High Prevalence of RLS Found in Patients with MDD, Migraine, Anxiety

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A study found that among 600 psychiatric patients, 41.2% had restless legs syndrome (RLS), and psychiatric disorders with a high prevalence of RLS include major depressive disorder (MDD) and anxiety disorders.

RLS, a sleep-related neurological disorder characterized by an urge to move legs during sleep, is often underdiagnosed. In 2018, NeurologyLive reported that 94% of patients are either undiagnosed or misdiagnosed with RLS.2

RLS is often diagnosed using the pneumonic URGE: U stands for the urge to move, R stands for sleep worsening the symptoms, G stands for getting better when they move around, and E stands for evening time often being worse. It has been suggested that dopamine dysfunction or an iron transport problem could be the potential why patients suffer from RLS.

Despite the low number of people diagnosed with RLS, this sleep disorder is one of the most common sensory-motor neurological conditions.2 A 2023 systematic review reported that this sleep disorder has a global prevalence of 3% (95% confidence interval [CI], 1.4% – 3.8%).3 The study also reported that this prevalence varied for men (2.8%), women (4.7%), alcohol users (1.4%), and smokers (2.7%).

But what is the prevalence of RLS among psychiatric disorders? Sleep and mental health often have a 2-way relationship. For instance, racing thoughts in anxiety, oversleeping in depression, nightmares or night terrors in PTSD, energy levels in mania, and side effects of antipsychotics all can lead to sleep issues.4 Conversely, poor sleep can increase the risk of depression, anxiety, and suicidal ideation.5

Since poor sleep increases the risk of mental health issues, investigators, led by Ramita Goel, from Maharishi Markandeshwar Institute of Medical Sciences and Research in India, sought to estimate the presence of RLS and its impact on sleep disturbance in patients who visited a psychiatry clinic.1 The team conducted a cross-sectional, observational, single-center, interview-based study of 600 patients diagnosed with a psychiatric disorder. Participants completed the International Restless Leg Syndrome Scale (IRLS) to evaluate the severity of RLS and the Pittsburgh Sleep Quality Index (PSQI) scale to assess sleep disturbance.

Investigators discovered that among the sample, the overall prevalence of RLS was 41.2%, totaling 247 patients. Additionally, the study showed that RLS had significantly impacted sleep. Patients with RLS had difficulty falling asleep and experienced shorter and more fragmented sleep, resulting in poor sleep quality.

The comorbidities of MDD, migraine, and anxiety all had a high prevalence of RLS, with prevalences of 42.9%, 19.40, and 50%, respectively. Moreover, alcohol use disorder had a low RLS prevalence of 2.4%.

“RLS is a highly prevalent disorder, and it needs to be evaluated in patients with sleep disturbance especially those presenting with symptoms of mood, migraine, and anxiety,” investigators concluded.

References

1. ^{Goel R, Satodiya V, Kosambiya R, Vala A. Prevalence of Restless Leg Syndrome, Associated Variables and Impact on Sleep Quality in a Cohort of Patients with Neuropsychiatric Disorders. Niger Med J. 2024 Nov 6;65(5):705-715. doi: 10.60787/nmj-v65i3.428. PMID: 39633705; PMCID: PMC11612333.}
2. ^{Payesko, J. Restless Leg Syndrome Warrants More Attention, Expert Says. NeurologyLive. October 4, 2018. https://www.neurologylive.com/view/restless-leg-syndrome-an-area-that-warrants-more-attention. Accessed December 13, 2024.}
3. ^{Broström A, Alimoradi Z, Lind J, Ulander M, Lundin F, Pakpour A. Worldwide estimation of restless legs syndrome: a systematic review and meta-analysis of prevalence in the general adult population. J Sleep Res. 2023 Jun;32(3):e13783. doi: 10.1111/jsr.13783. Epub 2023 Jan 4. PMID: 36600470.}
4. ^{Sleep and Mental Health. Mental Health Foundation. https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/sleep-and-mental-health. Accessed December 13, 2024.}
5. ^{How Sleep Deprivation Impacts Mental Health. Columbia University Department of Psychiatry. March 16, 2024. https://www.columbiapsychiatry.org/news/how-sleep-deprivation-affects-your-mental-health. Accessed December 13, 2024.}