Published Research - General Sleep and RLS (WED)

For everything and anything else not covered in the other WED/RLS sections.
rthom
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Re: Published Research - General Sleep and RLS

Postby rthom » Sun Jun 03, 2012 1:32 pm

Yes thanks anne
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Re: Published Research - General Sleep and RLS

Postby Polar Bear » Sun Jun 03, 2012 2:16 pm

:lol:
Betty
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Re: Published Research - General Sleep and RLS

Postby badnights » Sun Jun 03, 2012 7:59 pm

probably multiple genes are involved anyway, if I understand that stuff (which I don't, much less than any of the other papers)
Beth - Wishing you a restful sleep tonight
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cornelia

Re: Published Research - General Sleep and RLS

Postby cornelia » Tue Jun 19, 2012 9:02 am

Guys, I have always been a bit skepticalin my mind when some of you wrote that vit. D helped their RLS. I have to apologise because there is new research with shows that the role of vit. D can be important:

Sleep Med. 2012 Jun 13. [Epub ahead of print]
Serum 25-hydroxyvitamin D levels in restless legs syndrome patients.
Balaban H, Yıldız OK, Cil G, Sentürk IA, Erselcan T, Bolayır E, Topaktaş S.
Source
Department of Neurology, Cumhuriyet University, Faculty of Medicine, TR-58140 Sivas, Turkey.
Abstract
OBJECTIVE:
Restless legs syndrome is characterised by discomfort during rest and an urge to move the limbs that is accompanied by abnormal sensations. Studies on disease pathophysiology have focused on dopaminergic dysfunction. Vitamin D may play an important role in dopamine function, but the role of vitamin D in restless legs syndrome has not been examined. We compared the serum vitamin D levels of RLS patients and matched controls and explored the correlation of plasma vitamin D levels with disease severity.
PATIENTS/METHODS:
We measured serum 25-hydroxyvitamin D levels in 36 patients with restless legs syndrome and compared them to 38 healthy control subjects.
RESULTS:
The mean serum 25-hydroxyvitamin D levels were 7.31±4.63ng/mL in female patients with restless legs syndrome and 12.31±5.27ng/mL in female control subjects (p=0.001). We found a significant inverse correlation between vitamin D levels and disease severity in females (p=0.01, r=-0.47).
CONCLUSION:
The mean serum vitamin D levels were lower in female patients with restless legs syndrome. Low vitamin D levels may cause dopaminergic dysfunction in restless legs syndrome patients. Further studies are required to confirm these results.

Corrie

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Re: Published Research - General Sleep and RLS

Postby Betty/WV » Tue Jun 19, 2012 2:00 pm

But in the published research it stated "the role of Vitamin D i n restless legs syndrome has not been examined.????????
I am such a "doubting Thomas".

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Re: Published Research - General Sleep and RLS

Postby Chipmunk » Thu Jun 21, 2012 4:32 am

Betty/WV wrote:But in the published research it stated "the role of Vitamin D i n restless legs syndrome has not been examined.????????
I am such a "doubting Thomas".

BETTY/WV

This just means that they know it works; they just don't know HOW it works.

An r-value of 1 or -1 would be a perfect match, so -0.47 is quite significant. Guess I'll start taking Vitamin D regularly again!
Tracy

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Re: Published Research - General Sleep and RLS

Postby badnights » Thu Jun 21, 2012 4:45 am

Betty, that part you quote is in the "objectives" section, where they lay out the problem and summarize the state of affairs as of when they started their study. They could have said " ..but the role of vitamin D in restless legs syndrome had not been examined before this study". But no one writes that way, by convention.

It's also true they still don't know HOW it works.

Vitamin D is the only thing I've ever recommended to anyone that had no direct research to back it up. (HAD! :lol: :lol: thanks, cornelia)There were 3 or 4 people here, me one, who had profoundly improved WED symptoms after supplementing with D after having their D levels measured below about 20 ng/mL.
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Re: Published Research - General Sleep and RLS

Postby Betty/WV » Thu Jun 21, 2012 10:53 am

My husband and I took vitamin D for years, then the study came out that it wasn't as beneficial as they thought and it was actually bad for the heart. So, since I have had a heart attack, I quit taking it. Now its good for you again. Hmmmm---now what?

BETTY/WV
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Re: Published Research - General Sleep and RLS

Postby badnights » Sat Jun 23, 2012 3:29 am

BettyWV are you sure that was vitamin D you stopped, or was it calcium?
Beth - Wishing you a restful sleep tonight
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Re: Published Research - General Sleep and RLS

Postby ViewsAskew » Sun Jul 22, 2012 6:14 am

New study - Women with WED have higher incidence of depression that women without WED : http://aje.oxfordjournals.org/content/e ... hort?rss=1


Most research on the association between restless legs syndrome (RLS) and depression has involved cross-sectional data. The objective of the present study was to evaluate this issue prospectively among Nurses' Health Study participants. A total of 56,399 women (mean age = 68 years) who were free of depression symptoms at baseline (2002) were followed until 2008. Physician-diagnosed RLS was self-reported. During 300,155 person-years of follow-up, the authors identified 1,268 incident cases of clinical depression (regular use of antidepressant medication and physician-diagnosed depression). Women with RLS at baseline were more likely to develop clinical depression (multivariate-adjusted relative risk (RR) = 1.5, 95% confidence interval (CI): 1.1, 2.1; P = 0.02) than those without RLS. The presence of RLS at baseline was also associated with higher scores on the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) and the 15-item Geriatric Depression Scale (GDS-15) thereafter. Multivariable-adjusted mean differences were 1.00 (standard error, 0.12) for CESD-10 score and 0.47 (standard error, 0.07) for GDS-15 score between women with RLS and those without RLS (P < 0.0001). In conclusion, women with physician-diagnosed RLS had an increased risk of developing clinical depression and clinically relevant depression symptoms. Further prospective studies using refined approaches to ascertainment of RLS and depression are warranted.
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Re: Published Research - General Sleep and RLS

Postby ViewsAskew » Tue Oct 09, 2012 6:57 am

Interesting research about RLS (WED and polyneuropathy.

http://www.sciencedirect.com/science/ar ... 5712003231

Abstract
Background

The association of restless legs syndrome (RLS) with polyneuropathy, and its prevalence, have been evaluated differently throughout various studies. As subtypes of polyneuropathy characterized by neuropathic pain seem to be preferentially associated with RLS, we intended to investigate the prevalence and the features of RLS occurring with painful neuropathy, and to define whether there is a specific sensory phenotype.
Methods

We prospectively investigated 58 consecutive patients with distal symmetric polyneuropathy and neuropathic pain or dysesthesia, using a bedside protocol for sensory assessment. RLS was diagnosed with an interview assessing the International RLS Study Group diagnostic criteria.
Results

Overall, RLS was reported by 21 patients (36.2%), but it was occurring at the time of the evaluation in 12 patients (20.7%), significantly more than in controls. RLS was chronic in nine patients and remitting–intermittent in 12 patients. No difference was demonstrated between patients with or without RLS. Comparing patients with chronic RLS and remitting-intermittent RLS, the latter had more severe electrophysiological changes, whereas hyperalgesia, suggesting central sensitization, was significantly more frequent in chronic RLS patients.
Conclusions

RLS is frequently associated with painful polyneuropathy, in keeping with the hypothesis that its occurrence is favored by small fiber involvement. It represents a heterogeneous entity, differentiated in chronic and remitting-intermittent subtypes, possibly conditioned by indolent or aggressive neuropathy course and phenomena of central sensitisation.
Keywords

Restless legs syndrome;
Small fiber neuropathy;
Neuropathic pain;
Diabetic neuropathy
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Re: Published Research - General Sleep and RLS

Postby ViewsAskew » Tue Oct 09, 2012 7:02 am

And more supporting research that older woman with RLS are more likely to have heart disease.

http://www.health.harvard.edu/blog/rest ... 12-pjs1_tw

Restless legs linked to broken hearts
Posted September 26, 2012, 3:24 pm
Daniel Pendick, Executive Editor, Harvard Men's Health Watch

The sleep-robbing condition known as restless legs syndrome (RLS) raises the risk of heart disease in older women about as much as smoking and obesity, according to a new Harvard-based study published online in the journal Circulation.

“If the link to heart disease is confirmed—and there is a growing body of evidence to support that—it would show that restless legs syndrome carries a burden of future risk of a serious medical illness,” explains research team member Dr. John Winkelman, medical director of the Sleep Health Center of Brigham and Women’s Hospital and associate professor of psychiatry at Harvard Medical School.

Uncovering this link could help people with RLS pay better attention to their cardiovascular health and potentially ward off a heart attack, stroke, or other cardiovascular condition. “We can use RLS to identify those who have a higher risk of developing coronary heart disease if our findings are confirmed by future studies,” says study leader Dr. Xiang Gao, an assistant professor of medicine at Harvard Medical School and research scientist at the Harvard School of Public Health.
Restless sleep

RLS is a disorder that doesn’t yet have widespread awareness and acceptance. There is still a tendency for some, even in medicine, to dismiss it as a “made up” condition. “For those who have moderate to severe restless leg syndrome, it’s not just a curiosity or minor annoyance—it can ruin their lives,” Dr. Winkelman says.

The key sign of RLS is an irresistible urge to move the legs, often accompanied by an uncomfortable “creepy-crawly” sensation. It affects about 2% of adults and is twice as common in women as in men. Symptoms typically flare as people settle into bed, but may also arise when simply resting in a chair or sitting at a desk. Most people with RLS also experience periodic jerking leg motions during sleep.

How could a problem like that be related to heart disease? Nighttime leg movements rev up the cardiovascular system, triggering frequent spikes in blood pressure. In addition, overstimulation and general sleep deprivation take their toll the next day with fatigue, fuzzy thinking, lower work productivity, and depression.

Previous studies have shown that individuals with RLS tended to have lower sleep quality. And since poor sleep quality has been linked to heart disease, “this could be one of the reasons for the connection between RLS and heart disease observed in the study,” says Dr. Gao.

He and his colleagues made the connection between RLS and cardiovascular disease by examining health records of more than 70,000 women participating in the Nurse’s Health Study, the world’s largest, longest-running study of women’s health. Over a six-year period, about one in 60 of the women diagnosed with RLS developed heart disease, compared with about one in 100 of the women without RLS. After correcting for other influences, the researchers determined that women with RLS were about 50% more likely to develop heart disease than women without RLS. The link was strongest for women who had experienced RLS symptoms for at least three years.

“The risk of heart disease relative to RLS is comparable to the relative risk of smoking, being overweight, and not exercising regularly,” says Yanping Li, PhD, a research fellow at Harvard Medical School and Brigham and Women’s Hospital.
What can you do?

If you are experiencing uncomfortable urges to move while at rest, either during the day or night, talk to a doctor.

If you have RLS, treatment involves a combination of lifestyle and behavior changes to help keep waking symptoms at bay, such as remaining physically and mentally active when symptoms are most likely to occur. To improve sleep, there are four FDA approved drugs that are remarkably effective, says Dr. Winkelman.

Women with RLS might also consider taking a closer look at their heart health and doing what they can to lower their cardio risk. Should men with RLS do the same? Probably. A similar study is in the works to see if there is a connection between RLS and heart disease in men, but it never hurts to improve your cardiovascular health.
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Re: Published Research - General Sleep and RLS

Postby ViewsAskew » Tue Oct 16, 2012 2:37 am

http://www.ajmc.com/publications/supple ... Salas_S207

It's not new to us, but it's reaffirming and will hoping help get funding and more attention regarding our dilemma.

note - This is a 4 page article. I've posted it as four separate posts. Please read them all.

In case the link above stops working, we've attached a downloadable PDF , and here is a copy of the article:

The Real Burden of Restless Legs Syndrome: Clinical and Economic Outcomes
Rachel E. Salas, MD; and Anthony B. Kwan
Restless legs syndrome (RLS) is a highly prevalent and substantially underdiagnosed sensorimotor disorder. Only relatively recently have the large impact on patient quality of life (QoL) and the economic burden associated with RLS become more widely recognized. QoL in patients with RLS has been shown to be worse than that of many other chronic conditions, including type 2 diabetes, clinical depression, and osteoarthritis. Sleep disturbance, a cardinal feature of RLS, is the most common and most destructive of its symptoms. More than two-thirds of RLS patients experience serious insomnia, and waking up several times per night is typical for this patient population. Moreover, RLS disrupts rest during waking hours, such as when the patient is sitting or relaxing. Thus, whether awake or asleep, the RLS patient finds little opportunity for the general restorative behaviors necessary for healthy human functioning, resulting in high rates of comorbidities including depression, anxiety, and hypertension. The direct and indirect costs related to RLS have been evaluated in a few studies. Although the cost studies are associated with certain limitations (eg, use of questionnaires), the results show that costs related to RLS are substantial. Healthcare utilization, primarily in the form of doctor visits, constitutes the largest proportion of direct expenditures for RLS in the United States. Indirect costs are also large, primarily due to productivity losses, which are as high as 20% in RLS patients. Effective treatment of RLS is necessary to limit the negative effects of RLS on QoL and to reduce costs associated with the condition.

(Am J Manag Care. 2012;18:S207-S212)
Introduction
Restless legs syndrome (RLS) is a highly prevalent sensorimotor disorder with the potential to exert a very substantial negative impact on the quality of life (QoL) of those affected.1,2 The 4 standard diagnostic criteria for RLS are: 1) an urge to move the legs, 2) such an urge, or unpleasant feelings, while in a state of rest or inactivity, 3) relief of the urge and unpleasant feeling through movement, and 4) experience or intensification of the urge/unpleasant feelings during the evening or night hours.3,4

The pathophysiology of RLS is not fully understood; however, dopaminergic dysfunction and brain iron deficiency are thought to play a role. RLS is categorized as either primary or secondary. Primary RLS is idiopathic, with no known cause. Secondary RLS is associated with particular medical conditions, for example iron deficiency or chronic renal failure, or the use of certain medications.5

Reports regarding the epidemiology of RLS provide somewhat variable prevalence estimates based on the particular countries in which prevalence is measured, and how RLS is reported visà-vis the threshold of symptom severity. The REST General Population study, which included interviews with 15,391 adults in the United States (n = 6014), France, Italy, Spain, and the United Kingdom, found that 7.2% of the total study population met all 4 diagnostic criteria with “any frequency” of symptoms, while 5% experienced symptoms at least once per week, and 2.7% were designated RLS “sufferers,” meaning they experienced moderately or severely distressing symptoms at least twice per week. Data from the United States showed that 7.6% experienced the 4 diagnostic symptoms of RLS with any frequency, 5.8% experienced the 4 symptoms once or more per week, and 3.1% were designated RLS sufferers.2

A recent systematic review by Innes et al of RLS epidemiology studies from North America and Western Europe—which included 34 papers comprising over 230,000 participants— found prevalence rates in adults ranging from 4% to 29%.6 The RLS Epidemiology, Symptoms, and Treatment (REST) General Population study found the prevalence of RLS approximately 2 to 3 times more common in women—depending on severity of symptoms—which was roughly consistent with the Innes findings.2,6 Other demographic risk factors for RLS have been identified in epidemiologic studies. A study published in 2012, for example, examined demographic and socioeconomic risk factors for RLS based on the results of 2 population-based cohort studies conducted in Germany. One of the studies included was conducted in Dortmund and included 1312 participants; the other study was conducted in Pomerania and included 4308 participants. The authors found that risk factors for RLS in the Pomeranian study, which had a mean follow-up of 5.2 years, included female gender, being retired, and being unemployed. The study from Dortmund, which had a mean 2.2 year follow-up, observed slightly different risk factors: being retired, not having an education beyond primary school, being unemployed, having a low income, and doing shift work. Both studies also found that increased age and having an overall lower socioeconomic status were both associated with elevated RLS risk.7

Underdiagnosis of RLS is common, with only 41% of those requiring medical treatment actually receiving an RLS diagnosis; less than one-third of those experiencing frequent RLS symptoms receive an appropriate diagnosis.1 In addition to underdiagnosis, misdiagnosis is common. Hening et al noted a high risk for confounding symptoms (“mimics”) in RLS and conducted a study that examined the risk of being misdiagnosed with RLS despite qualifying for a diagnosis based on the 4 standard diagnostic criteria.3 Of the 1232 participants in the Hening study, 126 were found not to have RLS and yet reported experiencing symptoms that were consistent with the 4 diagnostic criteria.3 The authors further identified 6 mimics that sufficiently resembled 1 or more of the 4 diagnostic criteria so as to provoke misdiagnosis. These 6 mimics were: leg cramps, peripheral neuropathy, radiculopathy, arthritic pain, positional discomfort (ie, a particular seated/lying position causing RLS-like symptoms rather than urge/discomfort while being at rest per se), and pronounced or frequent unconscious movement of the feet or legs (eg, foot tapping, hypnic jerks).3

RLS has, in recent years, become the subject of intensifying study as the prevalence of RLS and the seriousness of an RLS diagnosis are becoming better recognized. The purpose of the present article is to examine the clinical and QoL burdens experienced by those who live with RLS symptoms as well as the economic burden borne by managed care organizations (MCOs) and the public at large.

Quality of Life

The burden on patient QoL arising from RLS can be severe, as has been observed in numerous QoL studies. Kushida et al, employing the SF-36 instrument for measuring QoL, found that across all 8 domains addressed by SF-36—including physical functioning, physical role functioning, bodily pain, general health perceptions, vitality, social role functioning, emotional role functioning, and mental health—participants with RLS scored significantly worse than published norms for the general US population. The authors also compared SF-36 scores for RLS with those scores observed in patients with type 2 diabetes, clinical depression, and osteoarthritis, and found that RLS patients had lower scores in nearly every domain, both physical and mental, compared with those other patient populations.8

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Last edited by badnights on Thu Oct 18, 2012 6:12 am, edited 1 time in total.
Reason: added a PDF of the article
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Re: Published Research - General Sleep and RLS

Postby ViewsAskew » Tue Oct 16, 2012 2:39 am

The Real Burden of Restless Legs Syndrome: Clinical and Economic Outcomes - Page 2
Rachel E. Salas, MD; and Anthony B. Kwan

PAGE 2 - CONTINUED FROM PRIOR POST

These results are consistent with a study conducted by Abetz et al, which also employed the SF-36 and which also found significantly worse scores in each of the SF-36 domains for RLS patients compared with the general population. Similarly to the Kushida study, the study authors compared QoL scores in RLS participants with those of people with type 2 diabetes, clinical depression, chronic obstructive pulmonary disease (COPD) with hypertension, and osteoarthritis with hypertension. RLS patients were found to experience worse QoL scores for role-physical, bodily pain, and vitality compared with the other 4 groups, and worse scores for social function, role-emotional, and mental health than all but those with clinical depression. RLS patients also fared worse for general health compared with the type 2 diabetes and osteoarthritis groups.9

Sleep Disturbance

The burden of RLS on QoL can manifest in numerous ways, but much of the burden arises from the disturbance of sleep that the condition engenders. Sleep-related symptoms were by far the most commonly reported troublesome symptom experienced by patients with RLS in the REST Primary Care study, which included data from 23,052 patients in primary care centers in the United States and Western Europe (Figure).10 More than two-thirds (68.6%) of REST study participants required more than 30 minutes to fall asleep (diagnostic for insomnia), while 60.1% stated that they awoke at least 3 times every night, and the same percentage described difficulty sitting or relaxing.10,11 In addition, 57.2% of respondents reported that their activities of daily living (ADLs) were disturbed by RLS and 53.9% described depressive symptoms. When asked about the overall effect of RLS on their QoL, more than one-third of the study participants said that RLS had a high negative impact on their lives, and the remainder reported that it had some degree of negative impact.10

In the REST General Population study, which involved face-to-face or telephone interviews, more than three-fourths of study participants designated as RLS sufferers reported sleeprelated symptoms, 55.5% reported disturbance of daytime functioning, -59.4% reported pain associated with their RLS symptoms, and 26.2% reported mood disturbance (tendency to become depressed or “low”). The authors of a German study of patients with RLS diagnosed at movement disorder or neurological clinics observed that it took participants an average of 82.5 minutes to fall asleep and that patients averaged 4.3 awakenings per night.12

Sleep disturbance due to RLS has a negative impact on patient QoL, including performance. Many participants in the REST study reported daytime sleepiness and difficulty concentrating the next day, presumably due to sleep disturbance.2

Other Common Comorbidities in Patients With RLS

A variety of comorbidities are associated with RLS, including renal disease, iron deficiency, anemia, neuropathy, sleep apnea, pregnancy, and attention deficit disorder.13,14 It has been observed that people with Parkinson’s disease often have RLS, although this connection is not observed in untreated Parkinson’s; it is hypothesized that RLS in patients with Parkinson’s disease may be a consequence of treatment with certain drugs rather than the result of a direct pathological relationship.15

The psychological distress experienced by people with RLS can be quite severe, as RLS is a chronic condition in which rest, in both awake and sleeping states, is repeatedly and indefinitely disrupted. The extent and varieties of psychological distress associated with RLS were the subject of a recent study by Scholz et al. Psychological abnormalities commonly observed among the RLS participants were somatization (ie, the emergence of medical symptoms without a discernable organic cause), anxiety, compulsivity, and depression, all of which occurred at significantly higher rates than in members of the general population. In addition, a significant correlation was observed between psychological issues and disease severity.16

RLS is relatively common in patients with renal disease. The form of RLS observed in this patient population, uremic RLS, may be associated with greater symptom severity and different patterns of patient age at onset.17 An Italian study of patients with end-stage renal disease undergoing hemodialysis found an RLS prevalence rate of 18.4% in this patient population, and notably severe symptoms: 41% described moderate symptoms, 31% had severe symptoms, and 16% had very severe symptoms. Only 12% of study participants reported a mild form of RLS symptoms, which comprises a much smaller proportion than typical participants with idiopathic RLS.17 These results are consistent with a recent Greek study, which observed an RLS prevalence of 42% in 70 patients undergoing hemodialysis, and also found an average symptom score, for all participants with RLS, that met or exceeded the threshold for categorization as severe.18 The Greek study also observed that RLS patients undergoing hemodialysis showed evidence of significant muscle atrophy in the legs, a clinical manifestation not observed in patients undergoing hemodialysis who did not have RLS.18

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Re: Published Research - General Sleep and RLS

Postby ViewsAskew » Tue Oct 16, 2012 2:40 am

The Real Burden of Restless Legs Syndrome: Clinical and Economic Outcomes - Page 3
Rachel E. Salas, MD; and Anthony B. Kwan

PAGE 3 - CONTINUED FROM PRIOR POST

Hypertension is another comorbidity strongly associated with RLS, as shown by data from the Nurses Health Study II, one of the largest prospective studies ever conducted. The participants included in the RLS/hypertension study were, in fact, a subpopulation of the larger study, and consisted of 65,544 middle-aged women (aged 41-58 years), among whom 2475 experienced RLS symptoms 5 to 14 times per month, and 1748 of whom experienced RLS symptoms at least 15 times per month. Within the more frequent symptoms group, the rate of hypertension was 33%, compared with 26% in the less frequent symptom group and 21.4% among participants without RLS. The age-adjusted odds ratio (OR) for hypertension in the more frequent and less frequent symptom groups compared with the non-RLS group was 1.73 and 1.24, respectively (P <.0001 for trend). The multivariate-adjusted OR was 1.41 for the more frequent symptom group and 1.06 for the less frequent symptom group (P <.0001 for trend).19

Studies of patients with fibromyalgia also reveal a high prevalence of RLS. A US study of 172 fibromyalgia patients observed an age- and gender-adjusted RLS prevalence of 33% versus 3% in 63 matched controls (P <.01).20 In a Swedish study of women with diagnosed fibromyalgia, researchers mailed questionnaires to 266 patients who attended a fibromyalgia rehabilitation clinic; 232 patients (87%) responded. Of these responders, 64% were reported to have fulfilled the standard criteria for an RLS diagnosis.21 A small recent study involving participants with irritable bowel syndrome (IBS) also observed RLS to be very common in those with diarrhea-predominant IBS (62%), but less prevalent in those with constipation-predominant IBS (4%) or mixed-symptom IBS (33%).22

Economic Burden

The economic impact of RLS has been somewhat, if not extensively, studied; unfortunately, few such studies have been undertaken in the United States. One such US study, conducted by Allen et al and published in 2011, gathered data regarding lost productivity, healthcare resource use, and expenditures as reported by patients in 2007. These patient-reported data, while revealing, are somewhat less rigorous in their sourcing compared with a study that, for example, employs insurance claims data to determine disease-related expenditures.

Beginning with a large pool of possible candidates (over 300,000 individuals), the study authors identified and recruited 251 participants with “primary” RLS; that is, RLS without a recognizable secondary cause. Within this group, a subgroup of 131 RLS “sufferers” was also identified, ie, participants whose RLS severity required medical intervention based on symptoms that occurred at least twice per week and that were regarded by the participant as moderate or severely distressing.1 Half of those with primary RLS were employed during the course of the study: 36% worked full time and 15% worked part time. An additional 15% participated in volunteer work. Participants with primary RLS worked an average of 30.4 hours per week. Absenteeism associated with primary RLS was found to be 1.1% (0.3 hours per week), while on-the-job effectiveness was decreased by 13.5% in participants with primary RLS (“presenteeism”). Overall workplace productivity loss due to primary RLS was 14.1%, or 5.6 hours per 40-hour work week.1 RLS sufferers experienced similar, if somewhat worse, rates of productivity loss. The absenteeism rate was 1.9%, the presenteeism rate was 18.9%, and the overall productivity loss was 19.9%, or 1 day per 40-hour week.1 Disease severity was strongly correlated with loss of productivity in both groups: r = 0.54 for primary RLS and r = 0.53 for RLS sufferers (both P <.0001).1

Healthcare resource use reported in the Allen study included medical treatment received by participants during the 3 months preceding their recruitment. During that 3-month period, 57.6% of participants with primary RLS reported making at least 1 visit to a primary care/general practitioner; 36.4% of the visits were RLS related. By comparison, 64.1% of RLS sufferers had at least 1 primary care/ general practitioner visit, of which 44% were RLS related. In addition, 29.8% of participants with primary RLS undertook specialist visits (31.2% RLS related) versus 36.6% of RLS sufferers (37.5% RLS related). The emergency department was used by 7.8% of participants with primary RLS (12.5% RLS related) over the course of the 3-month pre-study period compared with 9.2% (16.7% RLS related) of RLS sufferers. With regard to medication use, 44.4% of participants with primary RLS and 54.2% of RLS sufferers were receiving at least 1 medication, with ropinirole being the most common (7.3% primary RLS vs 11.5% RLS sufferers), hydrocodone the second-most common (6.8% primary RLS vs 8.4% RLS sufferers), and pramipexole being the third-most common (primary RLS 5.4% vs 7.6% RLS sufferers).1 Annualized direct expenditures based on these 3-month data, for RLS specific healthcare resources only, were estimated to be $350 for participants with primary RLS ($187 medical visits, $129 medications) and $490 for RLS sufferers ($274 medical visits, $171 medications). Both medication and healthcare resource use costs related to RLS were significantly associated with symptom severity.1


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