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RLS in primary care

Clinical bottom line

About 1 in 30-50 adults has RLS symptoms sufficiently severe to be worthy of treatment. Of these, only a quarter have been diagnosed, and fewer treated.


Reference

W Hening et al. Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: The REST (RLS epidemiology, symptoms, and treatment) primary care study. Sleep Medicine 2004 5: 237-246.

Study

The study was conducted in the USA, France, Germany, Spain and Uk. Primary care practices in all countries (182) had 23,052 patients. Primary care physicians participating were not told that it was a study of RLS.

In the study, patients who visited for any reason over a two week enrolment period were asked to complete a screening questionnaire. A presumptive diagnosis of RLS required a positive response to four diagnostic criteria. Those with a presumptive diagnosis and whop reported RLS at least once a week were asked to complete a more detailed questionnaire, including information on demographics, lifestyle, symptoms, and diagnostic and treatment history. Doctors also filled a separate questionnaire for these patients.

Results

The prevalence of any degree of RLS was 11%, and for symptoms occurring at least once a week was 10%, twice a week 5%, and 2.4% in those with a significant negative impact on quality of life (defined as sufferers and likely to require treatment). The variation between countries was large, with 1.9% of sufferers in Spain to 5.8% in the USA and 5.6% in the UK.

Sufferers had an average age of 57 years, with two-thirds women, with a mean duration of symptoms of 10-12 years. About two-thirds of sufferers had consulted a GP about their symptoms in the previous 12 months, with about a quarter receiving a diagnosis of RLS. Most had other conditions, and back pain, depression, hypertension, insomnia, anxiety, arthritis, obesity and cardiovascular conditions were common, whether defined by patient or doctor.

Symptoms most frequently reported are shown in Table 1, with sleep-related symptoms, uncomfortable feelings in legs, and pain the most common symptoms.

Table 1: Commonly reported symptoms by RLS sufferers

Symptom
Percent affected
Sleep-related symptom
43
Uncomfortable feeling in legs
27
Pain
21
Inability to stay still/ urge to move
12
Inability to get comfortable
11
Exhaustion/fatigue
10
Twitching/jerking of legs
9
Daytime sleepiness
6

RLS sufferers reported considerable difficulty in getting off to sleep. Only 30% were asleep within 30 minutes, with 34% taking more than an hour, and 15% more than two hours. Almost two-thirds of sufferers were woken during the night by their restless legs three times or more.

The study also describes the number of different consultations with specialists the sufferers had had, and any medications prescribed for it. Patients in France saw a specialist most often (70% of them), whilst those from the UK saw a specialist least often (fewer than 50%). There was no simple or consistent pattern to prescribing, but those with a diagnosis of RLS were more likely to be prescribed L-dopa.

Comment

This is a large study, well conducted. The estimate of 10% of adults having RLS symptoms at least once a week is possibly a bit high because it sampled people visiting their primary care physician, though it is in general agreement with other estimates. Perhaps as few as 1 in 30-50 has symptoms sufficiently severe to be worthy of treatment. Of these, only a quarter have been diagnosed, and fewer treated.