Sleep Disorders: Restless Legs Syndrome.

Deepa Burman

FP essentials 2017 Sep

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Restless legs syndrome (RLS) is a common disorder that often is underdiagnosed and undertreated. Patients with RLS describe an urge to move their legs, especially in the evenings and during periods of inactivity. The prevalence of clinically significant RLS is approximately 2% to 3% in adults in Europe and North America. RLS can be an independent disorder or may occur in conjunction with other conditions (eg, iron deficiency, pregnancy, chronic renal failure). Diagnosis is based on clinical history. Routine polysomnography typically is not recommended unless there is suspicion of other sleep disorders (eg, obstructive sleep apnea). Management includes a combination of supportive measures, dopaminergic drugs, gabapentinoids, opioids, or benzodiazepines. Good sleep hygiene can help prevent development of insomnia related to RLS. Avoiding alcohol and reducing caffeine intake is recommended. If iron stores are low, iron supplementation may improve symptoms. The main pharmacologic options for RLS management are dopaminergic agonists (eg, pramipexole and ropinirole); gabapentinoids also are good options. Patients may experience augmentation, an increase in RLS symptom severity with increasing drug dosage, which is the main complication of dopaminergic drugs. There is no evidence to support use of vibratory devices that provide stimulation to the lower extremities. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.