Review of Restless Legs Syndrome Save
JAMA has published a full read review of RLS - restless leg syndrome - a frequent, but often unrecognized, cause of poor sleep and the resultant hazards of insomnia.
RLS is a sleep-related movement disorder that affects approximately 3-8% of US adults. It is is characterized by unstopable urges to move the limbs, typically the legs, accompanied by unpleasant limb sensations (eg, achiness, tingling). Symptoms, provoked by immobility, are relieved with movement. Symptoms are usually present or most severe in the evening or at night.
The consequences of RLS include difficulty falling asleep, staying asleep, or returning to sleep. RLS also leads to impaired quality of life, increased cardiovascular disease (29.6% with coronary artery disease, stroke, or heart failure), depression (30.4%), and suicidal ideation or self-harm (0.35 cases/1000 person-years).
Restless legs syndrome is common in many disorders included multiple sclerosis (27.5%), end-stage kidney disease (24%), and iron deficiency anemia (23.9%); during pregnancy (especially 3rd trimester (22%); peripheral neuropathy (eg, diabetic, idiopathic; 21.5%); and Parkinson disease (20%).
Risk factors include family history of RLS, northern European descent, female sex (2:1) older age (10% prevalence ≥65 years), and iron deficiency.
Restless legs syndrome is diagnosed based on clinical history; polysomnography is not necessar for dyiagnosis.
Simple treatment includes iron supplementation (eg, ferrous sulfate 325-650 mg qd or qod) if serum ferritin < 100 ng/mL or transferrin saturation <20%. Some drugs can contribute to RLS and should be discontinued (serotonergic antidepressants, dopamine antagonists, and centrally acting H1 antihistamines (eg, diphenhydramine). Pharmacologic options include gabapentin, and pregabalin. Gabapentinoids are more effective than placebo (70% vs 40%; P < .001).
Dopamine agonists for sleep (eg, ropinirole, pramipexole, rotigotine) are no longer recommended due to the risk of augmentation, an iatrogenic worsening of RLS symptoms
Low-dose opioids (eg, methadone 5-10 mg daily) are effective and may be necessary in those who are refractory to 1st line therapy.
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