Restless legs syndrome: relationship between prevalence and latitude.
OBJECTIVE
Restless legs syndrome (RLS) has a broad worldwide prevalence between 0.01% and 18.3%. While differences in RLS definitions and data ascertainment methods account for some variability, other factors likely contribute. The circadian nature of RLS and the fact that RLS symptoms track with endogenous melatonin levels suggest that light or ultraviolet radiation (UVR) may be related to RLS expression. As the amount of UVR decreases with latitude, we considered the potential effect of geography on RLS prevalence with the thought being that RLS prevalence rises with increasing latitude.


METHODS
RLS epidemiologic studies were sought via Pubmed search in the period between January 1, 1992 and November 15, 2010. Prevalence was mapped for each country or specific region studied and examined by continent. Pearson's correlational testing was carried out for RLS prevalence and latitude of the region studied.


RESULTS
Global RLS prevalence ranges from 0.01% in Africa, 0.7% to 12.5% in Asia, 2.0% to 18.9% in the Americas, and 3.2% to 18.3% in Europe. Mapping RLS prevalence by country or region in both the Americas and in Europe suggests increasing RLS frequency with greater northern latitude. RLS prevalence is positively correlated with northern latitude in both North America and Europe with correlation coefficients of r = 0.77 (0.15, 0.96; p = 0.02) and r = 0.74 (0.44, 0.89; p = 0.0002), respectively. In Europe, lower latitudinal countries like Greece and Turkey had RLS prevalence (per 1,000 persons) of 38 and 34, respectively, middle latitudinal countries like France and England of 108 and 86, respectively, and high latitudinal countries like Norway and Iceland of 143 and 183, respectively.


CONCLUSIONS
RLS epidemiology indicates an increase in RLS frequency in northern latitudinal countries as a function of distance from the equator, an effect most evident in Europe. This suggests that factors that track with latitude like UVR may be involved in the expression of RLS.
Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. koobri@gmail.com
Brian B
BB
Koo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000569:Americas; D001208:Asia; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008550:Melatonin / Q000097:blood; D008875:Middle Aged; D017440:Photoperiod; D012148:Restless Legs Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D013636:Tanzania; D019371:Topography, Medical; D014466:Ultraviolet Rays; D055815:Young Adult
D008550:Melatonin