Elsevier

Sleep Medicine

Volume 10, Issue 3, March 2009, Pages 295-305
Sleep Medicine

Original Article
Assessing health-related quality of life in patients with restless legs syndrome

https://doi.org/10.1016/j.sleep.2008.01.002Get rights and content

Abstract

Background

Restless Legs Syndrome (RLS) has a substantial impact on normal daily activities. Because of the high prevalence it is necessary to evaluate the impact on the health-related quality of life (HRQoL).

Objective

To assess health-related quality of life in patients with RLS.

Methods

A total of 519 patients (327 female patients; mean age: 64.2 y) were recruited in five different German centers according to the diagnostic criteria of the International RLS Study Group. Patients were either interviewed or completed a mailed questionnaire. The questionnaire consisted of an evaluation of the sociodemographic, clinical and health-related status. HRQoL was evaluated with the EuroQoL (EQ-5D). In addition, the IRLS scale, the MOS Sleep Scale, the Epworth Sleepiness Scale, and the BDI were applied as clinical rating scales.

Results

HRQoL is substantially affected by RLS. The mean EQ-5D-VAS was 55.6 and considerably lower compared to the general population. It was found to be as low as in other chronic neurological disorders such as Parkinson’s disease and stroke. From different factors investigated by uni- and multivariate analyses, severity of RLS and depressive symptoms had the most significant impact on HRQoL. Additionally, sleep deficits, the duration of the disease and net household income were identified as predictors for different EQ-5D outcome scores.

Conclusions

RLS considerably affects HRQoL. Further comparative studies are necessary to evaluate the effect of disease symptoms on HRQoL and their change due to medication.

Introduction

Restless legs syndrome (RLS) is one of the most frequent movement disorders characterized by an urge to move the legs that is often hard to resist and is usually, but not always, associated with uncomfortable leg sensations. About 5–15% of the general population, at least in parts of Europe and in the US, is affected with symptoms of restless legs syndrome [1]. RLS may already occur in childhood but onset of disease is frequently occurring in the second decade of life [2], [49].

RLS does not directly lead to life threatening complications, but its symptoms may manifest chronically as considerable impairments to the patient’s quality of life. There are only few studies available which have assessed the impact of RLS on health-related quality of life (HRQoL; Table 1). These studies used established questionnaires like the SF-36, the Restless Legs Syndrome Quality of Life questionnaire (RLSQoL) and visual analogue scales. Up to now there are no published studies which used the EQ-5D to assess the HRQoL in patients with RLS. The EQ-5D is a generic instrument to assess HRQoL, comprises five triple choice questions about HRQoL dimensions (mobility, self-care, daily activity, pain, anxiety/depression), and has been used in a variety of neurological diseases, such as Parkinson’s disease [3], [4], stroke [5] and multiple sclerosis [6]. It generates a health profile with five major dimensions but is also capable of expressing HRQoL as a single index value (utility value). Therefore, it can be applied for clinical as well as for economic evaluations of health care.

The aim of this study was to systematically explore the factors which are associated with RLS and which of those contribute to the decrease in patient-reported HRQoL. For this purpose we used the German version of the EuroQoL Index (EQ-5D) and its Visual Analogue Scale (VAS) [7] to quantify preference-based measures.

Section snippets

Patient selection

Patients were recruited in the following German centers: Department of Neurology, Philipps-University Marburg; Department of Clinical Neurophysiology, University Göttingen; Paracelsus Elena Klinik, Kassel; Department of Neurology, Hephata Klinik, Schwalmstadt; and at one office-based neurologist, Berlin.

Patients were included if they were in line with the following requirements: (1) a visit in one of the centers during the last 12 months. (2) The patients fulfilled the diagnostic criteria

Results

A total of 519 patients participated in our study, 192 (37.0%) men and 327 (63.0%) women. The demographic and clinical characteristics of the patients are presented in Table 2, Table 3. Individuals with RLS had a mean age of 64.2 y (SD: 11.1) with a mean age at symptom onset of 45.6 y (SD: 16.7). The average duration of disease was 18.7 y (SD: 14.5). Most of the patients lived with partners (76.1%) and 41.4% had a higher degree of school education (secondary school or higher). About 38% of

Discussion

This study evaluated the impact of RLS on HRQoL by using the generic scale EQ-5D. Previous studies using other scales have shown that RLS considerably affects HRQoL (see Table 1; see review [16]). Similarly, we could affirm the substantial impact of RLS on the HRQoL. The vast majority of the patients reported problems in at least one of the EQ-5D dimensions, however, pain (84%) and anxiety/depression (51%) were named most frequently. Thirty-nine percent refer to problems with daily activities.

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