Case history
Case history #1
A 58-year-old woman presents with symptoms of daytime sleepiness and fatigue, with difficulties concentrating at work. She drinks several cups of coffee during the day to keep awake. She goes to bed at 10 p.m. on most nights, and reports falling asleep within 15 minutes. She sets her alarm for 6.30 a.m. She is often aware of waking during the night, although she is not sure why, and reports feeling unrefreshed in the morning. Her husband describes her as 'a restless sleeper' and says that her nighttime movements often wake him up. She snores occasionally, although there is no history of waking with a dry mouth or morning headache. There is no significant past medical history, and she takes no regular drugs. On examination, her body mass index is 23.5. Physical examination is normal. Her Epworth Sleepiness Scale score is 17/24 (normal <11). Routine blood tests are normal.
Case history #2
A 68-year-old man presents with symptoms of daytime sleepiness. His wife reports that he is very restless and fidgety at night, and that their bed sheets are always 'pulled apart by the morning'. He reports an unpleasant sensation in his legs, and feels an irresistible urge to move his legs while sitting on his couch in the evenings or lying in bed at night. He has no history of snoring. There is no past medical history of note, and he takes no regular drugs. He feels unrefreshed in the morning, and frequently dozes off during the day while watching television. Clinical examination is unremarkable. In particular, there are no extra-pyramidal signs. He has an Epworth Sleepiness Scale score of 18/24.
Other presentations
Many patients are asymptomatic, but the sleep partner is disturbed - a finding that PLMD has in common with many other sleep disorders. PLMD may occur in restless legs syndrome (RLS) (up to 80% of patients with RLS have PLMD), obstructive sleep apnoea syndrome, rapid eye movement sleep behaviour disorder, narcolepsy, essential hypertension, end-stage renal disease, congestive heart failure, spinal cord injury, syringomyelia, alcohol dependence, Parkinson's disease, and Tourette's syndrome.[2][3][4][6][7]
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