliation: University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Radford
authors.affiliation: University of Wisconsin Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Francois
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Cornwell
authors.affiliation: Wisconsin Sleep Center and Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Benca
authors.affiliation: Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Hayney
authors.affiliation: Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA john.dopp@wisc.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Dopp
mesh_terms: D019540:Area Under Curve; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016040:Lung Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012148:Restless Legs Syndrome / Q000453:epidemiology*; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: lung transplantation; restless legs syndrome; tacrolimus