Prevalence of restless legs syndrome in North American and Western European populations: A systematic review

doi:10.1016/j.sleep.2010.12.018

Sleep Medicine

Volume 12, Issue 7, August 2011, Pages 623-634

https://doi.org/10.1016/j.sleep.2010.12.018 Get rights and content

Abstract

Background

Restless legs syndrome (RLS) is a potentially debilitating sleep disorder that affects a significant percentage of North American and European adults. Although standardized RLS diagnostic criteria are now established and widely accepted, reported prevalence estimates have varied widely. In this paper, we review the literature regarding RLS prevalence in North American and Western European adult populations, examine potential sources of variation, briefly discuss the impact of RLS, and offer recommendations for future research.

Methods

To identify qualifying studies, we searched 6 scientific databases and scanned bibliographies of relevant review papers and all identified articles. Studies including fewer than 300 participants, that did not use any of the 4 standard diagnostic criteria, were published prior to 1995 or targeted clinical populations were excluded.

Results

Thirty-four papers detailing results of large, population-based studies in 16 North American and Western European countries met our inclusion criteria, including 5 multi-country studies (N = 69,992 participants) and 29 single country studies (N = 163,188 participants); all but one were cross-sectional. Reported general prevalence rates ranged from 4% to 29% of adults, averaging 14.5 ± 8.0% across studies. Reported prevalence averaged higher in primary care populations than in populations derived from random sampling or geographically defined cohorts (19.5 ± 7.9% vs. 12.3 ± 7.2%). Diagnostic and severity criteria differed considerably among studies, as did inclusion criteria, with corresponding variation in prevalence estimates. Prevalence averaged higher in women and older adults; more limited data suggest race/ethnicity, parity, health status, and other factors may also contribute to the observed variation in prevalence. RLS has profound, negative effects on health, well-being, and quality of life, yet detection rates remain low.

Conclusions

Collectively, these studies indicate that RLS is a common disorder of major clinical and public health significance in the Western industrialized world, affecting between 4% and 29% of adults. The wide variation in reported prevalence likely reflects differences in demographic factors, health status, and other population characteristics; study population source and sampling frame; and inconsistencies in RLS diagnostic criteria and procedures. Prospective studies and corresponding incidence data on RLS are lacking, hindering the evaluation of both causal factors and sequelae.

Introduction

Restless legs syndrome (RLS) is a potentially debilitating sleep and sensorimotor disorder that affects a significant percentage of North American and Western European adults [1], [2], [3], [4]. RLS is characterized by a distressing, irresistible urge to move the legs which is usually accompanied by uncomfortable sensations in the lower extremities, that begins or worsens during periods of inactivity, is worse during the evening and nighttime hours, and is partially or totally relieved by movement [1], [3], [5]. Recognition of RLS as an important clinical condition is growing, in part aided by standardized minimal clinical criteria developed by an international expert consensus in 1995 [6] and revised in 2003 [1] (Table 1). While there remains some debate regarding the specificity of these criteria, the diagnostic guidelines developed by the international restless legs syndrome study group (IRLSSG) [1] are now widely accepted [2], [4]. The establishment of standardized diagnostic criteria, coupled with the increasing appreciation of RLS as a disorder of significant clinical and economic impact have, in turn, led to a growing number of population-based studies regarding RLS prevalence and epidemiology in both North American and Western European populations. However, despite apparent broad disparities in reported estimates and corresponding uncertainty regarding the public health significance of RLS, prevalence data from these studies have not, to our knowledge, been comprehensively reviewed. In this paper, we present a systematic review of the published literature regarding RLS prevalence in the general Western European and North American populations, discuss potential sources of variation, outline the implications regarding the clinical and public health impact of RLS, and offer recommendations for future research.

Section snippets

Methods

Included in this review are original population-based studies published from 1995–2010 in the peer-reviewed scientific literature that provided data on prevalence of RLS in North American and/or Western European populations. We excluded studies that targeted clinical populations, were based only on chart or medical record review, were not available in English, did not target North American or Western European populations, included fewer than 300 participants, did not specifically target RLS,

Results and discussion

Of over 1300 potentially relevant abstracts and citation indices scanned, 55 possibly eligible papers were identified for detailed review; of these, 21 were excluded for the following reasons: one targeted clinical populations only, 6 did not present original data or reported data included in another paper, 2 were not available in English, 3 were available only in abstract or report form, 4 did not specifically target RLS, 3 used a definition of RLS that did not include any of the 4 IRLSSG

Limitations

As described above, studies included in this review were heterogeneous in many respects; thus, summary estimates of prevalence must be interpreted with caution. An additional limitation includes restriction to papers published in the English language, potentially introducing bias and narrowing the scope of the review. However, only two (German language) publications were excluded on these grounds [93], [94]; these papers reported prevalence estimates consistent with those of other studies in

Conclusions and recommendations for future research

Collectively, these studies suggest that RLS is a condition of major public health significance in the Western industrialized world, affecting between 4% and 29% of adults and exacting substantial costs in terms of health, functioning, and quality of life. Estimates of prevalence in recent large population-based studies have varied considerably, likely reflecting differences in RLS diagnostic and severity criteria, population characteristics, and study population source. While standard criteria

Conflict of interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2010.12.018.

Acknowledgments

This work was made possible by the National Center for Complementary and Alternative Medicine and the Office of Research on Women’s Health (Grant Nos. R21AT002982 and 1 K01 AT004108 to K.E.I.) and West Virginia University. The contents are solely the responsibility of the authors and do not represent the official views of West Virginia University, the University of Virginia, or the National Institutes of Health.

References (96)

R.P. Allen et al.
Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health
Sleep Med
(2003)
R.E. Salas et al.
All the wrong moves: a clinical review of restless legs syndrome, periodic limb movements of sleep and wake, and periodic limb movement disorder
Clin Chest Med
(2010)
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 [see comment]
Sleep Med
(2004)
H.B. Lee et al.
Race and restless legs syndrome symptoms in an adult community sample in east Baltimore
Sleep Med
(2006)
B. Phillips et al.
Prevalence and correlates of restless legs syndrome: results from the 2005 National Sleep Foundation Poll
Chest
(2006)
J.W. Winkelman et al.
Prevalence and correlates of restless legs syndrome symptoms in the Wisconsin Sleep Cohort
Sleep Med
(2006)
R.P. Allen et al.
Physician-diagnosed restless legs syndrome in a large sample of primary medical care patients in western Europe: Prevalence and characteristics
Sleep Med
(2010)
M.M. Ohayon et al.
Prevalence of restless legs syndrome and periodic limb movement disorder in the general population
J Psychosom Res
(2002)
C. Möller et al.
Differential diagnosis of unpleasant sensations in the legs: Prevalence of restless legs syndrome in a primary care population
Sleep Med
(2010)
B. Bjorvatn et al.
Prevalence, severity and risk factors of restless legs syndrome in the general adult population in two Scandinavian countries
Sleep Med
(2005)

J. Ulfberg et al.

Comorbidity in restless legs syndrome among a sample of Swedish adults

Sleep Med

(2007)

W.A. Hening et al.

The four diagnostic criteria for Restless Legs Syndrome are unable to exclude confounding conditions (“mimics”)

Sleep Med

(2009)

W.A. Hening et al.

Validation of the Hopkins telephone diagnostic interview for restless legs syndrome

Sleep Med

(2008)

R.P. Allen et al.

Validation of the self-completed Cambridge-Hopkins questionnaire (CH-RLSq) for ascertainment of restless legs syndrome (RLS) in a population survey

Sleep Med

(2009)

Y. Tsuboi et al.

Prevalence of restless legs syndrome in a Japanese elderly population

Parkinsonism Relat Disord

(2009)

Y.-M. Park et al.

Prevalence of idiopathic and secondary restless legs syndrome in Korean Women

Gen Hos Psychiatry

(2010)

O.A. Minai et al.

Prevalence and characteristics of restless legs syndrome in patients with pulmonary hypertension

J Heart Lung Transplant

(2008)

K. Banno et al.

Restless legs syndrome in 218 patients: associated disorders

Sleep Med

(2000)

M. Manconi et al.

Pregnancy as a risk factor for restless legs syndrome

Sleep Med

(2004)

N.P. Pantaleo et al.

Pregnancy accounts for most of the gender difference in prevalence of familial RLS

Sleep Med

(2010)

L. Abetz et al.

Evaluating the quality of life of patients with restless legs syndrome

Clin Ther

(2004)

S. Happe et al.

Assessing health-related quality of life in patients with restless legs syndrome

Sleep Med

(2009)

M.J. Sateia

Update on sleep and psychiatric disorders

Chest

(2009)

B.S. McEwen

Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators

Eur J Pharmacol

(2008)

P. Meerlo et al.

Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity

Sleep Med Rev

(2008)

E.C. Suarez

Self-reported symptoms of sleep disturbance and inflammation, coagulation, insulin resistance and psychosocial distress: evidence for gender disparity

Brain Behav Immun

(2008)

B.E. Cohen et al.

Psychological risk factors and the metabolic syndrome in patients with coronary heart disease: findings from the heart and soul study

Psychiatry Res

(2010)

D.A.M.C. van de Vijver et al.

Epidemiology of restless legs syndrome as diagnosed in UK primary care

Sleep Med

(2004)

K. Ekbom et al.

Restless legs syndrome

J Intern Med

(2009)

C. Trenkwalder et al.

Restless legs syndrome: pathophysiology clinical presentation and management

Nat Rev Neurol

(2010)

J.E. Smith et al.

Recognition, diagnosis, and treatment of restless legs syndrome

J Am Acad Nurse Pract

(2008)

A.S. Walters

Toward a better definition of the restless legs syndrome

Mov Disord

(1995)

M. Alattar et al.

Sleep problems in primary care: a North Carolina family practice research network (NC-FP-RN) study

J Am Board Fam Med

(2007)

R.P. Allen et al.

Restless legs syndrome prevalence and impact: REST general population study

Arch Intern Med

(2005)

X. Gao et al.

Obesity and restless legs syndrome in men and women

Neurology

(2009)

C.A. Kushida et al.

Symptom-based prevalence of sleep disorders in an adult primary care population

Sleep Breath

(2000)

M. Mustafa et al.

Sleep problems and the risk for sleep disorders in an outpatient veteran population

Sleep Breath Schlaf Atmung

(2005)

D.A. Nichols et al.

Restless legs syndrome symptoms in primary care: a prevalence study

Arch Intern Med

(2003)

B. Phillips et al.

Epidemiology of restless legs symptoms in adults [see comment]

Arch Intern Med

(2000)

J.W. Winkelman et al.

Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study

Neurology

(2008)

C.L. Froese et al.

Depression and sleep-related symptoms in an adult, indigenous, North American population

J Clin Sleep Med JCSM: Official Publication Am Acad Sleep Med

(2008)

P. Elwood et al.

Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort

J Epidemiol Commun Health

(2006)

D. Egan et al.

A community study of the prevalence of restless legs

Ir Med J

(2003)

S.T. O’Keeffe et al.

The frequency and impact of restless legs syndrome in primary care

Ir Med J

(2007)

S. Celle et al.

Prevalence and clinical correlates of restless legs syndrome in an elderly French population: the synapse study

J Gerontol A Biol Sci Med Sci

(2010)

F. Tison et al.

Epidemiology of restless legs syndrome in French adults. A nationwide survey: The INSTANT Study

Neurology

(2005)

K. Berger et al.

Sex and the risk of restless legs syndrome in the general population

Arch Intern Med

(2004)

S. Happe et al.

Treatment wish of individuals with known and unknown restless legs syndrome in the community

J Neurol

(2008)

Cited by (144)

Prevalence of restless legs syndrome in maintenance hemodialysis patients: A systematic review and meta-analysis
2024, Sleep Medicine
Restless legs syndrome is associated with quality of life and risk of death in maintenance hemodialysis patients. Although relevant meta-analyses have been conducted, epidemiological studies of restless legs syndrome have increased in recent years.
Our aim was to systematically assess the prevalence of restless legs syndrome in maintenance hemodialysis patients and to evaluate the effect of different geographic regions, genders, study designs, and years of publication on the prevalence of restless legs syndrome.
PubMed, Web of Science, EMBASE, The Cochrane Library, China Knowledge Resource Integrated Database, Wanfang Database, Weipu, and Chinese Biomedical Database were searched before March 16, 2023 for the published literature. Two investigators independently performed literature screening, data extraction for eligible studies, and risk of bias assessment. A random-effects model using the stata 15.0 software was used to assess the pooled prevalence of restless legs syndrome.
Fifty-seven articles were included in this meta-analysis, and the pooled prevalence of restless legs syndrome in 12,573 maintenance hemodialysis patients was 24.0 % (95 % CI: 21.0%–26.0 %). Maintenance hemodialysis patients from the Americas region and females had severe symptoms of restless legs syndrome, and the prevalence of restless legs syndrome increased from year to year. The prevalence of restless legs syndrome was higher in maintenance hemodialysis patients in cross-sectional studies and cohort studies compared to case-control studies.
Maintenance hemodialysis patients have a significantly higher prevalence of restless legs syndrome. These findings may provide some reference value for hospital nursing staff to focus on the management and treatment of restless legs syndrome in maintenance hemodialysis patients.
Demographic and clinical risk factors for diagnosis of sleep disorders in ESRD patients
2023, American Journal of the Medical Sciences
Sleep disturbances in patients with end-stage renal disease (ESRD) are common and more prevalent than in the general population. This study aims to assess the demographic and clinical risk factors for the diagnosis of sleep disorders in ESRD patients.
This study is a retrospective analysis of the United States Renal Data System (USRDS) to evaluate risk factors for the diagnosis of sleep disorders, including hypersomnolence, insomnia, restless leg syndrome (RLS), or obstructive or central sleep apnea (OSA/CSA). All ESRD subjects enrolled in the USRDS between 2004-2015 were eligible for inclusion. The risk factors analyzed were age, race, sex, ethnicity, access type, dialysis modality, and the Charlson Comorbidity Index (CCI). All statistical analysis was performed using SAS 9.4, and statistical significance was assessed using an alpha level of 0.05. Descriptive statistics on all variables overall and by each sleep diagnosis were determined.
Increasing age, black race, other race, and Hispanic ethnicity were associated with decreased risk of each sleep diagnosis while CCI was associated with increased risk. Females were at increased risk of RLS and insomnia while males were at increased risk of OSA/CSA. Catheter and graft access decreased risk of RLS but increased risk of insomnia compared to AVF access. Catheter access increased risk of OSA/CSA compared to graft access. Hemodialysis increased risk of OSA/CSA compared to peritoneal dialysis.
Some ESRD patients are at an increased risk for diagnosis of sleep disorders based on age, race, sex, comorbid health conditions, and dialysis modality.
Restless legs syndrome in patients with multiple sclerosis: evaluation of risk factors and clinical impact
2022, Neurologia
El síndrome de piernas inquietas (SPI) es un trastorno caracterizado por la necesidad imperiosa de mover las piernas, estando a menudo acompañado de sensaciones desagradables. Su frecuencia es superior en pacientes con esclerosis múltiple (EM) que en la población general.
Evaluar la prevalencia del SPI, según el cumplimiento de los 4 requisitos esenciales incluidos en los criterios diagnósticos propuestos por la International Restless leg syndrome study group (IRLSSG, 2003), en una cohorte de pacientes con EM e identificar posibles factores de riesgo y repercusión clínica.
Se incluyeron 120 pacientes con EM, con una edad media de inicio de 40 años y un tiempo medio de evolución de 46 meses. La prevalencia de SPI, según el cumplimiento de criterios diagnósticos de la IRLSSG, fue del 23,3%. El tiempo de evolución de EM, desde la aparición de los primeros síntomas, fue significativamente menor en pacientes con SPI (p=0,001). La presencia de un brote reciente, así como de síntomas de ansiedad, depresión y dolor neuropático se asociaron de forma significativa con el riesgo de SPI (p=0,001, p<0,001, p<0,001 y p=0,001, respectivamente). Además, los pacientes con SPI y EM presentaron mayor riesgo de mala calidad de sueño, fatiga, somnolencia diurna y peor calidad de vida, que aquellos sin SPI (p=0,002, p=0,017, p=0,013 y p=0,009, respectivamente).
El SPI debe ser considerado en la evaluación neurológica de pacientes con EM, cuyo diagnóstico y tratamiento precoz mejoraría la calidad de vida de estos sujetos.
Restless legs syndrome (RLS) is a disorder characterised by an irresistible urge to move the legs, usually accompanied by unpleasant sensations. It is more frequent in patients with multiple sclerosis (MS) than in the general population.
To evaluate the prevalence of RLS, defined according to the 4 essential requirements included in the diagnostic criteria proposed by the International Restless Leg Syndrome Study Group, in a cohort of patients with MS; and to identify potential risk factors and the clinical impact of RLS.
The sample included 120 patients with MS, with a mean age of symptom onset of 40 years and an average disease duration of 46 months. The prevalence rate of RLS was 23.3%. MS progression time was significantly shorter in patients with RLS (P = 0.001). A recent relapse, and symptoms of anxiety, depression, and neuropathic pain were significantly associated with risk of RLS (P = 0.001, P < 0.001, P < 0.001, and P = 0.001, respectively). In addition, patients with RLS had a greater risk of poor sleep quality, fatigue, daytime sleepiness, and poor quality of life than those without RLS (P = 0.002, P = 0.017, P = 0.013, and P = 0.009, respectively).
RLS should be considered in the neurological evaluation of patients with MS; early diagnosis and treatment would improve the quality of life of patients with MS presenting RLS.
The prevalence of the restless legs Syndrome/Willis-Ekbom disease among teenagers, its clinical characteristics and impact on everyday functioning
2022, Sleep Medicine
Citation Excerpt :
The frequency in our group was relatively low and close to another European study [13], but the advantage was that all patients were thoroughly clinically examined during face-to-face consultation and underwent laboratory tests. Ethnicity seems to be a risk factor for developing RLS/WED – lower risk in Asian adults in comparison with European/US populations [2,21–27]. The data published on RLS/WED in adolescents, being mostly Asian, show higher prevalenceRLS/WED is highly unlikely to be equally or more frequent in children than in adults, which leads to conclusion that the methodology of the surveys was not always reliable enough [14,17–20,25,28].
The data on the prevalence of the Restless Legs Syndrome/Willis -Ekbom disease (RLS/WED) in the population of teenagers is scarce. The aim of this study was to determine RLS/WED occurrence in adolescents, its diagnostic accuracy, family history, clinical characteristics and impact on everyday functioning.
A group of 2379 pupils (aged 13–18 y.o.) from 6 randomly selected secondary schools in Gdańsk, Poland were screened for RLS/WED with the use of a questionnaire. In order to verify the diagnosis and perform additional tests (neurological examination, psychological evaluation, biochemical blood tests, demographic questionnaire, International RLS rating scale/IRLSS, Epworth daytime sleepiness scale). all of the respondents with RLS/WED suspicion and their parents were asked for a consultation by a child neurologist. Both children and parents with RLS/WED diagnosis were tested with actigraphy at home for at least two consecutive nights.
Two thousand and ninety seven students (88,15%) filled the questionnaire correctly (1171 girls and 926 boys, 56% and 44%). Sixty four respondents were suspected of having RLS/WED (3,1%), however, 36 of them were diagnosed as RLS/WED-mimics (mainly positional discomfort). Finally, 21 (1%) were diagnosed with definite idiopathic RLS/WED. The average age of symptom onset was 10.96 years. The severity was moderate in the most of the cases (61.9%) and the course of the disease was intermittent in all of them. Family history was positive in 80%. Abnormal actigraphy (PLMS index >5/h) was present in 80%. Blood level of ferritin was low (<50 ng/ml) in 85%. Excessive daytime sleepiness and school problems affected almost half of them. The presence of RLS/WED symptoms was associated with disrupted sleep, behavioral problems (irritability, aggression, hyperactivity), attention deficit and lowered mood. No correlation between RLS/WED and attention deficit hyperactivity disorder (ADHD), nocturnal enuresis or primary headaches was found. Thirty eight percent of the patients sought medical help, but none of them obtained proper diagnosis nor treatment of RLS/WED.
In this study restless legs syndrome affected 1% of Polish teenagers, in the majority of cases was idiopathic and associated with positive family history. It affected sleep and everyday functioning. Neurological consultation is essential to avoid false positive diagnoses of RLS/WED in teenagers.
Restless legs syndrome in chronic renal failure patients on dialysis
2023, African Health Sciences
Frequency, risk factors, and impacts on quality of life of the restless legs syndrome and side effects among antidepressant users in a tertiary hospital: An observational cross-sectional study
2023, International Clinical Psychopharmacology

View all citing articles on Scopus

¹: Tel.: +1 304 293 2082; fax: +1 304 293 2700.

²: Tel.: +1 304 293 2968; fax: +1 304 293 2700.

View full text

Review ArticlePrevalence of restless legs syndrome in North American and Western European populations: A systematic review

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results and discussion

Limitations

Conclusions and recommendations for future research

Conflict of interest

Acknowledgments

Sleep Med

Clin Chest Med

Sleep Med

Sleep Med

Chest

Sleep Med

Sleep Med

J Psychosom Res

Sleep Med

Sleep Med

Sleep Med

Sleep Med

Sleep Med

Sleep Med

Parkinsonism Relat Disord

Gen Hos Psychiatry

J Heart Lung Transplant

Sleep Med

Sleep Med

Sleep Med

Clin Ther

Sleep Med

Chest

Eur J Pharmacol

Sleep Med Rev

Brain Behav Immun

Psychiatry Res

Sleep Med

Restless legs syndrome

J Intern Med

Restless legs syndrome: pathophysiology clinical presentation and management

Nat Rev Neurol

Recognition, diagnosis, and treatment of restless legs syndrome

J Am Acad Nurse Pract

Toward a better definition of the restless legs syndrome

Mov Disord

Sleep problems in primary care: a North Carolina family practice research network (NC-FP-RN) study

J Am Board Fam Med

Restless legs syndrome prevalence and impact: REST general population study

Arch Intern Med

Obesity and restless legs syndrome in men and women

Neurology

Symptom-based prevalence of sleep disorders in an adult primary care population

Sleep Breath

Sleep problems and the risk for sleep disorders in an outpatient veteran population

Sleep Breath Schlaf Atmung

Restless legs syndrome symptoms in primary care: a prevalence study

Arch Intern Med

Epidemiology of restless legs symptoms in adults [see comment]

Arch Intern Med

Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study

Neurology

Depression and sleep-related symptoms in an adult, indigenous, North American population

J Clin Sleep Med JCSM: Official Publication Am Acad Sleep Med

Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort

J Epidemiol Commun Health

A community study of the prevalence of restless legs

Ir Med J

The frequency and impact of restless legs syndrome in primary care

Ir Med J

Prevalence and clinical correlates of restless legs syndrome in an elderly French population: the synapse study

J Gerontol A Biol Sci Med Sci

Epidemiology of restless legs syndrome in French adults. A nationwide survey: The INSTANT Study

Neurology

Sex and the risk of restless legs syndrome in the general population

Arch Intern Med

Review Article
Prevalence of restless legs syndrome in North American and Western European populations: A systematic review