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Restless legs syndrome linked to sleep problems in pregnant women

Restless legs syndrome was a significant contributor to many of the sleep disturbances experienced by pregnant women, according to findings recently published in the Journal of Clinical Sleep Medicine.

“Although [restless legs syndrome] is related to reduced quality of life and poor sleep in the general population, data on [restless legs syndrome]-associated maternal sleep-wake disturbances are lacking,” Galit L. Dunietz, PhD, of the Sleep Disorders Center at the University of Michigan, Ann Harbor, and colleagues wrote.

In addition to assessing key delivery outcomes, the researchers also aimed to determine the frequency of restless legs syndrome in a large, heterogeneous sample of pregnant women using standardized diagnostic criteria, and to examine the role of restless legs syndrome in sleep-wake disturbances.

Researchers gathered data from a recruited cohort of 1,563 women (mean age, 30 years) in their third trimester of pregnancy. Dunietz and colleagues built logistic regression models to examine the connection between restless legs syndrome and its prevalence with sleep disturbances.

Researchers found that 36% of the women had restless legs syndrome, and more than 65% had moderate to severe symptoms. In addition, those with restless legs syndrome were more likely to experience excessive daytime sleepiness (OR = 1.6; 95% CI, 1.3-2), poor daytime function (OR = 1.9; 95% CI, 1.4-2.4) and have poor sleep quality (OR = 2.2; 95% CI, 1.7–2.9) compared with women without this condition.

Although there was no observed connection between delivery outcomes and restless legs syndrome, the researchers found a dose-response relationship between sleep-wake disturbances and restless legs syndrome frequency.

“[This] is the largest study, thus far, to investigate [restless legs syndrome] in a United States population of pregnant women utilizing standard diagnostic criteria,” Dunietz and colleagues wrote.

The researchers also offered some suggestions on treating pregnant patients with restless legs syndrome.

“Nonpharmacological treatment is preferable during pregnancy for mild to moderate symptoms. Recommended approaches typically include moderate exercise, elastic stockings or pneumatic compression devices, and avoidance of caffeinated and alcoholic beverages,” Dunietz and colleagues wrote. “Pharmacological treatment approaches during pregnancy are discouraged due to lack of data regarding safety and efficacy. However, there may be benefit in treating women with persistent, severe [restless legs syndrome] symptoms with oral iron supplementation.”

According to the researchers, women may benefit with less than 75 µg/L of ferritin and are likely to benefit from less than 30 µg/L of ferritin.

“If symptoms persist, and the maternal benefit outweighs any risks to the fetus, other treatment options may include dopaminergic drugs, benzodiazepines, opioids or antiepileptic agents,” Dunietz and colleagues wrote. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.