High Prevalence Of Restless Legs Syndrome Research Articles

Socioeconomic impact of restless legs syndrome and inadequate restless legs syndrome management across European settings.

Restless legs syndrome (RLS) is one of the most common neurological disorders. It describes an irresistible urge to move the legs, mostly manifested in the evening and at night, which can lead to severe sleep disturbance. As part of the European Brain Council (EBC)-led Value-of-Treatment project, this study aimed at capturing the socioeconomic impact of RLS related to the inadequate diagnosis and treatment across different European healthcare settings. The economic burden of RLS was estimated using the published EBC framework of analysis in three separate European Union healthcare systems (France, Germany, and Italy). The RLS care pathway was mapped to identify the unmet needs of patients. Based on specific patient stories, the economic impact of correctly diagnosing RLS and changing between inadequate and target treatment was calculated using appropriate scenario analysis. RLS proved to be a significant personal and social burden, when epidemiological data, high prevalence of RLS, and its need for treatment are combined. By looking at the savings emerging from the provision of optimal care management (timely and correct diagnosis, evidence-based therapy, avoidance of therapy-related complications such as augmentation), the authors foresee substantial economic savings with the achievement of adequate diagnosis and treatment of RLS. Education about RLS is urgently needed for all subspecialties involved in RLS patient care as well as the general public. Equally important, the search for new causal treatment strategies should be intensified to reduce suffering and substantial societal cost.

‘Is RLS a harbinger and consequence of MS?: Striking results of the ‘RELOMS-T’ study’

BackgroundAlthough studies report a high prevalence rate of restless legs syndrome (RLS) among patients with multiple sclerosis (PwMS) ranging from 13.3 to 65.1%, little is known about the causes of this relationship. MethodsTo ascertain the prevalence, features and impact of RLS among PwMS a nation-wide, multicenter, prospective and a cross-sectional survey, designed to reflect all of the PwMS throughout Turkey, was conducted in 13 centers. Exploring the relationship of the two conditions could possibly contribute to the understanding of the causes of the high and wide-ranging prevalence rates and the pathophysiology of both diseases. ResultsOf the 1068 participants 173 (16,2%) found to have RLS [RLS(+)] and 895 (83,8%) did not [RLS(-)]. Among the RLS(+) 173, all but 8 patients (4,6%) were underdiagnosed in terms of RLS. More than half of the patients with RLS had ‘severe’ or ‘very severe’ RLS. The onset of RLS was before or synchronous with the onset of MS in about a half of our patients. ConclusionWe conclude that RLS should be meticulously investigated in PwMS and MS can be a direct cause of RLS at least in part of PwMS. Our data about the timing of the onset of MS and RLS, along with the high prevalence of RLS in PwMS suggest that the pathologic changes in the initial phases of MS can possibly trigger RLS symptoms.

The prevalence of restless legs syndrome and comorbid condition among patient with type 2 diabetic mellitus visiting primary healthcare.

Aim:The aim of this study was to determine the prevalence of restless legs syndrome (RLS) and Pittsburgh Sleep Quality Index (PSQI) in patients with type 2 diabetes mellitus (T2DM) attending primary healthcare.Subjects and Methods:This is a cross-sectional study and participants were between 25 and 70 years old who visited the diabetes and endocrinology department of Mega Medipol University Teaching Hospital, Istanbul. The diagnosis of RLS was performed according to the International Restless Legs Syndrome Study Group consensus criteria. The RLS and PSQI instruments were conducted on 871 patients with T2DM. Good sleep quality was defined as PSQI score <5. RLS severity was assessed by the Restless Legs Syndrome-6 Scales (RLS-6). The scale development and validation was carried out using Rasch measurement model.Results:The prevalence of RLS was 22.8% including 60.3% of females and 39.7% of males. This study showed significant differences between RLS and no RLS patients with respect to their age (years), body mass index (BMI) (kg/m2), physical activity, smoking habit, sheesha smoking, income, and sleeping quality with PSQI. Also, the analysis presented that statistically significant differences between both RLS and no RLS reported sleep complaints including difficulty falling asleep, inadequate sleep, anytime fatigue, and leg discomfort. There were statistically significant differences between RLS and no RLS patients regarding hypoglycemia, numbness in legs, retinopathy, neuropathy, nephropathy high blood pressure, depression, stroke, anemia, diabetic foot, ulcer, arthritis, respiratory disease, metabolic syndrome, and coronary heart disease. Furthermore, there were statistically significant differences between RLS and no RLS concerning the number of sleeping hours, wake-up time (AM), sleeping time (PM), BMI (kg/m2), HbA1c, vitamin D, calcium, creatinine, fasting blood glucose, low-density lipoprotein, triglyceride, uric acid, and systolic and diastolic blood pressure (mmHg).Conclusion:This study confirms positive relation and high prevalence of RLS among patients with T2DM visiting primary healthcare. The results suggest that physical activity is associated with a better perception of functional capacity and pain in diabetic patients with RLS, and thus a more active lifestyle should be encouraged.

Restless legs syndrome is highly prevalent in patients with post-polio syndrome

ObjectiveFew studies have quantified the prevalence of restless legs syndrome (RLS) in patients with post-polio syndrome (PPS). Our objective was to assess the prevalence and severity of RLS in patients with PPS and to examine the demographic characteristics of this population. MethodThis was a cross-sectional study conducted from April 2010 to May 2012 at the outpatient Neuromuscular Disorders clinic of Universidade Federal de São Paulo, São Paulo, Brazil. We evaluated 119 patients with PPS, consecutively recruited, and investigated for RLS based on the diagnostic criteria established by the International Restless Legs Syndrome Study Group (IRLSSG). Patients were evaluated with the Brazilian version of the IRLSSG severity scale. ResultsThe prevalence of RLS was 36% (n = 43; 32 women and 11 men). The ages at onset of RLS (median = 41 years) and PPS (median = 41 years) were concurrent, and the correlation between onset of symptoms of RLS and onset of symptoms of PPS was positive and very strong (Spearman r = 0.93, p = 0.01). The median RLS severity was 23 (range, 20–28). Low educational achievement and depression were predictive of RLS development. ConclusionIn the largest population of patients with PPS studied to date, our results indicate a high prevalence of RLS, marked disease severity, and concomitant onset of both conditions in many patients with PPS. Further studies are needed to elucidate a possible pathophysiologic mechanism linking these two conditions. We suggest that all post-polio patients with sensory and motor complaints in the legs be investigated for RLS.

0741 PREVALENCE AND CHARACTERISTICS OF RESTLESS LEGS SYNDROME IN KOREAN ADULTS: THE STUDY ON TWO-INDEPENDENT POPULATIONS

Restless legs syndrome (RLS) is regarded as a common sleep disorder with a significant impact on quality of life and with a genetic background, more frequently occurring in Caucasian than Asian population. RLS prevalence in Korean adult population is 3.9 - 14.3%, higher than those reported in other Asian countries. A wide range of reported prevalence derives from the differences in the population characteristics and in the methods to define RLS. We aimed to provide the RLS prevalence estimate in Korean adults, compared with previous reports in Korea, Asian and western countries. In this study, we included two independent samples of Korean adult populations: group-1 was a nation-wide stratified random sample of adult population (n = 2,824; aged 19 - 79 years) and group-2 was a community based cohort (n = 2,685; aged 47 - 79 years). The presence of RLS was evaluated with the Cambridge-Hopkins diagnostic questionnaire for RLS (CH-RLSq). We compared sleep profiles, sleep-related symptoms, mood/anxiety, and comorbid medical conditions between RLS and non-RLS groups. RLS prevalence was 0.42% in the group-1 and 0.86% in the group-2. There were no significant differences of age, sex, and body mass index between RLS and non-RLS groups. In group-1, RLS subjects have depression and insomnia more frequently than those without RLS (p < 0.05). In group-2, RLS subjects were more sleepy and depressive with shorter sleep duration, worse sleep quality and more severe insomnia symptom (p < 0.05). Underlying comorbidities including smoking, alcohol, hypertension, diabetes, hyperlipidemia, anemia, neurological disorder, or kidney disease were not statistically different between RLS and non-RLS groups. RLS prevalence in Korean adult was less than 1%, which contrasts with previously reported ones in Korea. Considering the ethnic difference and genetic background of RLS, and the RLS prevalence depending on the diagnostic metrics, a high prevalence of RLS in Korea is questionable. None

Restless Legs Syndrome in Multiple Sclerosis Patients – Patient Experience at Lipik Special Hospital for Medical Rehabilitation

The study included 60 patients with multiple sclerosis (MS) hospitalized at our institution from September 1 to December 31, 2014. The aim of the study was to assess the prevalence of restless legs syndrome (RLS) in MS patients and RLS relationship with patient age, sex, degree of disability, form of MS, time elapsed from MS diagnosis and use of antidepressants. The diagnosis of RLS was made according to the criteria set by the International Restless Legs Syndrome Study Group. Of the 60 patients, 24 (40%) met the criteria for the existence of RLS. In the group of patients with RLS, there was a significantly higher proportion of women and those that were taking antidepressants. There were no statistically significant between-group differences according to age, duration of illness, degree of disability and clinical course of MS. In the study, 37.5% of patients that met the criteria for RLS diagnosis had not informed the neurologists about their difficulties. The high prevalence of RLS and the fact that a large proportion of patients did not inform the neurologists about their difficulties related to RLS point to the need of an active approach to diagnosis and treatment.

Periodic limb movements and restless legs syndrome in children with a history of prematurity

IntroductionLittle is known about the pediatric population at an increased risk of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Polysomnographic data from the Caffeine for Apnea of Prematurity–Sleep (CAPS) study showed a high prevalence of elevated periodic limb movement index (PLMI) in a cohort of ex-preterm children, but the clinical importance of this finding, such as association with RLS, is unknown. We hypothesized that ex-preterm children would have a high prevalence of RLS and PLMD. MethodsEx-preterm children enrolled in CAPS, now aged 5–12 years, completed home polysomnography (PSG) and standardized questionnaires. A diagnosis of RLS or PLMD was established by participants meeting the International Classification of Sleep Disorders, 3rd edition, criteria based on questionnaires and polysomnograms. The clinically available serum ferritin levels were assessed. ResultsIn total, 167 participants underwent polysomnography and completed all questionnaires. The overall prevalence of RLS was 14/167 (8.4%). An additional 13 subjects (7.8%) were found to have PLMD. Of the 26 participants who had PLMI > 5/h, seven (26.9%) had RLS and 13 (50%) had PLMD. The serum ferritin levels were <50 mcg/L (range −38.4) for all eight participants referred for testing. ConclusionsChildren with a history of prematurity have a high prevalence of RLS, particularly those with elevated periodic limb movements. Iron deficiency likely contributes to RLS and PLMD symptoms in this population. Clinicians evaluating ex-preterm children with sleep disturbances should evaluate for RLS and PLMD. Further studies including serum ferritin evaluation are required to confirm these findings.

Restless legs syndrome in hemodialysis patients in Iran.

Restless legs syndrome (RLS) is a common sleep disorder that can present secondary to medical conditions such as renal failure. This study aimed to evaluate RLS frequency and its related factors in chronic renal failure patients treated with hemodialysis. In a cross-sectional design, 163 patients with chronic renal failure were consecutively enrolled from hemodialysis center at Rasool-Akram hospital. Demographics, clinical and laboratory data were recorded. Patients were screened for presence and severity of RLS according to the four International Restless Legs Syndrome Group (IRLSSG) diagnostic criteria and severity scale. Patients with and without RLS were compared using SPSS statistical software (Version 16.0). Sixty-one patients (37.4 %) were diagnosed with RLS. Mean age in RLS group was significantly higher (65.2 ± 9.3 years) than RLS-negative group (59.0 ± 14.7 years; P = 0.004). Serum creatinine level was significantly higher in patients with RLS (7.6 ± 2.1 mg/dl vs. 6.7 ± 1.8 mg/dl; P = 0.009). Glomerular filtration rate in RLS patients was lower than other patients (9.2 ± 3.1 ccs/min vs. 11.6 ± 4.8 ccs/min; P = 0.0001). Patients with RLS had shorter sleep duration, and higher incidence of insomnia, daytime sleepiness, and sedative-hypnotic medication usage (P < 0.05). There was no significant difference between RLS-positive and RLS-negative patients in terms of renal failure pathology, dialysis frequency per week, dose of dialysis, duration of dialysis, renal transplantation, and history of diabetes and hypertension. Hemodialysis patients have a high prevalence of RLS which deserves special attention and specific treatment.

Medications associated with restless legs syndrome: a case–control study in the US Renal Data System (USRDS)

ObjectiveThe objective of this study was to determine the association between the usage of four classes of “at-risk” medications (antidepressants, neuroleptics, antihistamines, and antiemetics with dopamine blockade) and restless legs syndrome (RLS) in dialysis patients within the United States Renal Data System (USRDS). MethodsThis was a case–control design within a national (United States) patient registry of all patients with end-stage renal disease (ESRD) in the USRDS anytime during the period of 1 October 2006 to 31 December 2010, inclusive. A total of 16,165 ESRD patients (3234 cases; 12,931 age-, sex-, and race-matched controls) were studied. ResultsAll four classes of “at-risk” medications see widespread use among patients in the USRDS. All were associated with increased odds of an RLS diagnosis (range of odds ratios, 1.47–2.28; all p < 0.0001) during the period of observation. Results were unchanged when controlling for time on hemodialysis. Usage of more than one class of medication increased the odds for having RLS. ConclusionsESRD patients often receive medication intended for relief of conditions associated with their disease, such as depression and psychological issues, pruritus, and gastroparesis; however, such medications may increase the risk of RLS. Given the high prevalence of RLS in ESRD patients, these medications should only be used when their benefits clearly outweigh the risk of development of the troubling and distressing symptoms of RLS.

Restless Legs Syndrome in Multiple Sclerosis

There is a growing interest in sleep disorders in multiple sclerosis (MS) due to their high frequency and possible relationship to fatigue, a hallmark symptom in MS. Among them, insomnia and restless legs syndrome (RLS) are the most common ones. RLS is a sleep-related motor disorder characterized by a strong urge to move associated with uncomfortable sensations in the limbs. It is frequently under diagnosed in patients with MS although its course is often particularly severe. Several arguments support a symptomatic origin of RLS in MS patients. Independently of any causal relationship, the high prevalence of RLS in MS patients has clinical implications. The purpose of the present review is (i) to summarize the epidemiological data and clinical characteristics of RLS in MS patients in order to increase sensitivity to this disorder; (ii) to document the substantial body of evidence in support of a symptomatic origin of RLS in MS and from this (iii) to delineate the proposition that MS may represent a clinical model to study RLS-associated pathological changes.

Restless Legs Syndrome in Liver Transplant Recipients

Background: The prevalence of restless legs syndrome (RLS) is approximately 10% in general population. This condition is more prevalent in certain diseases and we previously reported the prevalence of RLS in chronic liver disease population to be 62%. Objectives: Our aim was to assess the self-reported prevalence of RLS using an RLS symptom specific questionnaire in liver transplant patients. Methods: Subjects were a convenience sample in transplant clinic. They completed a validated survey for core RLS symptoms and if positive went on to completed a telephone survey using the validated International RLS Severity Scale Questionnaire (IRLS) and the Johns Hopkins RLS QoL survey to measure the effect of RLS symptoms on daily activities. Results: 40 patients surveyed, RLS was found in 16 subjects (40%) with moderate severity {17 (SD + 7.2, high score 31)}. Hepatitis C as indication for liver transplant was more likely associated with RLS (p = 0.05). Calcium channel blockers were protective (p = 0.032) while antidopaminergic agent use was statistically significant for RLS symptom (p = 0.005). On multiple linear regression analysis, diabetes (p = 0.024) and use of antidepressants/antihistamines (p = 0.049) were associated with RLS. Quality of Life (QoL) surveys specific to RLS suggested RLS symptoms resulted in significantly diminished QoL, with an average QoL score of 80 (SD + 11.7). Conclusion: There was a very high prevalence of RLS in our liver transplant patients with majority experiencing moderate or severe symptoms. The explanation for this higher prevalence is likely due to combination of comorbidites as well as medications that can trigger RLS.

Restless Legs and Substantia Nigra Hypoechogenicity are Common Features in Friedreich’s Ataxia

Friedreich's ataxia (FA) is a multisystemic degenerative disease, but the prevalence of restless legs syndrome (RLS) is unknown. FA patients might be particularly susceptible to develop RLS as FA presents with features commonly associated with RLS, e.g. multisystemic network dysfunction, peripheral neuropathy and disturbances in subcellular brain iron homeostasis. In this work, we assessed the following: (1) the prevalence of RLS; (2) the prevalence of sonographic hypoechogenicity of the substantia nigra (SN), which is known to be associated with idiopathic RLS; and (3) the relation between both in 28 FA patients. Thirty-two percent of the patients suffered from RLS, thus clearly exceeding the prevalence rate in the general population. SN hypoechogenicity was more frequent in FA patients (61%) compared to healthy controls (7%) and was significantly associated with RLS. However, as SN echogenicity also correlated inversely with disease severity, it seems to be related not only to RLS, but also to the neurodegenerative process in FA itself. The high prevalence of RLS in FA patients warrants specific assessment by neurologists involved in the care of FA patients as treatments are readily available. Similar to patients with idiopathic RLS, reduced SN echogenicity is a frequent finding in FA, possibly indicating regional changes in subcellular brain iron regulation in FA.

099 IMPROVEMENT OF RESTLESS LEGS SYNDROME AFTER RENAL TRANSPLANTATION IN CHILEAN PATIENTS WITH CHRONIC RENAL FAILURE

Introduction: Restless legs syndrome (RLS) is a common cause of sleep disturbance that is frequently experienced by patients on dialysis suffering from chronic renal failure (CRF). Previous studies have described a reduction in RLS symptomatology after successful renal transplantation. However, the underlyingmechanism is not fully understood, and there are no local studies regarding this subject. Objective: This study aimed to evaluate the prevalence of RLS in patients with CRF on dialysis, to assess the improvement of symptoms after renal transplantation and to analyze laboratory parameters related to changes in symptomatology. Methods: We conducted a retrospective study on patients suffering from CRF on dialysis who were subjected to renal transplantation procedures. A standardized survey was applied for RLS diagnosis, according to the International RLS Study Group criteria, and the severity of the symptoms was evaluated before and after transplantation by use of ad-hoc intensity measurement scores. Multiple laboratory parameters were evaluated preand post-transplantation. Results: A total of 58 patients subjected to renal transplantation were evaluated, with an average age of 44 years (range, 18-72 years), of which 30 were males and 28 were females. Of these patients, 16 (28%), 5 females and 11 males with an average age of 45 years (range, 24-69 years), met the diagnostic criteria for RLS. The RLS mean severity score pre-transplantation was 23.7 (10-35) and 1.4 after transplantation (0-7) (p<0.001). Of the RLS group, 75% presented complete remission of symptoms after transplantation, and 25% (4/16) showed significant improvement. The average time in which this improvement was observed was 5.4 weeks. This reduction in symptomatology was related to an improvement in serum phosphate level and renal function (p<0.001); improvement was also seen for hematocrit and parathyroid hormone (PTH) levels (p<0.002 and p<0.05, respectively). Conclusions: Patients suffering from CRF treated with dialysis have a high prevalence of RLS. Patients with CRF and RLS subjected to renal transplantation showed a significant reduction of their symptomatology (100% in our series), and in most of the cases, complete recovery was observed. Similar to results described in international reports, this improvement after transplantationwas associatedwith an improvement in hematocrit, renal function and serum levels of phosphate and PTH. Nevertheless, the specific biological process underlying this improvement is still not fully understood.

Prevalence and Characteristics of Restless Legs Syndrome in Patients With Pulmonary Hypertension

Patients with pulmonary hypertension (PH) have an increased prevalence of risk factors for restless legs syndrome (RLS). We performed a cross-sectional study to determine the prevalence and characteristics of RLS in this population. Patients filled out two questionnaires during a visit: (1) a diagnostic tool for RLS, based on the core clinical features; and (2) a 10-question rating scale used to assess severity. Data were obtained by medical record review with regard to demographics, characteristics of PH and known RLS risk factors. Restless legs syndrome was found in 43.6% (24 of 55) (mean age +/- SD: 49 +/- 14 years; 41 women, 14 men) of patients and 54% of these had moderate or severe RLS. Patients with RLS were younger but gender differences were not appreciated. Presence of RLS did not correlate with measures of PH severity; however, patients with RLS were more likely to have a better 6-minute walk distance (p = 0.015) and lower BNP level (p = 0.07) and less likely to be WHO Class IV or require oxygen during the 6-minute walk test. Patients with a history of hypothyroidism (67%; p = 0.04) and those on opioids for relief of leg pain (69%) were more likely to have RLS. Patients with PH had a very high prevalence of RLS and most had moderate or severe symptoms. RLS was more common in more active patients and those who were hypothyroid or on opioids for relief of leg pain. Patients with PH should be screened for RLS because good treatment options are available.

Restless Legs Syndrome in Lung Transplant Recipients

Given the increased incidence of steroid-induced diabetes and drug-induced anemia, renal dysfunction and neuropathy, we believed that lung transplant recipients would be at an increased risk of developing restless legs syndrome (RLS). We performed a cross-sectional, observational study to determine the prevalence and characteristics of RLS in this population. Patients filled out two questionnaires during a routine visit: (1) a diagnostic tool for RLS, based on the core clinical features; and (2) a 10-question rating scale used to assess severity. Data were obtained by medical record review with regard to demographics, lung transplant characteristics and known risk factors for RLS. Forty-two lung transplant recipients (age 46.6 +/- 15.4 years [mean +/- SD]; 24 women, 18 men) without a family history of RLS were recruited. RLS was found in 47.6% (20 of 42) of the patients and 80% had moderate or severe RLS. Seventy-five percent of those with RLS were women (p = 0.03). RLS patients had a serum calcium level that was higher than those without RLS (p = 0.05) and were more likely to be recipient (p = 0.02) or donor positive (p = 0.07) for cytomegalovirus (CMV). All 4 hypothyroid patients on replacement therapy were in the RLS group. The prevalence of diabetes mellitus and chronic renal failure were not significantly different between the RLS and non-RLS groups. There was a very high prevalence of RLS in our lung transplant population and most patients had moderate or severe symptoms. RLS patients were more likely to be women, donor or recipient positive for CMV, hypothyroid, and to have an elevated serum calcium level.

Risk Factors for Restless Legs Syndrome in Dialysis Patients

Background: Restless legs syndrome (RLS) is a movement disorder that affects 6.6–62% of dialysis patients. The aims of this multicentre cross-sectional study were to document the frequency, prevalence and severity of RLS in patients attending 5 dialysis centres for chronic hospital haemodialysis (HHD) and to identify associated risk factors. Methods: Thediagnosis of RLS was made using the criteria of The International Restless Legs Study Group. The following data were collected: age; gender; duration of renal replacement therapy (RRT); current smoking status; urea reduction ratio; weekly erythropoietin dose; weekly intravenous iron dose; prescribed beta blocker; prescribed renin/angiotensin system inhibitors and pre-dialysis blood concentrations of haemoglobin, ferritin, total calcium (corrected for albumin), albumin, phosphate, parathyroid hormone. Associations with RLS were analysed by univariate and multivariate logistic regression. Results: Data relating to 277 of 295 patients who had been attending for regular HHD for >3 months were collected. RLS was present in 127 (45.8%). 82 (29.6%), 27 (9.7%) and 18 (6.5%) patients had mild, moderate and severe RLS, respectively. 39 patients (14.1%) were prescribed medicines aimed at reducing RLS. 30 (76.9%) of these 39 patients still had RLS. Female gender (RR 2.17; p = 0.01), increasing duration since first dialysis (RR 1.06 per year; p = 0.03) and increasing body weight(RR 1.02 per kg; p = 0.02) were independent risk factors for RLS by multivariate analysis. In contrast to previous studies, we found no association with iron status, haemoglobin, serum phosphate or smoking. Conclusions: There is a high prevalence of RLS in our population and therapeutic intervention appears to have limited efficacy. The associations with female gender, duration of RRT and body weight deserve further study.

Restless legs syndrome in end-stage renal disease

Patients undergoing dialysis therapy due to end-stage renal disease (ESRD) present a high prevalence of sleep disorders, including restless legs syndrome (RLS). However, the known data generally have been obtained from relatively small patient samples, coming from single or very few dialysis units. Moreover, some data were collected prior to the recent improvements in dialysis techniques, pharmacological therapies and to the establishment of internationally recognised diagnostic criteria for RLS. In order to study the incidence of the different sleep disorders, and of RLS in particular, in a large population of dialysis patients, a questionnaire was administered to all the patients in dialysis units of the ‘Triveneto’ area (Italy) who agreed to participate. The first part of the questionnaire included questions about demographic data, general medical history, history of renal disease, dialytic treatment and pharmacological therapy. The second part, which was self-administered, explored the patient's complaints about sleep, the presence of the minimal International Restless Legs Syndrome Study Group (IRLSSG) criteria for the diagnosis of RLS, the Epworth Sleepiness Scale and questions particularly related to somnolence. Patients whose responses indicated a diagnosis of RLS according to the IRLSSG criteria were requested to answer the 10 questions of the IRLSSG Severity Scale. The same group of patients was compared to those who did not fulfil any of the four minimal criteria for RLS. Statistical analysis was performed by using ANOVA and non-parametric tests. Whenever possible, data were compared with the database of the Veneto Dialysis Register. The first 601 consecutive questionnaires that we were able to analyse are presented in this paper. Applying the IRLSSG criteria for the diagnosis, the percentage of RLS patients in our sample was 21.5%, with a score of 20.5±8.7 on the IRLSSG Severity Scale. Comparing patients who are definitely affected by RLS ( n =127) with unaffected patients ( n =280), we found that the two groups did not differ as to age, sex, weight, body mass index (BMI), and intake of nicotine, alcohol and caffeine. Similarly, the two groups did not differ as to the etiology of ESRD, type of dialysis or percentage of previous transplantations; however, the period of dialysis dependence was significantly lower in the group negative for RLS. The use of drugs did not differ in the two groups, except for lower intake of phosphorus binders and antihypertensive drugs among RLS patients. No patient was receiving specific treatment for RLS. RLS patients reported more fragmented, less restful nightly sleep and more daytime somnolence, more often presented symptoms of other sleep disorders and were more affected by anxiety or depression. The high prevalence of RLS and other sleep disorders among uremics requires careful investigation of nocturnal sleep; although often underdiagnosed, correct identification of these disorders can lead to better therapy and improvement of clinical conditions and quality of life. Sleep fragmentation and sleep deprivation caused by RLS may contribute to the cardiovascular complications and infections, often with bad prognosis in dialysis patients.