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

Abstract

Background: Restless legs syndrome (RLS) is a common and distressing sensorimotor disorder of unknown etiology. While the epidemiology of RLS has been examined in several North American and European studies, research on RLS and RLS burden in poor, rural populations, including those residing in Appalachia, remains sparse. In this study, we investigated RLS prevalence in an Appalachian primary care population and examined the association of RLS to demographic factors, lifestyle characteristics, sleep quality, and mood disorders. Methods: Participants of this anonymous survey study were community-dwelling adults aged ≥ 18 years visiting one of 4 West Virginia primary care clinics. Data gathered included detailed information on sleep patterns, demographic characteristics, lifestyle factors, and health/medical history; the survey also included questions specifi c to RLS diagnosis and severity. Response rates were excellent, with 68% of eligible adults contacted returning completed surveys (N = 1,424/2,087). Pregnant women (N = 65) and those with missing data on key variables (N = 142) were excluded from the analyses. Results: Of the 1,217 participants included in the fi nal analytic sample, 19.6% (18.2% with symptoms at least once/month) met the 4 IRLSSG diagnostic criteria in the absence of positional discomfort or leg cramps; 14.5% reported RLS symptoms at least once/week and 10.1% indicated symptoms ≥ 3×/week. Excluding respondents with diabetes, kidney disease, or anemia

The Relationship of Restless Legs Syndrome to History of Pregnancy-Induced Hypertension

“…3 We restricted our sample to women 40 years of age and older (*45% of all respondents and 65% of female respondents) to reduce the probability of including women with undetected pregnancy or early onset RLS, 13,54,55 which is thought by some to more strongly reflect genetic and other factors. 13,54 Survey methods have been described in detail elsewhere.…”

“…13,54 Survey methods have been described in detail elsewhere. 3 Written survey questionnaires were offered to each adult patient seated in the clinic waiting area. The survey was presented to potential participants as an investigation regarding sleep patterns in Morgantown area adults, including both those who slept well and those who did not.…”

“…Survey response rates were excellent overall, with 76.7% of women contacted returning completed surveys. 3 The survey instrument included 41 self-report items and required 5-10 minutes to complete. Data gathered included detailed information on the following: demographic and lifestyle factors; current height and weight; history of physician-diagnosed health conditions and current medications for these conditions; sleep duration and quality during the past 7 days; and, in women, reproductive history, including history of PIH.…”

“…4 In addition, these symptoms cannot be due to another condition, such as leg cramps or positional discomfort. 5 A major cause of chronic sleep loss, 3,6 RLS leads to significant impairment of daily functioning and quality of life, increased health-related costs, and declines in productivity that are comparable to those reported in other serious chronic disorders, including diabetes, hypertension, Parkinson's disease, and stroke. [7][8][9][10][11] While data regarding the overall financial burden of RLS in the United States remain limited, a comprehensive cost study conducted in Australia estimated the economic impacts of RLS to total $11.1 billion in 2004.…”

“…[1][2][3] RLS is characterized by a compelling urge to move the legs that begins or worsens during periods of inactivity, is worse during the evening and at night, is at least partially relieved by movement, and is frequently accompanied by uncomfortable, often painful sensations in the legs. 4 In addition, these symptoms cannot be due to another condition, such as leg cramps or positional discomfort.…”