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Summary: Sleep is an essential human behavior that shows prominent gender differences. Disturbed sleep, in particular, is much more prevalent in females than males. Restless legs syndrome (RLS) as one cause of disturbed sleep was observed to be somewhat more common among women than men in Ekbom''s 1945 seminal series of clinical cases with the disease. He, however, reported this gender difference mainly for those with more severe symptoms. Since then numerous studies have reported that women are affected by RLS about twice as often as males for mild as well as moderate to severe RLS. The present review focuses on RLS in females from the perspectives of both epidemiology and pathophysiology. RLS will generally become worse or might appear for the first time during pregnancy. Parity increases the risk of RLS later in life suggesting that pregnancy is a specific behavioral risk factor for developing RLS. Some evidence suggests that dysfunction in iron metabolism and high estrogen levels might contribute to RLS during pregnancy. But, menopause does not lower the incidence of RLS nor does hormone replacement therapy lead to an increase, suggesting a quite complex uncertain role of hormones in the pathophysiology of RLS. Therefore, further, preferably longitudinal studies are needed to unravel the factors causing RLS in women. These studies should include genetic, clinical and polysomnographic variables, as well as hormonal measures and variables assessing iron metabolism. [Copyright &y& Elsevier]

Background: The prevalence of restless legs syndrome (RLS) among the general population is 2–15%, and with fibromyalgia syndrome (FMS) 2%. Both RLS and FMS are more common among women. The aim of our study was to evaluate the prevalence of RLS in a group of female patients diagnosed with FMS and to compare the occurrence of symptoms of daytime sleepiness and experienced sleep disorders between fibromyalgia patients with or without RLS. Method: Three hundred and thirty-two female patients, 20–60 years old, diagnosed with FMS at Skönviks Rehab between 2002 and 2006, answered a questionnaire mailed to their home address. The questionnaire consisted of the international RLS study group criteria as well as of questions concerning symptoms of insomnia and daytime sleepiness measured according to the Epworth Sleepiness Scale. Results: Nearly 64% of the women were also suffering from RLS. More patients suffering from both RLS and FMS were affected by problems of initiating and maintaining sleep than those suffering from FMS only. More patients suffering from both RLS and FMS did not feel refreshed on awakening compared with those suffering from FMS without RLS. The patients with concomitant RLS and FMS were more often hypersomnolent than those suffering from FMS only. Conclusion: This study shows that 64% of a group of female patients diagnosed with fibromyalgia also concurrently suffered from RLS. Compared with patients who suffer from FMS only, patients with both FMS and RLS more often experience sleep disturbances and pronounced daytime sleepiness. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Background: Restless legs syndrome (RLS) is a neurological movement disorder, which often causes sleep problems. However, the comorbidity of this disorder is not well known. This study aimed to document the prevalence of RLS in the general population of Sweden and to identify factors associated with this condition. Methods: A cross-sectional study was performed in Sweden. One thousand subjects aged 18–90 years old underwent telephone interviews. The questionnaire assessed such factors as sleep variables, depressive mood, treatment of diabetes mellitus, and treatment with drugs for depression during the previous four-week period. RLS was diagnosed based on the minimal criteria provided by the International RLS Study Group. Results: The prevalence of RLS was 5% (5.7% in women, 3.5% in men). Severe or very severe RLS symptoms during the previous week were noted by 64% of the RLS subjects. Factors associated with RLS were insomnia, excessive daytime sleepiness, periodic limb movements in sleep, and depressed mood. Those affected by RLS were not more often consumers of drugs for depression than non-RLS subjects. Conclusions: RLS is prevalent in the general population in Sweden. RLS negatively influenced sleep and was associated with depressed mood. Antidepressive drug treatment was not associated with RLS. [Copyright &y& Elsevier]

A random sample of 200 women, aged 18–64 years, living in a county in mid-Sweden, was sent a questionnaire that included questions about sleep habits, symptoms of sleepiness and neuropsychiatric complaints. Standardized diagnostic criteria determined by the International Restless Legs Syndrome Study Group were used to investigate the prevalence of restless legs syndrome (RLS). Possible associations between RLS and neuropsychiatric complaints were also investigated. Odds ratios for different variables were calculated by means of multivariate logistic regression. 11.4% of the women suffered from RLS. Sleep-related complaints were more frequent among RLS sufferers than among nonsufferers. Complaints of daytime headache were reported 5 times more frequently among RLS sufferers, and there was a tendency towards social isolation related to RLS. Subjective problems in performing work due to sleepiness were ninefold among the women with RLS. These results indicate that RLS together with an association to neuropsychiatric symptoms is common among working-aged women.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In this article the author discusses the minimal attention given to the restless legs syndrome (RLS) which made the disorder under-diagnosed and under-treated. He refers to the 1945 comprehensive study of neurologist Karl-Axel Ekbom which suggests to educate health care personnel and the public on the common disease that is linked to insomnia. The author thinks that recent studies have defined the neuropathological basis of RLS.

Abstract: Background and Purpose: To estimate prevalence and severity (using the International Restless Legs Syndrome Study Group Rating Scale (IRLS)) and to identify risk factors of restless legs syndrome (RLS). Patients and Methods: Population-based cross-sectional study; 2005 randomly selected adults 18 years and above participated in a telephone interview in Norway and Denmark, employing the next-birthday technique. Results: Of the cross-section, 11.5% fulfilled the diagnostic criteria for RLS. Half of these reported the symptoms as moderate to very severe. Mean duration of the complaint was 10 years. Prevalence was higher in females than in males (13.4 vs 9.4%) and lowest in the youngest age group (18–29 years, 6.3%). From 30 years and above, no clear age-related difference was seen. Main predictors of RLS were insomnia (odds ratios: 1.71–3.16) and symptoms of periodic limb movements in sleep (3.20–7.85). The response rate was 47%, making the results less reliable. Conclusions: This study indicates that there is a high occurrence of RLS among adults. Main predictors are insomnia and periodic limb movements in sleep. [Copyright &y& Elsevier]