Restless Legs Syndrome and Impulsive Decision-Making: Impact of Symptom Severity, Chronotype and Interoception

Background: Restless Legs Syndrome (RLS) is a neurological disorder reported to be associated with impulsivity and impairments in interoception and emotional regulation. However, limited research has explored the combined influence of RLS severity, psychological factors, and chronotype on impulsive decision-making and risk-taking behavior in RLS patients. Objectives: To assess impulsive-decision making and its modulation by RLS severity, chronotype, and psychological factors (including interoception, anxiety, alexithymia, and sleep quality) in RLS patients compared to healthy controls (HC). Methods: A case-control study was conducted with 20 RLS patients and 20 age- and sex-matched HC. Participants completed a series of questionnaires measuring interoception, anxiety, alexithymia, sleep quality, and chronotype, followed by a temporal discounting task to assess impulsivity. Statistical analyses included Mann-Whitney U tests, Spearman's rank correlations, and multiple regression analysis. Results: No significant differences in impulsive decision-making were observed between groups. RLS patients exhibited higher levels of depression and alexithymia, along with lower scores on interoceptive awareness compared to HC. However, within the RLS group, greater symptoms' severity, poorer sleep quality, and higher anxiety were positively correlated with increased impulsivity. Regression analysis showed that the MAIA-2-Not Distracting sub-scale was a significant predictor of impulsivity in RLS patients. Conclusions: Interoceptive deficits, particularly difficulties in ignoring bodily sensations, play a central role in impulsive decision-making in RLS patients. These findings highlight the importance of targeting interoception, emotional regulation, and sleep quality in therapeutic interventions for RLS. Further research with larger samples is needed to confirm these relationships.