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

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. In addition, prospective studies and corresponding incidence data on RLS are lacking, hindering the evaluation of both causal factors and sequelae.

Restless Legs Syndrome in an Appalachian Primary Care Population: Prevalence, Demographic and Lifestyle Correlates, and Burden

“…1,12,[33][34][35] Documented prevalence of RLS in primary care settings has typically averaged higher than that reported in population cohorts or random samples from the general population, possibly reflecting overall poorer health in primary care patients. 1 Primary care patients may also be more likely to seek medical care for conditions related to RLS.…”

“…1,12,[33][34][35] Documented prevalence of RLS in primary care settings has typically averaged higher than that reported in population cohorts or random samples from the general population, possibly reflecting overall poorer health in primary care patients. 1 Primary care patients may also be more likely to seek medical care for conditions related to RLS. 1,39 The definition of clinically significant RLS has varied across studies, from no symptom frequency or severity requirement 36 to symptoms at least twice/week with at least moderate distress.…”

“…Prevalence estimates of RLS have varied widely (from 4% to 29%) depending on the study population characteristics, study location, and RLS definition and ascertainment 1 ; even among the five studies in US primary care populations, prevalence estimates have ranged from 13.3% 12 to 29.3%. 19 Findings have likewise been inconsistent regarding the association of RLS to specific socioeconomic (SES) 1,6,[20][21][22][23] and lifestyle characteristics. 1,6,[20][21][22]24 Moreover, few studies have investigated RLS and RLS burden in poor, rural populations, including those residing in Appalachia.…”

“…19 Findings have likewise been inconsistent regarding the association of RLS to specific socioeconomic (SES) 1,6,[20][21][22][23] and lifestyle characteristics. 1,6,[20][21][22]24 Moreover, few studies have investigated RLS and RLS burden in poor, rural populations, including those residing in Appalachia. Situated entirely within the Appalachian region, West Virginia is characterized by a rural and socioeconomically disadvantaged population with a health status of citizens among the worst in the country.…”

The Past Is Prologue: The Future of Sleep Medicine

“…1 Clinical and basic research demonstrated the necessity and importance of sleep to human health, [2][3][4][5][6][7][8] polysomnography moved from the laboratory to the clinic, 9,10 and epidemiological studies showed that sleep disorders were some of the most prevalent diseases known to mankind. [11][12][13] These advances fostered creation and development of organizations focused on clinical sleep medicine such as the American Academy of Sleep Medicine (AASM) and the American Board of Sleep Medicine (ABSM). These organizations appreciated the need for specialized training and certification to ensure physician competency in caring for patients with sleep disorders.…”