Sleep Disorders

Opioid Treatment for Restless Legs Syndrome

Buprenorphine Effectiveness for Severe Restless Legs Syndrome and Dopaminergic Augmentation

ESS=Epworth Sleepiness Scale; ISI=Insomnia Severity Index, PHQ-9=Patient Health Questionnaire-9, PROMIS-SD=Patient-Reported Outcomes Measurement Information System-Sleep Disturbance.

Opioids are a consensus second-line treatment for moderate to severe restless legs syndrome (RLS). The use of buprenorphine in RLS can facilitate successful weaning from dopamine agonists for patients with augmentation. Demographics and RLS medications were accounted for in the analyses as potential confounders. Fifty-five patients (56.4% female, 64.9 ± 12.1 years) started buprenorphine for RLS. The percentage of patients on buprenorphine that showed a positive response on the Clinical Global Impressions Scale increased by 13% at baseline to at least 85% at all other time points. The International RLS Study Group rating scale score was 27.8 (25.3, 30.3) at baseline and was significantly reduced at every interval (P < 0.001), including 11.4 (7.4, 15.4) at the 1-year visit. There was a statistically significant longitudinal trend in 1-year improvement in ESS: 9.9 (8.0, 11.8) to 6.9 (4.5, 9.4), P = 0.003; ISI: 18.0 (15.9, 20.1) to 15.0 (11.6, 18.3), P = 0.048; PHQ-9: 10.4 (8.2, 12.5) to 6.1 (3.6, 8.6), P <0.001; and PROMIS-SD: 63.0 (60.2, 65.7) to 53.8 (49.8, 57.8), P <0.001. The findings in this clinical cohort show buprenorphine markedly reduced RLS symptoms.