Abstract
Objective: Iron deficiency anemia (IDA) is a well-known cause of secondary restless legs syndrome (RLS). Iron deficiency without anemia (IDNA) is insidious, and its association with RLS is less evaluated. We investigate prevalence and features of IDNA in a consecutive cohort of patients with RLS.Methods: We included sequential primary RLS patients and RLS patients with IDA. We also recruited age- and gender-matched healthy controls. RLS mimics and other comorbidities were carefully excluded.Results: One-hundred and ninety-six RLS patients without anemia, 26 RLS patients with IDA, and 63 controls were included. 42.3% of RLS patients without anemia had iron deficiency. Women were much more susceptible for IDNA with a relative risk of 5.51 (p < 0.0001). Women with IDNA and RLS had younger age both at interview and at RLS onset compared to women with RLS without iron deficiency (NID) (P < 0.01). IDNA RLS patients showed a tendency to higher risk of severe/very severe tiredness or sleepiness during the day as compared to NID RLS patients. Furthermore, IDNA RLS patients had longer duration of RLS (P < 0.01 in men, P < 0.05 in women) and younger age at onset (only in men, P < 0.05) compared to IDA RLS patients.Conclusion: IDNA is frequent in RLS and iron deficiency may be severe despite a normal hemoglobin level. Women are at much higher risk for IDNA, and IDNA in women presents some specific clinical features. Features of IDNA RLS are different from IDA RLS. Regular screening of peripheral iron parameters even in patients with normal blood counts is recommended for timely optimal management.
Highlights
Restless Legs Syndrome (RLS) is a common neurological disorder [1], and iron deficiency plays a key role in its pathogenesis [2, 3]
Iron deficiency is common in RLS and iron deficiency anemia (IDA) is a well-known cause of secondary RLS [4, 5], which is associated with a six-fold increase in risk for RLS in the general population [6]
We continuously enrolled a total of 196 primary RLS patients without anemia (IDNA RLS and without iron deficiency (NID) RLS) in this study, including 66 male patients (33.7%) and 130 female patients (66.3%)
Summary
Restless Legs Syndrome (RLS) is a common neurological disorder [1], and iron deficiency plays a key role in its pathogenesis [2, 3]. Iron deficiency is common in RLS and iron deficiency anemia (IDA) is a well-known cause of secondary RLS [4, 5], which is associated with a six-fold increase in risk for RLS in the general population [6]. Nonanemic Iron Deficiency in RLS iron deficiency) is usually insidious, and recently attracted attention for its worldwide prevalence and challenge for diagnosis and management [7]. Despite a clear relationship between clinical significance of RLS in IDA population [6], the prevalence and features of IDNA in RLS has not been systematically investigated. We aim to investigate clinical features of RLS with IDNA compared to those without iron deficiency (NID, noniron deficiency) and to IDA patients in a consecutive cohort of Chinese RLS patients
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