The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia

Abstract

Restless Legs Syndrome (RLS) a common, under-recognized disorder disrupts sleep and diminishes quality of life. Despite a clear relation between low peripheral iron and increased prevalence and severity of RLS, the prevalence and clinical significance of RLS in iron-deficient anemic (IDA) populations is unknown. In this study all new patients referred for anemia to a community-based hematology practice over a 1-year period (March 2011(March -2012 were included if they had IDA and no RLS treatment. Patients completed a validated questionnaire identifying RLS, blood tests, and a sleep-vitality questionnaire (SVQ). Patients with RLS were compared to patients with no RLS for differences on SVQ, blood tests, baseline characteristics, and sleep quality. Three hundred forty-three patients were evaluated and 251 (89.2% female, average age of 45.6 years) included in the study. The prevalence of clinically significant RLS (RLS sufferers) was 23.9%, nine times higher than the general population. IDA-RLS sufferers reported poorer quality of sleep, decreased sleep time, increased tiredness, and decreased energy during the day compared to patients with IDA without RLS. Blood tests did not relate to RLS diagnosis but RLS was less likely for African-American than Caucasian patients. Clinically significant RLS occurs commonly with IDA producing much greater disruption of sleep and shorter sleep times than does IDA alone. This indicates the need for identification of RLS with IDA and consideration of appropriate therapeutic interventions for this sizeable subgroup: either aggressive iron treatment to reduce the RLS symptoms or medications for RLS or both. Am. J. Hematol. 88:261-264, 2013. V C 2013 Wiley Periodicals, Inc. IntroductionIron deficient anemia (IDA) occurs commonly particularly among American women of child-bearing age [1] The Willis-Ekbom Disease, better known as the restless legs syndrome (RLS) is exacerbated and engendered by reduced peripheral iron stores and therefore should be both common and moderately severe in IDA. RLS is well-defined but commonly over-looked cause of significant morbidity with established relationships to genetics [2] and iron biology [3]. Moderately severe to severe RLS is a major health problem [4] producing periods of torturous restlessness during sleep often reducing sleep times to 5 hr or less [5]. Presumably RLS occurring with IDA if not adequately treated will have the same adverse health effects, but this has not been previously studied.The only two prior studies of RLS in patients with IDA reported a very high RLS prevalence of about 40% [6,7]. These studies used small, academic-hospital-based populations with limited, nonvalidated, nonstandardized criteria to make the diagnosis. The accuracy of these prevalence estimates is therefore questionable. More significantly, the severity of RLS was not reported. RLS has a broad range of severity from a rarely occurring mild annoyance to a clinically significant disease severely impairing sleep, quality of life, health, and ability to work...

Assessment of subjective sleep quality in iron deficiency anaemia

“…In a study of Allen et al 34 , prevalence of clinically significant RLS (RLS sufferers) was 23.9% in 251 patients with IDA, nine times higher than the general population. In another study, the said ratio was reported as 40% 35 .…”

Prevalence, severity, and impact on quality of life of restless leg syndrome in patients with liver cirrhosis in India

“…Large population-based studies have shown that RLS affects up to 5 % to 15 % of individuals [7]. It is commonly observed in persons with peripheral neuropathy [8], and its prevalence is increased in systemic illnesses such as chronic kidney disease (CKD) [9], hypothyroidism [10], diabetes mellitus [11,12], and iron deficiency anemia [13]. Since both RLS [14] and cirrhosis [5,15] are known to be associated with sleep disturbance, one may expect an association between RLS and LC.…”

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“…3,5,23 Although anemia is a known etiological factor causing to RLS, hemoglobin levels were similar of guides' recommended levels to hemodialysis patients. Even though hemoglobin levels were obtained lower than the renal transplant group, the lower frequency of RLS in transplant group shows other factors 47 predisposing rather than the anemia.…”