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To systemically describe the clinical features, polysomnography (PSG) finding, laboratory tests and single-nucleotide polymorphisms (SNPs) in a clinic based Chinese primary restless legs syndrome (RLS) population. This observational study, conducted from January 2020 to October 2021 across 22 sleep labs in China, recruited 771 patients diagnosed with RLS following the 2014 RLSSG criteria. Clinical data, PSG testing, and laboratory examination and SNPs of patients with RLS were collected. A total of 32 SNPs in 24 loci were replicated using the Asian Screening Array chip, employing data from the Han Chinese Genomes Initiative as controls. In this study with 771 RLS patients, 645 had primary RLS, and 617 has DNA available for SNP study. Among the 645 primary RLS, 59.7% were women. 33% had a family history of RLS, with stronger familial influence in early-onset cases. Clinical evaluations showed 10.4% had discomfort in body parts other than legs. PSG showed that 57.1% of RLS patients had periodic leg movement index (PLMI) of >5/h and 39.1% had PLMI >15/h, respectively; 73.8% of RLS patients had an Apnea-Hypopnea Index (AHI) > 5/h, and 45.3% had an AHI >15/h. The laboratory examinations revealed serum ferritin levels <75 ng/ml in 31.6%, and transferrin saturation (TSAT) of <45% in 88.7% of RLS patients. Seven new SNPs in 5 genes showed a significant allelic association with Chinese primary RLS, with one previously reported (BTBD9) and four new findings (TOX3, PRMT6, DCDC2C, NOS1). Chinese RLS patients has specific characters in many aspects. A high family history with RLS not only indicates strong genetic influence, but also reminds us to consider the familial effect in the epidemiological study. Newly developed sequencing technique with large samples remains to be done. • This study systemically described the clinical features, PSG finding, laboratory tests and SNPs in a clinic based Chinese primary RLS population. • Chinese primary RLS patients has specific characters in many aspects including a lower PLMI, highly familial, especially in early onset case and a high rate of iron deficiency. OSA combined with RLS is common, and atypical RLS requires attention. • Replication study identified that 7 new SNPs in 5 genes associated with Chinese primary RLS. MEIS1 is specific to Caucasian and has a low mutation rate in the Chinese population. [ABSTRACT FROM AUTHOR]

Restless legs syndrome is associated with quality of life and risk of death in maintenance hemodialysis patients. Although relevant meta-analyses have been conducted, epidemiological studies of restless legs syndrome have increased in recent years. Our aim was to systematically assess the prevalence of restless legs syndrome in maintenance hemodialysis patients and to evaluate the effect of different geographic regions, genders, study designs, and years of publication on the prevalence of restless legs syndrome. PubMed, Web of Science, EMBASE, The Cochrane Library, China Knowledge Resource Integrated Database, Wanfang Database, Weipu, and Chinese Biomedical Database were searched before March 16, 2023 for the published literature. Two investigators independently performed literature screening, data extraction for eligible studies, and risk of bias assessment. A random-effects model using the stata 15.0 software was used to assess the pooled prevalence of restless legs syndrome. Fifty-seven articles were included in this meta-analysis, and the pooled prevalence of restless legs syndrome in 12,573 maintenance hemodialysis patients was 24.0 % (95 % CI: 21.0%–26.0 %). Maintenance hemodialysis patients from the Americas region and females had severe symptoms of restless legs syndrome, and the prevalence of restless legs syndrome increased from year to year. The prevalence of restless legs syndrome was higher in maintenance hemodialysis patients in cross-sectional studies and cohort studies compared to case-control studies. Maintenance hemodialysis patients have a significantly higher prevalence of restless legs syndrome. These findings may provide some reference value for hospital nursing staff to focus on the management and treatment of restless legs syndrome in maintenance hemodialysis patients. • The total prevalence of RLS in maintenance hemodialysis patients 24.0 %. • The higher prevalence of restless legs syndrome was found in the Americas region and in females. • The prevalence of RLS syndrome varied in maintenance hemodialysis patients in different regions, genders, study designs. [ABSTRACT FROM AUTHOR]

Objectives: Restless legs syndrome (RLS) is a common complaint in patients undergoing hemodialysis (HD). Despite the fact that the estimated prevalence of RLS among HD patients is widely reported, these results varied significantly in the relevant literature. Due to this limitation, the aim of this study was to determine the global prevalence of RLS among HD patients. Methods: This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses 2020 statement. We searched the electronic databases: Cochrane Library, PubMed, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database, and Weipu Database. A random effects model was employed to calculate pooled prevalence rates. Results: The global pooled prevalence of RLS in HD patients was 27.2% (95% CI: 24.8–29.7). Stratified analyses demonstrated that included studies with sample size <100 had the highest pooled prevalence of RLS. The prevalence of RLS using clinical interviews and questionnaires was 28.7% (95% CI: 25.2–32.2) and 25.9% (95% CI: 22.8–29.1), respectively. RLS prevalence is higher in females (29.7%, 95% CI: 26.2–33.2) HD patients than in males (23.5%, 95% CI: 20.9–26.0), and the African region has the highest prevalence in the world when the diagnostic criteria were restricted to the 2003 version of International RLS Study Group criteria, the prevalence of RLS was highest (28.9%, 95% CI: 25.9–31.9). Conclusion: Our results revealed a high RLS prevalence in HD patients worldwide. However, the prevalence of RLS among HD patients varied significantly based on sample size, data collection method, gender, diagnostic criteria, and geographical region. [ABSTRACT FROM AUTHOR]

Sleep disorders in patients with end-stage renal disease are common but have rarely been reported in previous studies. Therefore, we examined the prevalence of sleep disorders and the risk factors for declining sleep quality in patients undergoing peritoneal dialysis (PD). A multicenter prospective cohort study was conducted at five PD centers across different provinces in China. A total of 449 patients who underwent PD between March to November 2013 were enrolled. Demographic data, laboratory indicators, presence of depression, and sleep assessment data were collected. Sleep questionnaires reflecting five categories of sleep disorders, namely, insomnia, restless legs syndrome, excessive daytime sleepiness, possible narcolepsy, and sleepwalking and nightmares, were administered at baseline and at 24 months postoperatively. Sleep disorders were diagnosed when a patient had at least one sleep problem. At baseline, 335 (74.6%) patients had at least one type of sleep disorder. Depression, diabetes mellitus (DM), and male were found to be associated with the presence of a sleep disorder. At follow-up, the prevalence of insomnia, restless legs syndrome, and excessive daytime sleepiness had significantly increased in 285 patients. Furthermore, cardiovascular disease (CVD) was found to be associated with the presence of sleep disorders in patients with one or more disorders at baseline, whereas a low serum albumin level was found to be associated with sleep disorders in patients without any sleep disorders at baseline. The prevalence of sleep disorders was relatively high among PD patients at baseline and increased afterthe2-year follow-up. Depression, DM, and male were associated with all sleep disorders at baseline. CVD was associated with the presence of a sleep disorder at baseline and worse sleep quality at the 2-year follow-up; whereas a low serum albumin level was associated with the risk of acquiring a sleep disorder at the 2-year follow-up among patients with normal sleep status at baseline. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance can be an important predictor associated with suicide behaviors. However, to date, few studies have examined the prospective relationships between different types of sleep disturbance and suicidal behaviors. The current study examined which sleep disturbance types were independent risk factors for subsequent suicidal behaviors in a large sample of Chinese college students.Methods: Data came from a large-scale health-related cohort study in Guangdong, China. Participants were 11,740 college students initially assessed in March and April in 2019 and reassessed six month later. Self-administered structured questionnaires were used to assess suicidal behaviors, insomnia, nightmares, sleep disordered breathing (SDB) symptoms, restless legs syndrome (RLS) symptoms, depression, substance abuse and demographic characteristics. A series of logistic regression analyses were conducted to examine the associations between different types of sleep disturbance and suicidal behaviors.Results: Overall, 12.2% and 1.2% of college students reported suicidal ideation and attempts at baseline, and 8.6% and 2.4% reported similar behavior at follow-up. After adjustment for key covariates and prior suicidal behaviors, frequent nightmares (AORs = 1.35-1.69) and RLS symptoms (AOR = 1.37) at baseline predicted subsequent suicidal ideation, and only frequent nightmares (AOR = 2.40) at baseline predicted subsequent suicidal attempts.Limitations: All measures were based on self-report instead of objective assessments or clinical diagnostic evaluations.Conclusions: Frequent nightmares and RLS symptoms were independently associated subsequent suicidal ideation or attempts. Screening and managing sleep disturbance may be helpful for reducing the risk of suicidal behaviors among college students. [ABSTRACT FROM AUTHOR]

Background: The clinical spectrum of restless legs syndrome (RLS) has not been described in a Chinese population. We aim to evaluate the detailed clinical profile in a cohort of unselected RLS patients in China.Methods: We enrolled RLS patients continuously according to the diagnostic criteria. Laboratory examinations were performed to exclude mimics and notable comorbidities.Results: A total of 359 patients with RLS were enrolled. RLS symptoms were mostly symmetrical (65.2%), and purely unilateral RLS was not common (5.6%); however, unilateral dominant RLS was relatively more common. Only 1.1% of RLS patients reported no unpleasant sensations in the legs. The largest proportion of RLS patients described their uncomfortable sensation as indescribable (43.5%) and reported soreness (40.4%). In all, 8.9% of RLS patients described their abnormal sensation as painful, and 34.5% of RLS patients reported their symptoms fluctuated with seasonal trends. This population had a higher likelihood of an RLS family history. RLS patients with summer exacerbation had a younger age at RLS onset and longer disease duration (p < 0.01). Iron deficiency without anemia was common in Chinese RLS patients. Early-onset RLS patients were more likely to have a positive family history (p < 0.01), more summer worsening of symptoms (p < 0.01) and more severely disturbed peripheral iron status (p < 0.01) when compared to late-onset RLS patients.Conclusion: The subjective description is somewhat different, with Chinese RLS patients reporting less pain and more soreness than patients from Western countries. Seasonal fluctuation and iron deficiency without anemia are frequently seen in Chinese RLS patients and predict some other features. Differentiating these various subtypes can facilitate optimal management. [ABSTRACT FROM AUTHOR]

In recent years, Chinese scholars have made some progress in the field of restless legs syndrome (RLS), including epidemiological investigation of prevalence of RLS in some areas of China, the pathogenesis, comorbidities research, drug therapy and non - drug therapy of RLS, such as repetitive transcranial magnetic stimulation (rTMS), acupuncture and moxibustion treatment, etc. This has laid a solid foundation for understanding and treating the disease in a better way, and also makes some contributions to RLS research for our country. [ABSTRACT FROM AUTHOR]

Objective: To perform a detailed epidemiological study of Chinese women and the relationship between restless legs syndrome (RLS) in pregnancy and any associated complications during delivery.Methods: A total of 3874 pregnant women (18-40 years) who had delivered babies at The First Affiliated Hospital of Zhengzhou University from May 2011 to May 2014 were enrolled in the study. Using a face-to-face interview questionnaire, data were collected pertaining to RLS incidence in pregnancy and any associated complications during delivery. The relationship between RLS frequency and pregnancy or delivery complications was further investigated.Results: Among 12.3% of the eligible participants, RLS prevalence occurred at least weekly. Older pregnant women were more likely to suffer from RLS. Individuals who experienced RLS at least weekly reported a statistically higher frequency of excessive daytime sleepiness and an increased prevalence of hypertension, cardiovascular disease, and preeclampsia compared with those without RLS.Conclusion: The study revealed that RLS was frequent in Chinese pregnant women, especially in those with pregnancy or delivery complications such as hypertension, cardiovascular disease, and preeclampsia. Restless legs syndrome was also associated with excessive daytime sleepiness. [ABSTRACT FROM AUTHOR]

Objective: Few studies regarding the epidemiology of essential tremor (ET) and its non-motor symptoms (NMS) have been conducted to date. We thus conducted a door-to-door survey to investigate the ET and its NMS and their clinical manifestations in a rural area of Shanghai, China.Methods: We recruited 19,614 residents (≥ 50 years old), living in Malu town, Shanghai. Investigations were divided into two steps. In first step, trained physicians conducted door-to-door surveys and reported probable ET subjects to movement disorder specialists. In the second step, participants with suspected ET had their diagnosis confirmed by movement disorder specialists. We randomly selected 123 subjects from those adults who screened negative for neurological conditions as healthy controls for the study of NMS.Results: The prevalence of ET in individuals (≥ 50 years old) was 0.306% (PR = 3.06 per 1000). The mini-mental state examination (MMSE) scores were lower in ET patients than in controls (25.81 ± 4.20 vs. 26.63 ± 3.14, P= 0.024). Complaints of restless legs reported by ET patients were significantly higher than those in controls (P < 0.05). In contrast, we did not observe a significant difference for other NMS between ET patients and controls, including olfactory function (P = 0.82), depression (P = 0.94), and rapid eye movement sleep behavior disorder (RBD) (P = 0.71).Conclusions: The prevalence of ET in people ≥ 50 years old in a rural area of Shanghai China is low. Prevalence of certain NMSs was higher among participants with ET relative to health controls. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the prevalence and severity of restless legs syndrome (RLS) in a town in China and to explore potential factors correlated with the severity of the disease. Methods: Face-to-face home interviews were conducted among a random sample of 2101 residents in one town in China, all aged 16years and above. An individual questionnaire was administered to all participants to obtain a diagnosis of RLS and other information. An additional questionnaire was then handed out to each patient diagnosed with RLS to collect information on RLS severity and potential factors correlating with RLS severity. Results: The prevalence of RLS in the studied population was 7.2%. The prevalence in women was significantly higher than in men and increased with age. Diabetes mellitus, anemia, arthritis, and varicose veins were also associated with RLS. Among the 152 patients, 21.7% were classified as having severe RLS. Multiple correlation analysis reveals that RLS severity was positively correlated with longer disease duration, number of cigarettes smoked per day, and level of work-related physical activity, but negatively correlated with level of leisure time physical activity. Conclusions: RLS is common in the studied population. Lifestyle factors may be associated with RLS severity. [Copyright &y& Elsevier]

Abstract: Objective: The aim of the study is to investigate the prevalence rate of restless legs syndrome (RLS) in elderly Chinese people over 50 years of age in an urban suburb of Shanghai by a community-based study. Methods: A 3-step survey was adopted including two telephone-based interviews and one face-to-face interview. We used questions based on four diagnostic criteria for RLS to perform the first telephone interview. The second telephone interview was performed by a sleep specialist to rule out the ‘mimics’ and secondary RLS. The final face-to-face interview was performed in the clinic for confirmation and examination. Results: There were 2609 inhabitants in the Wuli Bridge suburb of Shanghai who responded to the first telephone interview (men 68.55±10.13 years of age and women 65.34±10.52 years of age, mean±SD). Eighteen people were finally diagnosed with RLS. In this sample, the overall prevalence rate of RLS was about 0.69% (95% confidence interval (CI): 0.41–1.09). Conclusion: Our study provided the first data about the prevalence rate of RLS in an urban suburb of Shanghai from mainland China, which is consistent with the low prevalence rate reported in other Asian countries. [Copyright &y& Elsevier]

Purpose: Augmentation is a major complication of long-term pramipexole treatment of restless legs syndrome (RLS). However, there have been no studies on augmentation in Chinese patients with RLS. We therefore investigated the clinical characteristics of augmentation in RLS patients treated with pramipexole in a real-world Chinese setting., Methods: This study was an observational, retrospective assessment of 103 patients with RLS, who had been continuously treated with pramipexole for at least one month between January 2016 and December 2018 in a tertiary hospital in East China. Demographic data and disease and drug treatment information were collected from electronic medical records and telephone interviews to analyze the rate and clinical features of augmentation. Augmentation was confirmed by Max Planck Institute criteria. Comparisons were made between patients with and without augmentation., Results: Fifteen patients (15%) were classified as having augmentation. Compared to RLS patients without augmentation, more patients with augmentation switched from other dopaminergic drugs (P<0.05) and had a longer duration of RLS symptoms before pramipexole treatment (P<0.05). In addition, patients with augmentation had a longer duration (P<0.05) and higher dosage (P<0.05) of pramipexole than those without augmentation. Augmentation was possibly associated with pramipexole tolerance (P<0.01)., Conclusion: The augmentation rate of the Chinese RLS patients in our study was 15%. Augmentation may be associated with switching from other dopaminergic drugs, long disease duration before pramipexole use, the dose and duration of pramipexole, and tolerance to pramipexole., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Parkinson's disease (PD) and restless legs syndrome/Willis-Ekbom disease (RLS/WED) are both common movement disorders. Based on their clinical overlap, association studies of PD and RLS/WED have been conducted for many years., Objective: To investigate whether or not the genetic risk factor of PD was also associated with RLS/WED., Subjects and Methods: We included 102 idiopathic RLS/WED patients and 189 matched controls from southeast China. The clinical data included the International Restless Legs Syndrome Study Group Rating Scale, the subtypes of RLS/WED symptoms (painful or other discomfort), the comorbidities, the pregnancy history of female patients, the Hamilton Depression Scale (HAMD), and the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Risk gene analysis between RLS/WED and control groups including 21 SNPs (single nucleotide polymorphisms) was conducted. Genotyping was done by Sanger sequencing., Results: We found that rs4273468 polymorphism of BST1 gene increased the risk of idiopathic RLS/WED patients in southeastern Chinese population (P = <0.001, OR = 2.85, p = 0.019 after Bonferroni correction). Moreover, the haplotype of G-G (rs4698412-rs4273468) was significantly associated with Chinese RLS/WED patients (p = <0.001)., Conclusion: BST1 may contribute to the development of RLS/WED. Further studies on larger cohorts are needed to confirm these findings., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature.)

Objective: Previous research has documented an association between insomnia and depression among patients with restless legs syndrome (RLS)/Willis-Ekbom disease. Given that leg motor restlessness (LMR) is closely related to RLS, the purpose of this study was to investigate the prevalence of insomnia and depression among individuals with LMR. In addition, we examined the associations among LMR, insomnia, and depression in a sample of young Chinese men living in high-altitude areas., Methods: Chinese military personnel working on the Qinghai Tibet Plateau (Lhasa, an altitude of 3600 m) were recruited in 2019 to complete a series of questionnaires. Participants having the urge to move their legs but not meeting the diagnostic criteria for RLS were classified as having LMR. Hierarchical linear regressions and mediational analyses using the SPSS PROCESS macro in SPSS were conducted to examine the associations among LMR, insomnia, and depression., Results: Of 196 participants, 36 (18%) had LMR. Only 1 participant was diagnosed with RLS. The proportions of participants suffering from insomnia who had LMR and did not have LMR were 44% and 22%, respectively. For depression, the proportions were 47% and 28%, respectively. Results of the hierarchical linear regressions showed that both LMR and depression were associated with increased insomnia symptoms. In addition, results from the mediational analyses indicated that the indirect effect of LMR on depression was significant and accounted for 52% of the total effect., Conclusions: Participants with LMR had a higher prevalence of insomnia and depression compared with those without LMR. In addition, LMR was correlated with depression, and insomnia played a significant role in this co-occurrence.

Stroke-related sleep disorders (SSD) are common symptoms after stroke, which are common but easily ignored. Studies have shown that sleep disorders in stroke patients would have negative impact on prognosis. However, there is still a lack of consensus and guidance on SSD evaluation and management worldwide. This consensus proposes the concept of SSD based on systemic literature review and discussion with experts. It comprises recommendations of assessment and management for all types of SSD, including insomnia, excessive daytime sleepiness, sleep apnea, rapid eye movement (REM) sleep behavior disorder, restless leg syndrome/periodic limb movements of sleep, circadian rhythm sleep-wake disorders. The purpose of this consensus is to provide a standard reference of SSD management.

Study Objectives: Many studies have investigated the association between restless legs syndrome (RLS) and cardiovascular risk factors, leading to conflicting results. Therefore, the aim of the current study was to determine whether RLS is associated with cardiovascular risk factors and disease., Methods: This cross-sectional study included 5,324 consecutive subjects who visited the Physical Examination Center of The First Affiliated Hospital of Zhengzhou University for their yearly routine physical examination. Participants underwent a face-to-face interview with a neurologist for the assessment of RLS, based on the International Restless Legs Study Group criteria. They also completed a questionnaire related to cardiovascular risk factors and other health-related and demographic information. Logistic regression was used to assess which of the demographic and cardiovascular risk factors increased the odds of RLS. Then, unadjusted and adjusted models were designed to determine whether RLS was associated with increased odds of cardiovascular disease, coronary artery disease, or hypertension., Results: RLS was observed in 9.2% of the participants. Multivariable logistic regression models, which included the covariates age, sex, body mass index, smoking status, hypercholesterolemia, and Pittsburgh Sleep Quality Index score (dichotomized at 5), demonstrated that female sex (odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.99-2.95), smoking (OR: 1.96, 95% CI: 1.31-2.92), high cholesterol (OR: 1.30, 95% CI: 1.03-1.64), and PSQI score > 5 (OR: 5.61, 95% CI: 2.14-14.69) are significantly associated with RLS. Additionally, RLS was associated with hypertension, after adjusting for age, sex, body mass index, smoking, hypercholesterolemia, Pittsburgh Sleep Quality Index score > 5, diabetes, anemia, and decreased renal function., Conclusions: RLS is associated with the prevalence of hypertension but not with that of cardiovascular disease or coronary artery disease., (© 2018 American Academy of Sleep Medicine.)

Study Objectives: The aim of the study was to investigate the relationship between genetic factors and primary restless legs syndrome (RLS) in Chinese population., Methods: A total of 116 RLS patients and 200 controls were recruited and the diagnosis of RLS was based on the criteria of International RLS Study Group. Polymer chain reaction (PCR) and sequencing were used to detect 19 single nucleotide polymorphisms (SNPs) in six genetic loci (MEIS1, BTBD9, PTPRD, MAP2K5/SKOR1, TOX3, and Intergenic region of 2p14)., Results: Our study found that one SNP increased the risk of RLS in Chinese population: rs6494696 of MAP2K5/SKOR1 (odds ratio [OR] = 0.09, p < .0001, recessive model). A further meta-analysis of RLS in Asian population found that two SNPs of BTBD9 increased the risk of RLS: rs9296249 of BTBD9 (OR = 1.44, p = .000, T allele), rs9357271 of BTBD9 (OR = 1.38, p = .021, dominant model)., Conclusion: Our results confirmed the association of BTBD9 and MAP2K5/SKOR1 with primary RLS in Chinese population., (© Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.)

Background: Restless legs syndrome (RLS) often responds to agents that enhance dopamine neurotransmission. The present 12-week study aimed to evaluate the efficacy and adverse events of pramipexole (PPX) for the treatment of adult, Chinese people with primary RLS., Methods: A total of 204 Chinese people with RLS were randomly assigned to receive either the placebo or PPX (flexibly titrated from 0.25 mg to 0.75 mg), 2 h to 3 h before bedtime for 12 weeks. The primary measuring outcomes were the International RLS Study Group Rating Scale (IRLS) and the Clinical Global Impressions-Improvement (CGI-I) scale. The secondary outcome was adverse events., Results: One hundred and ninety participants completed the study. At 12 weeks, the adjusted mean (SE) change from baseline was greater for PPX (vs placebo) for the IRLS score (-13.2 ± 0.7 vs -9.4 ± 0.6; p <0.01), and (-12.1 ± 0.6 vs -8.3 ± 0.6; p <0.01) at the end of one month follow-up after treatment. The CGI-I rating of "very much improved" or "much improved" in the percentage of participants (61.8% vs 34.3%; p <0.01), and (51.0% vs 26.5%; p <0.01) after week 12, and one month follow-up of treatment, respectively. The proportion of adverse events was 60.8% in the PPX group and 45.1% in the placebo group. No deaths related to PPX treatment were recorded., Conclusions: In summary, the present study showed that PPX is efficacious and well tolerated in Chinese people with primary RLS., (Copyright © 2014 Elsevier B.V. All rights reserved.)