Elsevier

Sleep Medicine

Volume 5, Issue 3, May 2004, Pages 237-246
Sleep Medicine

Original article
Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study

https://doi.org/10.1016/j.sleep.2004.03.006Get rights and content

Abstract

Objectives: To assess the frequency, impact, and medical response to the restless legs syndrome (RLS) in a large multi-national primary care population.

Method: Questionnaire surveys of matched patients and primary care physicians (PCPs) in five modern industrialized western countries.

Results: An RLS screening questionnaire was completed by 23,052 patients: 2223 (9.6%) reported weekly RLS symptoms; 1557 of these patients had medical follow-up questionnaires completed both by themselves and by their physician. An RLS sufferer subgroup (n=551) likely warranting treatment was defined as reporting at least twice weekly symptoms with appreciable negative impact on quality of life. A total of 88.4% of RLS sufferers reported at least one sleep-related symptom. Most reported impaired sleep consistent with a diagnosis of insomnia. Out of 551 sufferers, 357 (64.8%) reported consulting a physician about their RLS symptoms, but only 46 of these 357 (12.9%) reported having been given a diagnosis. PCPs reported that 209 (37.9%) RLS sufferers consulted them about RLS symptoms, but only 52 (24.9%) were given an RLS diagnosis. In most countries, sufferers, regardless of diagnosis, were prescribed therapies not known to be effective in RLS.

Conclusions: RLS significantly impairs patients' lives, often by severely disrupting sleep. The marked under-diagnosis and inappropriate treatment of RLS indicates that PCPs need better education about this condition. Recognizing how often disrupted sleep results from RLS should improve diagnosis.

Introduction

Restless legs syndrome (RLS) is a sensorimotor disorder [1] characterized by an urge or need to move the limbs, usually associated with abnormal sensations in the legs. These symptoms are worse at rest, are relieved by movement, and mainly occur in the evening and/or at night [2], [3], [4]. RLS was probably first described in the 17th century [5], but modern interest in the condition began with the work of Ekbom in the 1940s [6]. RLS morbidity in patients involves significant sleep disturbance and negative impact on quality of life [7]. The current understanding of the pathophysiology of RLS suggests the involvement of iron metabolism and dopaminergic dysfunction [1], [7].

Epidemiological studies indicate that the symptoms of RLS are present in about 5–10% of the general population [8], [9], [10]. Despite this high frequency of affected individuals, experience suggests that it is often undiagnosed in those who present for treatment [7]. It follows that there is a need to understand more about RLS and how it is likely to present in a medical practice.

The objective of the RLS epidemiology, symptoms, and treatment (REST) Primary Care study was to survey the diagnosis, impact, and treatment of clinically significant symptoms of RLS in an international primary care population. REST Primary Care is the first study to provide a matched view of RLS from both patient and physician perspectives. A unique feature of the study design is the opportunity to compare the responses of physicians and patients to questions on the presentation and management of RLS symptoms within the primary care population.

Section snippets

Methods

Primary care centers in the USA and four European countries participated in this study. The goal was to obtain similar numbers of respondents from each country. Data were obtained from 182 primary care physicians (PCPs) and 23,052 patients, as follows: France (59 PCPs/4808 patients); Germany (32/6723); Spain (30/5752); UK (28/2114); USA (33/3655). As practices in France are smaller, more PCPs were selected from France than from other countries. Physicians were recruited from all regions of each

Prevalence of RLS symptoms in a primary care population

The prevalence of any degree of RLS symptoms was 11.1% (2564/23,052) and that for symptoms at least once weekly was 9.6% (2223/23,052). Considering only patients with matched questionnaires, a minimum estimate of the prevalence in those with at least twice-weekly symptoms is 3.9% (899/23,052; Fig. 1) and in those whose symptoms have also appreciable negative impact on quality of life, 2.4% (551/23,052; Fig. 1). Figures for individual countries are given in Table 4.

Because there were 666

Discussion

The REST Primary Care study indicates that RLS is a common cause of sleep disruption that usually remains undiagnosed in primary care. Even when diagnosed, RLS is often not appropriately treated. These results highlight the need for education to make physicians more aware of how RLS presents and how it is diagnosed as well as the medications established to be most effective for its treatment. REST Primary Care is the first profile study of RLS to collect data on the condition from both the

Conclusions

In conclusion, the results of the REST Primary Care study suggest that RLS is a major cause of sleep disturbance among patients visiting PCPs in western Europe and the USA. The data reported here support the view that moderately severe symptoms of RLS causing appreciable distress are present in about 3% of patients visiting a PCP, but RLS often remains undiagnosed. Awareness of the condition appears to be low as shown by the wide range of diagnoses given to those with symptoms of RLS and by the

Acknowledgements

We would like to thank Trevor Brown of Premark, Inc. for his assistance in organizing the study, and Insight International Research with supervision by Nicola Cowland for carrying out the survey in all countries. Funds for the study were provided by GlaxoSmithKline.

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