Men with Restless Legs Syndrome Should Beware
Two new studies about restless legs syndrome are in the news, with one focusing on the increased risk of early death and the other concerning a review of treatment options. Up to 10 percent of adults experience restless legs syndrome, and although women are affected slightly more than men, it’s males who are being warned in one of these latest studies, while the other study may benefit both men and women.
Do you have restless legs syndrome?
Restless legs syndrome is a nervous system disorder that has a significant impact on sleep, which is why it also is often referred to as a sleep disorder. Individuals with the condition have an uncontrollable urge to move their legs (and sometimes arms or other body parts as well) to get relief from sensations of itching, “crawly,” and tingling that typically are worse when lying down.
These sensations can range from mild to severe, and they can significantly impair a person’s ability to sleep. Middle-aged and older individuals are usually affected most, although the condition can appear in people of any age.
According to researchers at Brigham and Women’s Hospital and Harvard Medical School, men who have restless legs syndrome appear to have a 30 to 39 percent increased risk of dying early when compared with men without the syndrome. The reason for this higher risk has not been identified.
Indeed, scientists are not certain what causes restless legs syndrome either, although genetics do seem to have a role. Some research has uncovered genes associated with the syndrome, while other investigations have found a link between genes and iron deficiency.
What the men's study shows
A total of 18,425 men (average age, 67 years) were evaluated for restless legs syndrome and then followed for 8 years, during which time researchers collected health information about major chronic conditions every two years. A total of 690 men were found to have the syndrome at the start of the study.
All the men were free of arthritis, diabetes, or kidney failure at the beginning of the study. This is significant because kidney disease and peripheral neuropathy (common in people with diabetes) have been linked to restless legs syndrome.
- 25 percent (171 of 690) of men with restless legs syndrome died
- 15 percent (2,594 of 17,735) of those without the syndrome died
- Overall, men with restless legs syndrome had a 39 percent greater risk of dying early when compared with men without the syndrome
- When factors such as weight, lifestyle, medical conditions, and sleep disorders were taken into account, the risk declined only to 30 percent
- When individuals who had major medical problems such as hypertension, cancer, or heart diseases were excluded from the analysis, the link between restless legs syndrome and early death climbed to 92 percent
Why the greater risk of dying?
According to one of the study’s authors, Xiang Gao, of the Channing division of network medicine at Brigham and Women’s Hospital and also of Harvard School of Public Health, the increased risk of dying observed with restless legs syndrome was not associated with the usual risk factors, such as obesity, a sedentary lifestyle, or poor diet.
Instead, the greater risk was “more frequently associated with respiratory disease, endocrine disease, nutritional/metabolic disease, and immunological disorders.” Although this study does not establish restless legs syndrome as a cause of early death, men with the condition should consult their physicians, especially if they have a respiratory disease or any of the other medical conditions mentioned as risks.
Treatment of restless legs syndrome
Currently there is no cure for restless legs syndrome. Treatments can range from lifestyle changes (e.g., regular exercise program, establishing a regular sleep pattern, avoiding use of alcohol, tobacco, and caffeine) to massage, application of heat or ice to the legs, and medications such as narcotics for severe pain, anticonvulsants, and dopaminergic drugs.
A new study in Sleep Medicine Reviews is a meta-analysis of both dopaminergic and non-dopaminergic drugs. Data on nearly 9,600 patients were reviewed and analyzed. In fact, this is the first meta-analysis of all randomly controlled trials for the drug treatment of restless legs syndrome.
The authors discovered that while dopaminergic medications can be effective, "other treatments with different pharmacological principles show efficacy in small samples and may be well-tolerated alternatives" for treating people with the syndrome.
In another new study published in Postgraduate Medicine the investigators noted that current therapy for restless legs syndrome focuses on non-ergot-derived dopamine receptor agonists, the drugs of choice for moderate to severe cases of the syndrome. Among those drugs include pramipexole (Mirapex), ropinirole (Requip), and rotigotine.
When using drugs for restless legs syndrome, a medication that helps one person may make another person’s symptoms worse. In addition, some drugs lose their effectiveness over time.
If you are man who has restless legs syndrome, consult your healthcare provider about treatment options. Men who have any of the risk factors noted in this study should talk to their doctor about ways to reduce their risk of early death.
Updated June 16, 2013
Bogan RK, Cheray JA. Restless legs syndrome: a review of diagnosis and management in primary care. Postgraduate Medicine 2013 May; 125(3): 99-111.
Hornyak M et al. What treatment works best for restless legs syndrome: Meta-analyses of dopaminergic and non-dopaminergic medications. Sleep Medicine Reviews 2013 Jun 6
Li Y et al. Prospective study of restless legs syndrome and mortality among men. Neurology 2013 Jun 12. Published online before print.