Restless Legs Syndrome/Willis-Ekbom Disease: A Frequent Condition in Patients Sequentially Admitted to a Sleep Medicine Outpatient Clinic

Keywords

restless legs syndrome - Willis-Ekbom Disease - periodic leg movements

Introduction: Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is a neurological condition characterized by an irresistible urge to move the legs, often associated with discomfort, leading to insomnia symptoms, non-restorative sleep and daytime fatigue.

Objective: To demonstrate the high prevalence of RLS/WED in patients sequentially admitted to a sleep medicine clinic and to describe their clinical and epidemiological features.

Methods: Retrospective analysis of medical records from patients sequentially admitted to a reference clinic for sleep disorders over the past 17 months.

Results: RLS/WED was diagnosed in 18.7% of the 187 patients (55% male) sequentially admitted to the sleep clinic. None of the 35 patients (63% female), aged 35 to 80 years (mean 60 years), had a prior diagnosis of RLS/WED, with snoring or apnea being the primary complaint in 43% of cases, followed by insomnia symptoms (37%), non-restorative sleep (8.5%), nocturnal leg discomfort (8.5%), and sleep bruxism (3%). Main psychiatric comorbidities were generalized anxiety disorder (60%) and depression (14%), with 43% using selective serotonin reuptake inhibitors (SSRIs). Cardiovascular risk factors were present in 69% of the sample. Obstructive sleep apnea was found in 93% of the 29 patients who underwent polysomnography, with a periodic limb movement index above 5/h in 55% (31% above 15/h) of the sample. Anemia was not found in any cases, and ferritin levels below 75 ng/mL were detected in 14%. Symptoms were moderate in 23%, severe in 20%, and very severe in 11% of cases according to the International Restless Legs Syndrome Severity Scale, and 43% of patients described RLS/WED symptoms as painful. Symptoms occurred 2 or more times per week in 77% of cases. Treatment was carried out with behavioral measures alone in 37% of patients, pharmacological treatment with alpha-2-delta ligands in 51%, and intravenous iron in 11%. Three patients reported complete relief of RLS/WED symptoms after starting obstructive sleep apnea treatment with CPAP.

Conclusion: Systematic screening for RLS symptoms is necessary in the evaluation of patients with sleep complaints, as RLS/WED is a highly prevalent disorder, detected in approximately one-fifth of patients. OSA is the main comorbidity, and its diagnosis and treatment may help control RLS symptoms. SSRIs treatment was common and may worsen or trigger RLS/WED symptoms.

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Publikationsverlauf

Artikel online veröffentlicht:
16. September 2025