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Clinical features variability between familial and sporadic restless legs syndrome/Willis-Ekbom disease (RLS/WED) has been previously reported. With this retrospective cohort study, we aimed to determine the clinical and polysomnographic characteristics of 400 RLS/WED patients. Patients with familial RLS/WED were significantly younger than sporadic RLS/WED, while clinical and polysomnographic characteristics were similar in both groups. No difference was found for the age-at-onset between idiopathic and secondary RLS/WED. Periodic limb movements (PLM) index and REM sleep time were higher in idiopathic RLS/WED. Time of onset of symptoms was in the evening or at bedtime in 28.04 and 37.80 % of patients, respectively, while in 21.34 % of patients onset was more than 1 h after sleep onset. Impulse control and compulsive behaviours (ICBs) were found in 13.29 % patients on dopamine agonist therapy. Our analyses support the hypothesis that patients with a familial history of RLS/WED may have a genetic component. Nevertheless, the dichotomy between early and late onset disease seems to be less sharp than previously reported. A large proportion of RLS/WED patients can have atypical features, therefore making the diagnosis challenging. Some cases can be missed even when the patient refers to a sleep specialist, as revealed by the partial absence of daytime symptoms, the high comorbidity with insomnia and other sleep complaints and the high percentage of symptoms beginning after sleep onset. This draws attention on the importance of a careful evaluation of the patient, to recognize potentially treatable secondary forms of RLS/WED. [ABSTRACT FROM AUTHOR]

The aims of this study were to measure the error in sleep estimation in normal controls and subjects with primary insomnia to establish the minimum amount of sleep needed for reliable subjective estimation and to depict the distribution of the error in sleep estimation in both groups. A two-step retrospective (study 1) and prospective (study 2) validation study was carried out. Study 1 included 288 normal subjects [176 females and 112 males, mean age 58.5 years, standard deviation (SD) 7.23]. Study 2 included 159 patients (98 females and 61 males; mean age 49.1 years, SD 12.71) with primary insomnia. Participants underwent a full-night polysomnographic study, followed by a morning assessment of subjective sleep parameters. A misperception index (MI) was computed using the following formula: MI = [objective total sleep time (oTST)−subjective total sleep time (sTST)]/oTST. The statistical properties of this index were analysed in detail in both groups. In controls, the Bland–Altman test demonstrated the reliability of this index for values of oTST >120 min. Healthy subjects estimated their sleep time correctly, while insomniacs largely underestimated their sleep time. Statistical analysis of the distribution of MI in insomnia patients disclosed the presence of two subgroups, one with moderate sleep misperception (132 patients) and the other with high sleep misperception (27 patients). The latter presented MI values ≥0.9, exhibiting statistical properties different from those with MI <0.9 and from normal subjects. The MI gives a reliable and immediate description of sleep misperception in healthy and insomnia subjects. Its application supports the existence of the high misperception of insomnia as a separate pathological entity. [ABSTRACT FROM AUTHOR]