Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy

Abstract

Study Objectives: To estimate the association of restless legs syndrome (RLS) and its frequency with sleep-wake disturbances in pregnancy. Methods: A cohort of 1,563 women in their third trimester of pregnancy were recruited from prenatal clinics between March 2007 and December 2010. Demographic, pregnancy, and delivery data were extracted from medical records and sleep information was collected with questionnaires. To diagnose RLS, we used standardized criteria of RLS symptoms and frequency that were developed by the International Restless Legs Study Group. Logistic regression models were constructed to investigate the association of RLS and its frequency with sleep-wake disturbances (poor sleep quality, daytime sleepiness, poor daytime function) and delivery outcomes. Results: Overall 36% of the pregnant women had RLS, and half had moderate to severe symptoms. Compared to women without RLS, those with RLS were more likely to have poor sleep quality (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.7-2.9), poor daytime function (OR 1.9, 95% CI 1.4-2.4), and excessive daytime sleepiness (OR 1.6, 95% CI 1.3-2.0). A dose-response relationship also was evident between RLS frequency and each of the sleep-wake disturbances. There was no evidence for any association between RLS and delivery outcomes. Conclusions: RLS is a significant contributor to poor sleep quality, daytime sleepiness, and poor daytime function, all common and often debilitating conditions in pregnancy. Obstetric health care providers should be aware of these associations and screen women for RLS. I NTRO DUCTI O NRestless legs syndrome (RLS), also known as Willis-Ekbom disease, is a sensorimotor disorder composed of an urge to move, with or without associated discomfort that occurs with inactivity and improves with movement. It follows a circadian pattern, with a predilection for the evening and night.1 RLS is a common, underdiagnosed condition that affects up to 5% of the population worldwide, 2-4 with up to 15% prevalence in Caucasians. 5 The prevalence of RLS is positively correlated with age and body mass index (BMI) among both men and women.6,7 Although RLS has a genetic predisposition, it is also associated with other conditions such as end-stage renal disease, neuropathy, and pregnancy. 8 RLS affects up to one-third of pregnant women 9,10 peaks in the third trimester, 9-11 and usually subsides after delivery. 11Multiparous women are affected up to three times more often than nulliparous women. 10 The high prevalence of RLS during pregnancy has been attributed to hemodynamic and hormonal changes, iron and folate metabolism, and psychomotor behaviors.12 Although RLS is related to reduced quality of life and poor sleep in the general population 13,14 data on RLSassociated maternal sleep-wake disturbances are lacking. pregnancy and delivery outcomes (eg, preterm delivery, prolonged labor, cesarean section deliveries, and postpartum depression). [15][16][17] Therefore, the goal of this study was twofold: (1) to examine the frequency of RLS in ...

Sleep Disorders in Pregnancy

“…Most recently, Dunietz et al queried a cohort of 1,563 women in the third trimester of pregnancy using standardized RLS questionnaires and found a prevalence of 36%, with moderate-to-severe RLS in half. 72 This is the first large study to investigate and report a higher incidence of self-reported poor sleep quality and more excessive daytime sleepiness in pregnant women with RLS. These symptoms were proportional to RLS severity.…”

Sleep Pharmacotherapy for Common Sleep Disorders in Pregnancy and Lactation

“…RLS has been associated with increased odds of sleepwake disturbances such as poor sleep, poor daytime function, and excessive daytime sleepiness in pregnancy. 74 There also seems to be an association between hypertensive disorders of pregnancy and RLS diagnosed by using international RLS criteria in some studies, 75,76 in which women with RLS are more likely to have a hypertensive disorder of pregnancy. Conversely, pregnant women with hypertensive disorders also seem to have a higher risk of meeting RLS criteria, 77 suggesting a potential metabolic process underlying the pathogenesis of RLS in pregnancy and a possible bidirectional relation.…”

Shaking Up Perspectives of Restless Legs Syndrome in Pregnancy

“…24 Hence, conditions that result in poor sleep such as RLS, as demonstrated in this study, become critical to identify and possibly important to treat pharmacologically. The research by Dunietz et al 18 and others 14 elevate the diagnosis of RLS in pregnancy from a self-limited condition that would likely resolve postpartum to one with potential adverse obstetric events and beg for studies evaluating the efficacy and outcome of treating RLS in pregnancy.…”

“…Dunietz et al 18 recruited a total of 1,563 women in their third trimester of pregnancy. The study aimed at assessing the prevalence of RLS using standardized criteria for the diagnosis 19 and examining the effect of RLS severity on sleep-wake disturbances using the generalized sleep disturbance scale, 20 as well as associations with delivery outcomes.…”