The Burden of Restless Legs Syndrome

An Assessment of Work Productivity, Sleep, Psychological Distress, and Health Status Among Diagnosed and Undiagnosed Individuals in an Internet-Based Panel
  • Sheri Fehnel
  • Laurie Zografos
  • Tammy Curtice
  • Hemal Shah
  • Lori McLeod
Original Research Article

Abstract

Background: Restless legs syndrome (RLS) affects approximately 10–15% of the general population and has deleterious effects on sleep and subsequent daytime performance. The disorder may also give rise to long-term complications such as psychological distress and diminished quality of life. The condition is often unrecognized or misdiagnosed, and the magnitude of the effects of RLS on the sizeable proportion of undiagnosed (and therefore untreated) individuals has not previously been evaluated.

Objectives: This study examined the impact of RLS on overall health status, sleep, psychological functioning, work productivity, and daily activities in individuals with diagnosed and in those with undiagnosed (self-reported) RLS.

Methods: An internet-based survey was conducted on a multimillion-member panel of US adults. Eligible participants were currently experiencing RLS symptoms as determined using established diagnostic criteria. Participants provided information related to self-reported RLS diagnosis, treatment, symptom frequency and severity, and responses to validated instruments (Medical Outcomes study [MOS] Short Form 12, version 2 [SF-12v2], MOS Sleep Scale, Center for Epidemiological Studies Depression Scale [CES-D], Work Productivity and Activity Impairment — General Health Questionnaire [WPAI-GH] and Work Limitations Questionnaire [WLQ]). Analysis of co-variance (ANCOVA) models were developed to evaluate the relationships among symptom severity, diagnosis status, age, and sex, and the impact of RLS.

Results: Participants included 702 adults with RLS symptoms. Means for the SF-12v2 scores (physical component score = 35.6, mental component score = 42.6) were at least 1 standard deviation lower than sex- and age-adjusted general population norms. Participants reported poorer sleep quality scores across each MOS Sleep Scale domain, with differences from published norms of >16 points on 100-point scales, as well as approximately 1 hour less sleep per night on average. A majority (64%) met the cut-off score for depression. Compared with population norms, the sample reported greater limitations in time management, physical demands, mental/interpersonal demands, general work output, and usual activities. Symptom intensity and frequency were shown to be the primary predictors of RLS impact on the various outcomes.

Conclusion: These results support previous reports that RLS often goes undiagnosedxor misdiagnosed. The results of this survey also suggest that regardless of whether RLS is recognized, the burden of the disorder is substantial, implying a need for improved diagnosis and management of RLS.

References

  1. 1.
    Evidente VG, Adler CH. How to help patients with restless legs syndrome: discerning the indescribable and relaxing the restless. Postgrad Med 1999 Mar; 105(3): 59–61, 65-6, 73-4PubMedCrossRefGoogle Scholar
  2. 2.
    Milligan SA, Chesson AL. Restless legs syndrome in the older adult: diagnosis and management. Drugs Aging 2002; 19(10): 741–51PubMedCrossRefGoogle Scholar
  3. 3.
    Allen RP, Earley CJ. Restless legs syndrome: a review of clinical and pathological features. J Clin Neurophysiol 2001 Mar; 18(2): 128–47PubMedCrossRefGoogle Scholar
  4. 4.
    Abetz L, Allen R, Follet A, et al. Evaluating the quality of life of patients with restless legs syndrome. Clin Ther 2004 Jun; 26(6): 925–35PubMedCrossRefGoogle Scholar
  5. 5.
    Allen RP, Walters AS, Montplaisir J, et al. Restless legs syndrome prevalence and impact. Arch Intern Med 2005; 165: 1286–92PubMedCrossRefGoogle Scholar
  6. 6.
    Reilly Associates. WPAI scoring [online]. Available from URL: http://www.reillyassociates.net/WPAI_Scoring.html [Accessed 2006 Feb 15]
  7. 7.
    Lerner D, Amick III BC, Rogers WH, et al. The Work Limitations Questionnaire. Med Care 2001; 39(1): 72–85PubMedCrossRefGoogle Scholar
  8. 8.
    Hays RD, Stewart AL. Sleep measures. In: AL Stewart, JE Ware, editors. Measuring functional and well-being: the Medical Outcomes Study approach. Durham (NC): Duke University Press, 1992Google Scholar
  9. 9.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. J Appl Psychol Meas 1977; 1: 385–401CrossRefGoogle Scholar
  10. 10.
    QualityMetric. SF-12v2 scoring and interpretation manual. Boston (MA): QualityMetric, 2000Google Scholar
  11. 11.
    Hays RD, Martin SA, Sesti AM, et al. Psychometric properties of the Medical Outcomes Study sleep measure. Sleep Med 2005; 6(1): 41–4PubMedCrossRefGoogle Scholar
  12. 12.
    McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. 2nd ed. New York: Oxford University Press, 1996Google Scholar
  13. 13.
    Chesson Jr AL, Wise M, Davila D, et al. Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine report. Sleep 1999; 22(7): 961–8PubMedGoogle Scholar
  14. 14.
    Littner MR, Kushida C, Anderson WM, et al. Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep 2004; 27(3): 557–9PubMedGoogle Scholar
  15. 15.
    Hening WA, Allen RP, Earley CJ, et al. An update on the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep 2004; 27(3): 560–83PubMedGoogle Scholar
  16. 16.
    Trenkwalder C, Paulus W, Walters AS. The restless legs syndrome. Lancet Neurol 2005; 4(8): 465–75PubMedCrossRefGoogle Scholar
  17. 17.
    Silber MH, Ehrenberg BL, Allen RP, et al. An algorithm for the management of restless legs syndrome. Mayo Clin Proc 2004; 79(7): 916–22PubMedCrossRefGoogle Scholar
  18. 18.
    Reilly MC, Bracco A, Ricci JF, et al. The validity and accuracy of the Work Productivity and Activity Impairment questionnaire: irritable bowel syndrome version (WPAI: IBS). Aliment Pharmacol Ther 2004; 20(4): 459–67PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Sheri Fehnel
    • 1
  • Laurie Zografos
    • 1
  • Tammy Curtice
    • 2
  • Hemal Shah
    • 2
  • Lori McLeod
    • 1
  1. 1.RTI Health SolutionsNorth CarolinaUSA
  2. 2.Boehringer Ingelheim IncorporatedRidgefieldUSA

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