Quality of sleep in patients with nocturnal leg cramps and validity of a single-item measure of cramp-related sleep disturbance: an observational study
Only a few studies have addressed the impact of nocturnal leg cramps on sleep quality. We investigated the association between nocturnal leg cramps and sleep disturbance using the Pittsburgh Sleep Quality Index (PSQI), and assessed the criterion validity of a single-item daily measure of cramp-related sleep disturbance.
In this prospective observational study conducted in Western Switzerland from January 2015 to June 2016, 20 primary care physicians recruited up to 20 consecutive patients aged >50 years. During a 2-week period, patients recorded on a daily basis the number of cramps and their level of sleep disturbance using a single item measure (10-point visual analogue scale from 0 to 10). They also completed the PSQI questionnaire on day 14. Patients were considered as “poor sleepers” if the PSQI score was >5/21. The criterion validity of the single-item measure (averaged over the 2-week period) was assessed using Spearman’s rank correlation coefficient to determine the correlation with the PSQI.
129 patients participated (women 67%, mean age 70 years). The single-item and the PSQI mean scores were 2.6/10 (standard deviation 2.5) and 6.1/21 (SD 3.9), respectively. Being a “poor sleeper” (47% of patients) was not statistically significantly associated with patients’ characteristics and number of cramps. The averaged single-item measure was not correlated with the PSQI score (Spearman’s rank correlation 0.08, p-value 0.51).
In this primary care sample, poor sleep quality was not associated with suffering from a higher number of nocturnal cramps, and a single-item mean score was not a valid instrument to screen for sleep disturbance among these patients.
- Monderer RS, Wu WP, Thorpy MJ. Nocturnal leg cramps. Curr Neurol Neurosci Rep. 2010;10(1):53–9. doi:.https://doi.org/10.1007/s11910-009-0079-5
- Allen RE, Kirby KA. Nocturnal leg cramps. Am Fam Physician. 2012;86(4):350–5.
- Rabbitt L, Mulkerrin EC, O’Keeffe ST. A review of nocturnal leg cramps in older people. Age Ageing. 2016;45(6):776–82. doi:.https://doi.org/10.1093/ageing/afw139
- Grandner MA, Winkelman JW. Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors. PLoS One. 2017;12(6):e0178465. doi:.https://doi.org/10.1371/journal.pone.0178465
- Jansen PH, Lecluse RG, Verbeek AL. Past and current understanding of the pathophysiology of muscle cramps: why treatment of varicose veins does not relieve leg cramps. J Eur Acad Dermatol Venereol. 1999;12(3):222–9. doi:.https://doi.org/10.1111/j.1468-3083.1999.tb01032.x
- Maisonneuve H, Chambe J, Delacour C, Muller J, Rougerie F, Haller DM, et al. Prevalence of cramps in patients over the age of 60 in primary care : a cross sectional study. BMC Fam Pract. 2016;17(1):111. doi:.https://doi.org/10.1186/s12875-016-0509-9
- Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. 1999;53(7):494–6.
- Naylor JR, Young JB. A general population survey of rest cramps. Age Ageing. 1994;23(5):418–20. doi:.https://doi.org/10.1093/ageing/23.5.418
- Oboler SK, Prochazka AV, Meyer TJ. Leg symptoms in outpatient veterans. West J Med. 1991;155(3):256–9.
- Hawke F, Chuter V, Burns J. Impact of nocturnal calf cramping on quality of sleep and health-related quality of life. Qual Life Res. 2013;22(6):1281–6. doi:.https://doi.org/10.1007/s11136-012-0274-8
- Livingston G, Blizard B, Mann A. Does sleep disturbance predict depression in elderly people? A study in inner London. Br J Gen Pract. 1993;43(376):445–8.
- Dew MA, Hoch CC, Buysse DJ, Monk TH, Begley AE, Houck PR, et al. Healthy older adults’ sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosom Med. 2003;65(1):63–73. doi:.https://doi.org/10.1097/01.PSY.0000039756.23250.7C
- Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi:.https://doi.org/10.1016/0165-1781(89)90047-4
- Smith MT, Wegener ST. Measures of sleep: The Insomnia Severity Index, Medical Outcomes Study (MOS) Sleep Scale, Pittsburgh Sleep Diary (PSD), and Pittsburgh Sleep Quality Index (PSQI). Arthritis Care Res. 2003;49(S5):S184–96. doi:.https://doi.org/10.1002/art.11409
- Voorhees JR, Xierali IM, Bazemore AW, Phillips RL, Jr, Jaén CR, Puffer JC. A small percentage of family physicians report time devoted to research. J Am Board Fam Med. 2013;26(1):7–8. doi:.https://doi.org/10.3122/jabfm.2013.01.120125
- Sahin D, Yaffe MJ, Sussman T, McCusker J. A mixed studies literature review of family physicians’ participation in research. Fam Med. 2014;46(7):503–14.
- Sebo P, Haller D, Cerutti B, Maisonneuve H. A prospective observational study of the main features of nocturnal leg cramps in primary care. Swiss Med Wkly. 2019;149:w20048. doi:.https://doi.org/10.4414/smw.2019.20048
- Hallegraeff J, de Greef M, Krijnen W, van der Schans C. Criteria in diagnosing nocturnal leg cramps: a systematic review. BMC Fam Pract. 2017;18(1):29. doi:.https://doi.org/10.1186/s12875-017-0600-x
- Blais FC, Gendron L, Mimeault V, Morin CM. [Evaluation of insomnia: validity of 3 questionnaires]. Encephale. 1997;23(6):447–53. Article in French.
- Negative Binomial Regression | Stata Annotated Output [Internet]. [cited 2019 Nov 2]. Available from: https://stats.idre.ucla.edu/stata/output/negative-binomial-regression/
- Negative Binomial Regression | Stata Data Analysis Examples [Internet]. [cited 2019 Nov 2]. Available from: https://stats.idre.ucla.edu/stata/dae/negative-binomial-regression/
- Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, N.J: L. Erlbaum Associates: 1988.
- Brewster GS, Riegel B, Gehrman PR. Insomnia in the Older Adult. Sleep Med Clin. 2018;13(1):13–9. doi:.https://doi.org/10.1016/j.jsmc.2017.09.002