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. 2025 Aug;12(8):1066-1074.
doi: 10.1002/mdc3.70040. Epub 2025 Mar 18.

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

Giacomo Carollo  1 , Riccardo Quinci  2 , Gloria Pompea Mingolla  3 , Angela Sandri  3   4 , Michele Tinazzi  3   4 , Elena Antelmi  1   4
Affiliations

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

Giacomo Carollo et al. Mov Disord Clin Pract. 2025 Aug.

Abstract

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.

Keywords: alexithymia; chronotype; decision making; interoception; restless legs syndrome.

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Conflict of interest statement

Ethical Compliance Statement: The local institutional review board of Verona University approved the protocol (Prog. 3049CESC), and all patients provided written informed consent. All authors confirm that they have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.

Funding Sources and Conflicts of Interest: No specific funding was received for this work, and the authors declare that there are no conflicts of interest relevant to this work.

Financial Disclosures for the Previous 12 Months: All authors declare that there are no additional disclosures to report.

Figures

Figure 1
Figure 1
Violin plot distribution of the discount rate in RLS and HC groups. No significant difference was found between the groups (U = 195.0, p = 0.896). Dashed lines represent median values, dotted lines represent the 25th and 75th percentiles.
Figure 2
Figure 2
Boxplot of MAIA‐2 components for RLS patients and controls. Boxplot of data for each component of MAIA‐2 questionnaire for RLS patients (blue) and HC (light blue). Bold lines represent median values. * = p < 0.05.
Figure 3
Figure 3
Spearman's correlation matrix for RLS group. Correlations between clinical data, questionnaires scores and performance at the intertemporal decision‐making task. Numbers reported represent the Pearson's coefficients for each correlation. Darker colors mean stronger and significant positive (red) or negative (blue) correlations.
Figure 4
Figure 4
Significant Spearman's correlations between discount rate and IRLSSS (upper left, ρ = 0.535, p = 0.015), HADS‐Anxiety (upper right, ρ = 0.529, p = 0.016), ISI (lower left, ρ = 0.528, p = 0.017), and MAIA‐2‐Not‐Distracting (lower right, ρ = 0.677, p = 0.001).
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