Restless legs syndrome as a cause of sleep disturbances in cancer patients receiving chemotherapy

J Pain Symptom Manage. 2013 Jul;46(1):56-64. doi: 10.1016/j.jpainsymman.2012.06.018. Epub 2012 Oct 30.


Context: Sleep disturbances are frequent in cancer patients during chemotherapy; the contributory role of restless legs syndrome (RLS) in this setting has never been assessed.

Objectives: This study investigated the role of RLS in causing sleep disturbances and altering the quality of life in cancer patients during chemotherapy.

Methods: Evaluation tools included the Pittsburgh Sleep Quality Index (PSQI), the RLS questionnaires, the Functional Assessment of Cancer Therapy-General, and the Hospital Anxiety and Depression Scale for quality of life and anxiety/depression assessment. The study population was 173 cancer patients. The questionnaires were administered during the third chemotherapy cycle. Patients positive for RLS were reassessed six months after the end of chemotherapy.

Results: In all, 58.8% of patients reported experiencing sleep disturbances (PSQI≥5) and 20% screened positive for RLS. Neither sleep disturbances nor RLS was associated with anemia, neurotoxic cytotoxic drugs, or benzamide treatment. A direct relationship was found between the PSQI and RLS (P=0.007); both PSQI and RLS scores were significantly associated with poor quality of life (P=0.008 and 0.01, respectively) and anxiety (P=0.0001 and 0.01, respectively). PSQI score also was associated with depression (P=0.0001). RLS persisted in four of the 25 RLS-positive patients reassessed at six months after chemotherapy. RLS recovery was associated with a significant reduction in sleep disturbances and improvement in quality of life.

Conclusion: RLS can be a contributory factor in sleep disturbances in cancer patients undergoing chemotherapy. Screening for RLS could aid in tailoring a potentially more efficacious treatment of such disturbances.

Keywords: Cancer; anxiety; chemotherapy; depression; quality of life; restless legs syndrome; sleep disturbances.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Anxiety / diagnosis
  • Anxiety / psychology
  • Depression / diagnosis
  • Depression / psychology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Neoplasms / drug therapy
  • Neoplasms / psychology
  • Psychiatric Status Rating Scales
  • Quality of Life*
  • Restless Legs Syndrome / diagnosis
  • Restless Legs Syndrome / etiology*
  • Restless Legs Syndrome / psychology
  • Severity of Illness Index
  • Sleep
  • Sleep Wake Disorders / diagnosis
  • Sleep Wake Disorders / etiology*
  • Sleep Wake Disorders / psychology
  • Surveys and Questionnaires


  • Antineoplastic Agents