Elsevier

Sleep Medicine Reviews

Volume 16, Issue 4, August 2012, Pages 283-295
Sleep Medicine Reviews

Clinical review
Epidemiology of restless legs syndrome: A synthesis of the literature

https://doi.org/10.1016/j.smrv.2011.05.002Get rights and content

Summary

Restless legs syndrome (RLS) has gained considerable attention in the recent years: nearly 50 community-based studies have been published in the last decade around the world. The development of strict diagnostic criteria in 1995 and their revision in 2003 helped to stimulate research interest on this syndrome. In community-based surveys, RLS has been studied as: 1) a symptom only, 2) a set of symptoms meeting minimal diagnostic criteria of the international restless legs syndrome study group (IRLSSG), 3) meeting minimal criteria accompanied with a specific frequency and/or severity, and 4) a differential diagnosis. In the first case, prevalence estimates in the general adult population ranged from 9.4% to 15%. In the second case, prevalence ranged from 3.9% to 14.3%. When frequency/severity is added, prevalence ranged from 2.2% to 7.9% and when differential diagnosis is applied prevalence estimates are between 1.9% and 4.6%. In all instances, RLS prevalence is higher in women than in men. It also increases with age in European and North American countries but not in Asian countries. Symptoms of anxiety and depression have been consistently associated with RLS. Overall, individuals with RLS have a poorer health than non-RLS but evidence for specific disease associations is mixed. Future epidemiological studies should focus on systematically adding frequency and severity in the definition of the syndrome in order to minimize the inclusion of cases mimicking RLS.

Introduction

Restless legs syndrome (RLS) was first depicted in 1685 by Sir Thomas Willis, an English physician, in a sharp description of patients who cannot fall asleep because of «leapings and contractions» of the arms and legs. Sir Willis wrote that «restlessness and tossing» could be so severe that the patients «are no more able to sleep than if they were in a place of a greatest torture».1 In the nineteen century, RLS was termed as «anxietas tibiarum» in Germany by Wittmaack.2 It was in 1945, while studying a group of eight patients, that the Swedish neurologist Karl-Axel Ekbom coined the term “restless-legs syndrome,” apparently unaware of Willis’ previous description indicating the syndrome could also involve the upper extremities.3

RLS is a sleep disorder affecting a significant portion of the general population. The syndrome has a strong family component, and several co-morbid conditions may be associated with RLS. Research over the past 10 years has highlighted its heritability and has shed some interesting light to this disorder.

Clinically, RLS is characterized by disagreeable leg sensations occurring most often at sleep onset that provoke an irresistible urge to move the legs. Patients with RLS typically complain of itching, creeping, tingling in their legs, usually between the ankle and the knee. These unpleasant sensations occur when the individual is at rest and are more pronounced in the evening or at night. The unpleasant sensations are relieved temporarily with leg movements.

Here we review the data-based publications on the epidemiology of RLS in the general population and in primary care settings including RLS’s impact as a disorder or co-morbid condition and provide a synthesis of the available literature.

Section snippets

Methodology

The articles utilized in this review included only peer-reviewed original studies published between 1994 and 2010 and written in English, French or Spanish. Databases searched were PubMed, PsycInfo, and PsycArticles. Search terms were “Restless leg” with “community” or “epidemiology,” or “primary care.” The search returned a total of 653 peer-reviewed articles. In addition, references cited in retrieved articles were screened for additional reports.

The inclusion criteria were

  • -

    Articles had to

Results

In the last 10 years, there has been a surge in the evaluation of RLS in the general population. 47 studies of the general population were utilized in this review. Before 2000, there was only one epidemiological study published on RLS. Nine were published between 2000 and 2004. The number increased to 27 articles between 2005 and 2009 with a further 10 articles appearing in 2010 alone. In primary care practice, 9 studies were retained. Three were done between 2000 and 2004; 4 between 2005 and

Conclusions

Epidemiologic knowledge of RLS has increased considerably recently, in fact, since 2005 epidemiological research on RLS has effectively blossomed.

This synthesis of the literature reveals that RLS prevalence rates are linked to:

  • 1)

    The way RLS is evaluated. Single-item studies have provided the highest RLS prevalence followed by studies having limited the assessment to the 4 minimal criteria described by the IRLSSG. In this last case, prevalence of RLS in the adult general population ranges between

Acknowledgment

M.M. Ohayon was supported by National Institutes of Health grant R01NS044199.

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