title: Restless legs syndrome in an appalachian primary care population: prevalence, demographic and lifestyle correlates, and burden.
abstract: BACKGROUND
  Restless legs syndrome (RLS) is a common and distressing sensorimotor disorder of unknown etiology. While the epidemiology of RLS has been examined in several North American and European studies, research on RLS and RLS burden in poor, rural populations, including those residing in Appalachia, remains sparse. In this study, we investigated RLS prevalence in an Appalachian primary care population and examined the association of RLS to demographic factors, lifestyle characteristics, sleep quality, and mood disorders.
  
  
  METHODS
  Participants of this anonymous survey study were community-dwelling adults aged ≥ 18 years visiting one of 4 West Virginia primary care clinics. Data gathered included detailed information on sleep patterns, demographic characteristics, lifestyle factors, and health/medical history; the survey also included questions specific to RLS diagnosis and severity. Response rates were excellent, with 68% of eligible adults contacted returning completed surveys (N = 1,424/2,087). Pregnant women (N = 65) and those with missing data on key variables (N = 142) were excluded from the analyses.
  
  
  RESULTS
  Of the 1,217 participants included in the final analytic sample, 19.6% (18.2% with symptoms at least once/month) met the 4 IRLSSG diagnostic criteria in the absence of positional discomfort or leg cramps; 14.5% reported RLS symptoms at least once/week and 10.1% indicated symptoms ≥ 3×/week. Excluding respondents with diabetes, kidney disease, or anemia reduced these rates only slightly. Those with RLS were more likely to be older, female, lower income, unemployed, disabled, non-Hispanic white, and less likely to be college educated than those without RLS. Mood and sleep impairment were significantly elevated in those with RLS; after adjustment for demographic and lifestyle characteristics, health history, and other factors, those with RLS remained significantly more likely to indicate a history of depression (adjusted odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.4, 2.6) and anxiety (OR = 1.6, CI 1.1, 2.2), to report sleep impairment both 4 (OR = 2.4, CI 1.6, 3.7) and 7 days/week (OR = 1.8, CI 1.3, 2.4), and a mean sleep duration < 5 h/night (OR = 1.7, CI 1.2, 2.3). These associations increased in both strength and magnitude with increasing symptom frequency (p's for trend ≤ 0.01).
  
  
  CONCLUSIONS
  Findings of this preliminary anonymous survey study suggest that RLS prevalence is high in this Appalachian primary care population and that RLS is associated with significant burden in terms of both mood and sleep impairment.
authors.affiliation: Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV ; Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, Charlottesville, VA.
authors.forename: Kim E
authors.initials: KE
authors.lastname: Innes
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Flack
authors.forename: Terry Kit
authors.initials: TK
authors.lastname: Selfe
authors.forename: Sahiti
authors.initials: S
authors.lastname: Kandati
authors.forename: Parul
authors.initials: P
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D001061:Appalachian Region; D016001:Confidence Intervals; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012148:Restless Legs Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology; D012959:Socioeconomic Factors; D014903:West Virginia / Q000453:epidemiology
keywords: Restless legs syndrome; anxiety; demographics; depression; employment; lifestyle; mood; race; sleep; socioeconomic status