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Background: In addition to the gastrointestinal symptoms, inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is associated with extraintestinal manifestations, including neurological disorders, which are gaining increasing attention due to a recently increased focus on the gut–brain axis. Here we aim to evaluate the association between IBD and restless legs syndrome (RLS) as well as Parkinson's disease (PD) in a cohort of primary care patients in Germany. Methods: The study included 17,994 individuals with a diagnosis of IBD (7544 with CD and 10,450 with UC) and 17,994 propensity-score-matched individuals without IBD from the Disease Analyzer database (IQVIA). An initial diagnosis of RLS or PD was assessed as a function of IBD. Associations between CD and UC with RLS and PD were analyzed using Cox regression models. Results: During the 10-year observation period, 3.6% of CD patients vs. 1.9% of matched non-IBD pairs (p < 0.001) and 3.2% of UC patients vs. 2.7% of matched pairs (p < 0.001) were diagnosed with RLS. The results were confirmed by Cox regression analysis, which showed a significant association between UC (HR: 1.26; 95% CI: 1.02–1.55) and CD (HR: 1.60; 95% CI: 1.23–2.09) and subsequent RLS. The incidence of PD in IBD patients was not significantly increased. However, we observed a non-significant trend towards a higher incidence of PD in male patients with CD but not UC (HR: 1.55; 95%CI: 0.98–2.45, p = 0.064). Conclusions: The present analysis suggests a significant association between IBD and the subsequent development of RLS. These findings should stimulate further pathophysiological research and may eventually lead to specific screening measures in patients with IBD. [ABSTRACT FROM AUTHOR]

Background: There are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders. The present study aimed to evaluate the prevalence and clinical correlates in psychiatric inpatients in Germany and Switzerland. Methods: This is a multicenter cross-sectional study of psychiatric inpatients with an age above 18 years that were diagnosed and evaluated face-to-face using the International RLS Study Group criteria (IRLSSG) and the International RLS severity scale (IRLS). In addition to sociodemographic and biometric data, sleep quality and mood were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). In addition to univariate statistics used to describe and statistically analyze differences in variables of interest between patients with and without RLS, a logistic model was employed to identify predictors for the occurrence of RLS. Results: The prevalence of RLS in a sample of 317 psychiatric inpatients was 16.4%, and 76.9% of these were diagnosed with RLS for the first time. RLS severity was moderate to severe (IRLS ± SD: 20.3 ± 8.4). The prevalences in women (p = 0.0036) and in first-degree relatives with RLS (p = 0.0108) as well as the body mass index (BMI, p = 0.0161) were significantly higher among patients with RLS, while alcohol consumption was significantly lower in the RLS group. With the exception of atypical antipsychotics, treatment with psychotropic drugs was not associated with RLS symptoms. Regarding subjective sleep quality and mood, scores of the PSQI (p = 0.0007), ISI (p = 0.0003), and ESS (p = 0.0005) were higher in patients with RLS, while PHQ-9 scores were not different. A logistic regression analysis identified gender (OR 2.67; 95% CI [1.25; 5.72]), first-degree relatives with RLS (OR 3.29; 95% CI [1.11; 9.73], ESS score (OR 1.09; 95% CI [1.01; 1.17]), and rare alcohol consumption (OR 0.45; 95% CI [0.22; 0.94] as predictors for RLS. Conclusions: Clinically significant RLS had a high prevalence in psychiatric patients. RLS was associated with higher BMI, impaired sleep quality, and lower alcohol consumption. A systematic assessment of restless legs symptoms might contribute to improve the treatment of psychiatric patients. [ABSTRACT FROM AUTHOR]

Background: The primary symptoms of restless legs syndrome (RLS) are sleep onset insomnia and difficulty to maintain sleep. Previous studies have shown that regular physical activity can reduce the risk of developing RLS. However, the relationship between physical activity and sleep quality parameters in individuals suffering from RLS has not yet been investigated by applying accelerometry. Thus, the present study investigates the impact of physical activity (measuring both intensity levels and duration of physical activity) during the day (7-12 h, 12-18 h, 18-23 h) on sleep quality in patients suffering from idiopathic RLS by applying a real-time approach.Methods: In a sample of 47 participants suffering from idiopathic RLS, physical activity and sleep quality were measured over one week using accelerometers. For data analysis, physical activity levels and step counts during three periods of the day (morning, afternoon, evening) were correlated with sleep quality parameters of the subsequent night.Results: This observational study revealed that in most instances physical activity was not correlated with sleep parameters (two exceptions exist: steps taken in the morning were negatively correlated with periodic leg movements during sleep, and physical activity in the evening was negatively correlated with total sleep time). The physical activity levels of the participants in this study, however, were unexpectedly high compared to population-level data and variance in physical activity was low. The average activity was 13,817 (SD = 4086) steps and 347 (SD = 117) minutes of moderate physical activity per day in females, and 10,636 (SD = 3748) steps and 269 (SD = 69) minutes of moderate physical activity in males, respectively. Participants did not engage in any vigorous physical activity.Conclusions: Further interventional studies are needed to investigate the daily effects of different intensities of physical activity on RLS symptoms. [ABSTRACT FROM AUTHOR]

Background: Habitually shortened nighttime sleep is a common phenomenon in childhood and adolescence, sometimes associated with chronic sleep reduction (CSR). CSR is associated with impairments of performance ability and emotional well-being. The extent to which children and adolescents in Germany suffer from CSR is unclear; it is also unclear what factors are predictive of CSR. Methods: In the present study, we carried out a telephone survey in a representative sample of 998 children and adolescents aged 12 to 17, asking them about their sleep behavior, sleep disturbances, and mental well-being. A standardized method was used. Results: The point prevalence of CSR was found to be 12.5% (95% confidence interval, [10.5; 14.6]). Children and adolescents affected by CSR reported a significantly higher frequency of insomnia, delayed sleep-phase syndrome, restless legs syndrome, and obstructive sleep apnea. Female sex, pro - longed absence from school or vocational training, emotional and behavioral disturbances, age over 15 years, bedtimes after 10:38 pm on nights before school (or vocational training), getting up after 10:04 on days off, and reported insomnia were all associated with CSR, with odds ratios (OR) ranging from 2.2 to 21.1 (R² = 0.32 in a logistic regression model). Conclusion: One in eight persons aged 12 to 17 in Germany, particularly girls, meets the criteria for CSR. CSR is associated with sleep disturbances and significantly impaired mental health and should, therefore, always be kept in mind in routine clinical practice. We provide a set of indicators for possible CSR that patients can easily be asked about. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to investigate the relationship between impaired peripheral arterial circulation as measured by ankle-brachial index (ABI) and restless legs syndrome (RLS) in the general population.Methods: Data are derived from three independent, German population-based, prospective studies: the control sample of BiDirect (N = 966), the second follow-up of SHIP (N = 2333), and a subsample of SHIP-Trend (N = 1269). RLS was assessed with questions based on the RLS minimal criteria. ABI was measured with an automated method in BiDirect and with Doppler ultrasound in both SHIP studies. An ABI score below 0.9 was indicative of peripheral arterial disease (PAD). Co-morbidities, medications and behavioural factors were self-reported. Additional measurements included body mass index and haemoglobin from blood serum. For BiDirect, a follow-up with identical methodology was performed after a median of 2.5 years.Results: In cross-sectional analyses, decreased ABI was not significantly associated with RLS as outcome in multivariable logistic regression models adjusted for several potential confounders (BiDirect: odds ratio (OR) = 1.07 for a -0.1 change in ABI, 95% confidence interval (CI): 0.81-1.42, p = 0.62; SHIP-2: OR = 0.99, CI: 0.85-1.16, p = 0.94; SHIP-Trend: OR = 0.99, CI: 0.87-1.13, p = 0.88). Similar non-significant results were achieved using PAD (instead of ABI) as an independent variable. In BiDirect, baseline ABI was not a significant predictor of incident RLS in longitudinal analysis (OR = 0.77, CI: 0.53-1.12, p = 0.17).Conclusion: Results from three independent studies suggest that reduced ABI is not a risk factor for RLS in the general population. [ABSTRACT FROM AUTHOR]

Aim: Recent community-based studies have shown strong associations between restless legs syndrome (RLS) and major depressive disorder and panic disorder. The aim of the study was to investigate whether patients with a manifest depressive disorder have an increased prevalence of RLS and whether there is an association with different depressive disorders. Methods: Three psychiatry departments in two countries (Germany and Australia) each recruited 100 consecutive patients with current depression. All patients completed a standardized questionnaire including diagnostic questions for RLS, the Center for Epidemiologic Studies Depression Scale (CES-D), and the International RLS Severity Scale (IRLS), if RLS was present. The treating doctors completed a second standardized questionnaire including RLS diagnostic questions and comorbidities. Results: A total of 277 questionnaires could be evaluated, 184 in Germany (96 in Bremen, 88 in Freiburg) and 93 in Australia. The Australian patients were younger than the German patients (45.4 ± 13.8 vs. 49.7 ± 15.0 years, p = 0.02); the gender distribution was not different (p = 0.71). The minimal diagnosis criteria for RLS were fulfilled by 8.3% of the German and 17.0% of the Australian patients (p = 0.02). The treating physicians rated 4.3% of the German and 12.4% of the Australian patients as RLS cases. RLS prevalence was similar across all subtypes of depression. Conclusion: RLS is not more frequent in patients with manifest depression in Germany as compared to the general population. Possible reasons for the higher prevalence of RLS in depressive patients in Australia are discussed. [ABSTRACT FROM AUTHOR]

Approximately 10,000-15,000 Parkinson's disease (PD) patients per year undergo surgery in Germany. The demographic developments along with further surgical progress and procedural refinements will lead to increasing numbers of PD patients in the operating theatre (OR). There are several perioperative risk factors for PD patients, they more often require prolonged intensive care treatment and warrant particular anesthesiological attention with regard to the choice of drugs and equipment. Careful evaluation of concomitant diseases, maintenance of oral Parkinson therapeutic drugs up to the time of surgery and continuous perioperative dopaminergic therapy are key factors for reducing postoperative morbidity in PD patients undergoing surgery. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Prospective data about the new-onset of restless legs syndrome (RLS) are lacking. Our aim was to assess the incidence rate of RLS in the general population. Methods: RLS, defined by the minimal diagnostic criteria, was assessed twice in two independently conducted prospective population-based cohort studies in Germany. The Dortmund Health Study (DHS) had a mean follow-up of 2.2years, and included 1312 participants, and the Study of Health in Pomerania (SHIP) followed 4308 participants for, on average, 5.2years. RLS was assessed during face-to-face interviews in both studies at baseline and at follow-up in SHIP, and with mailed questionnaires at follow-up in DHS. Results: The age-standardized incidence rate of RLS was 22/1000 person-years (p-y) (cumulative incidence over the follow-up: 9.1%) in DHS and 9/1000 p-y (cumulative incidence: 7.0%) in SHIP. Women had a higher incidence rate than men (DHS: 27/1000 p-y vs. 17/1000 p-y, p =0.28; SHIP: 12/1000 p-y vs. 7/1000 p-y, p <0.001). There was a linear increase in RLS incidence rate with age in both studies. The persistence of RLS symptoms from baseline to follow-up was 47.4% in DHS and 41.5% in SHIP. Conclusion: The incidence rate of RLS is high, while the persistence of RLS over time is low, suggesting that RLS symptoms vary considerably. The increased RLS incidence rate among women and the elderly is consistent with previous prevalence data. [Copyright &y& Elsevier]

Background: Restless legs syndrome (RLS) is a sleep related movement disorder that occurs both in an idiopathic form and in symptomatic varieties. RLS is a frequent and distressing comorbidity in end stage renal disease (ESRD). For idiopathic RLS (iRLS), genetic risk factors have been identified, but their role in RLS in ESRD has not been investigated yet. Therefore, a case-control association study of these variants in ESRD patients was performed. Methods: The study genotyped 10 iRLS associated variants at four loci encompassing the genes MEIS1, BTBD9, MAP2K5/SKOR1, and PTPRD, in two independent case-control samples from Germany and Greece using multiplex PCR and MALDI-TOF (matrix assisted laser desorption/ionisation time-of-flight) mass spectrometry. Statistical analysis was performed as logistic regression with age and gender as covariates. For the combined analysis a Cochran-Mantel-Haenszel test was applied. Results: The study included 200 RLS-positive and 443 RLS-negative ESRD patients in the German sample, and 141 and 393 patients, respectively, in the Greek sample. In the German sample, variants in MEIS1 and BTBD9 were associated with RLS in ESRD (Pnom ⩽0.004, ORs 1.52 and 1.55), whereas, in the Greek sample, there was a trend for association to MAP2K5/SKOR1 and BTBD9 (Pnom ⩽0.08, ORs 1.41 and 1.33). In the combined analysis including all samples, BTBD9 was associated after correction for multiple testing (Pcorrected=0.0013, OR 1.47). Conclusions: This is the first demonstration of a genetic influence on RLS in ESRD patients with BTBD9 being significantly associated. The extent of the genetic predisposition could vary between different subgroups of RLS in ESRD. [ABSTRACT FROM AUTHOR]

The article presents information on a study to investigate the crosssectional prevalence of impulse control behaviours (ICBs) in restless legs syndrome (RLS) in a population in Germany. The study also aimed at determining factors associated with ICBs. The study concluded that RLS patients treated with dopaminergic agents and dopamine agonists should be warned of potential side effects.

Background: The primary characteristics of restless legs syndrome (RLS), including severe sleep disorders, restlessness in the evening and discomfort while at rest, have substantial impact on normal daily activities. Because of the high prevalence of RLS in the general population, it is necessary to evaluate the economic impact of RLS. Objective: To determine the health economic burden of patients with RLS in Germany. Methods: A total of 519 RLS patients (mean age: 65.2±11.1 years) in different stages of disease were recruited in five health centres (university hospitals, district hospitals and office-based neurologists) by applying the diagnostic criteria of the International Restless Legs Syndrome Study Group. A questionnaire was administered that assessed healthcare resource consumption as well as socioeconomic, demographic, clinical and health status. In addition, the International RLS severity scale (IRLS), Epworth Sleepiness Scale (ESS), EQ-5D and Beck Depression Inventory (BDI) were addressed in the assessment. Direct and indirect costs (€, year 2006 values) were derived from various German economic resources and calculated from the perspective of the healthcare and transfer payment providers. Results: We calculated average total costs over the 3-month observation period. It was determined that average total costs were €2090 for this period. The average direct medical and non-medical costs from the perspective of the health insurance provider were determined to be €780, with €300 attributed to drug costs and €354 to hospitalization costs. Average total indirect costs amounted to €1308 and were calculated based on productivity loss, using the human capital approach. As cost-driving factors we identified disease severity according to the IRLS (p < 0.01) and ESS (p < 0.04). Health-related quality of life was determined to be substantially affected by RLS; the mean EQ-5D visual analogue scale (VAS) was 55.6, considerably lower than that of the agematched general population. Conclusion: RLS places a notable financial burden on society as well as on patients and their families. More detailed studies are needed to evaluate the health economic impact of this disorder. [ABSTRACT FROM AUTHOR]

In the process of the Cologne Children’s Sleep Study, we assessed whether the occurrence of symptoms indicative of sleep onset and maintenance problems, daytime sleepiness, sleep disordered breathing (SDB), and restless legs syndrome (RLS) is related to an increased risk for the presence of symptoms of hyperactivity (ADHD). A total of 8,599 parents and 4th grade public school children were surveyed in a cross-sectional study concerning sleep habits, sleep problems, and environmental factors with a parental sleep questionnaire. Relative risks were calculated to examine the relationship between various sleep problems and ADHD symptoms. Frequent snoring was reported in 3.7% of the children, apneas in 0.6% and restless legs in 1.0%. Of the children, 8.9% were reported to be frequently hyperactive. Symptoms of sleep onset and maintenance problems were related to an increased risk of hyperactivity in contrast to daytime sleepiness that was not related to hyperactivity. Moreover, a significantly elevated risk for the symptom hyperactivity could be calculated for children presenting restless legs, snoring, and apneas. For apneas, however, this relationship only existed in children with moderate symptoms of hyperactivity but not in children with frequent hyperactivity. Our results clearly demonstrate that symptoms of hyperactivity are related to sleep onset and maintenance problems. In contrast, no indication was found for hyperactivity in children presenting increased daytime sleepiness. Our study results further support the hypothesis of significant correlations between ADHD, RLS, and SDB. [ABSTRACT FROM AUTHOR]

Background: Restless legs syndrome (RLS) is characterized by the desire to move the limbs associated with paresthesias of the legs, a motor restlessness, an intensification of symptoms at rest with relief by activity, and a worsening of symptoms in the evening or at night. Population-based studies are rare, and risk factors in the general population are not known. Methods: Cross-sectional survey with face-to-face interviews and physical examination among 4310 participants in the Study of Health in Pomerania in northeastern Germany. Participants were aged 20 to 79 years and were randomly selected from population registers. Restless legs syndrome was assessed with standardized, validated questions addressing the 4 minimal criteria for RLS as defined by the International Restless Legs Syndrome Study Group. Results: The overall prevalence of RLS was 10.6%, increasing with age, and women were twice as often affected as men. While nulliparous women had prevalences similar to those among men up to age 64 years, the risk of RLS increased gradually for women with 1 child (odds ratio, 1.98; 95% confidence interval, 1.25-3.13), 2 children (odds ratio, 3.04; 95% confidence interval, 2.11-4.40), and 3 or more children (odds ratio, 3.57; 95% confidence interval, 2.30-5.55). Subjects with RLS had significantly lower quality-of-life scores than those without the syndrome. Conclusions: Restless legs syndrome is a common disease in the general population, affecting women more often than men. It is associated with reduced quality of life in cross-sectional analysis. Parity is a major factor in explaining the sex difference and may guide further clarification of the etiology of the disease. [ABSTRACT FROM AUTHOR]

Restless legs syndrome (RLS) is one of the most common neurological disorders. It describes an irresistible urge to move the legs, mostly manifested in the evening and at night, which can lead to severe sleep disturbance. As part of the European Brain Council (EBC)-led Value-of-Treatment project, this study aimed at capturing the socioeconomic impact of RLS related to the inadequate diagnosis and treatment across different European healthcare settings. The economic burden of RLS was estimated using the published EBC framework of analysis in three separate European Union healthcare systems (France, Germany, and Italy). The RLS care pathway was mapped to identify the unmet needs of patients. Based on specific patient stories, the economic impact of correctly diagnosing RLS and changing between inadequate and target treatment was calculated using appropriate scenario analysis. RLS proved to be a significant personal and social burden, when epidemiological data, high prevalence of RLS, and its need for treatment are combined. By looking at the savings emerging from the provision of optimal care management (timely and correct diagnosis, evidence-based therapy, avoidance of therapy-related complications such as augmentation), the authors foresee substantial economic savings with the achievement of adequate diagnosis and treatment of RLS. Education about RLS is urgently needed for all subspecialties involved in RLS patient care as well as the general public. Equally important, the search for new causal treatment strategies should be intensified to reduce suffering and substantial societal cost., (© 2020 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Study Objectives: Periodic limb movements in sleep (PLMS) are frequent motor phenomena; however, population-based data are scarce. We assessed the prevalence of PLMS and factors associated with PLMS within two German population-based cohorts, the SHIP-TREND and BiDirect., Methods: Single-night polysomnography was performed on 1107 subjects recruited from the general population (mean age: 52.9 years, 54.1% men) in the SHIP-TREND and on 247 participants (mean age: 57.6 years, 50.6% men) in the BiDirect. PLMS were evaluated using the standard criteria of the American Academy of Sleep Medicine. Sociodemographic data, behavioral variables, medical history, current medication, and other sleep disorders were assessed., Results: The prevalence of PLMS index (PLMSI) >15/hour was 32.4% (SHIP-TREND) and 36.4% (BiDirect). In multivariable models, age (odds ratio [OR] = 1.05 per +1 year), male gender (OR = 2.20), restless legs syndrome (OR = 2.32), physical inactivity (OR = 1.52), current smoking (OR = 1.49), diabetes (OR = 2.13), antidepressant use (OR = 2.27), lower serum magnesium (OR per -0.1 mmol/L = 1.27) showed a positive, and the intake of beta-blockers an inverse association with PLMSI >15/hour in SHIP-TREND. In BiDirect, age (OR = 1.13 per +1 year), body mass index (OR = 1.11 per +1 kg/m2), and restless legs syndrome (OR = 8.77) were significantly associated with PLMSI >15/hour., Conclusions: A high PLMSI is frequent in the German population. Age, male gender, restless legs syndrome, physical inactivity, current smoking, obesity, diabetes, antidepressant use, and lower magnesium were independently associated with PLMSI >15/hour in at least one of the cohorts., (© Sleep Research Society 2018. Published by Oxford University Press [on behalf of the Sleep Research Society]. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: Previous research in clinical samples indicated a significant association between ADHD and restless legs syndrome (RLS). The present study examined the association between adult ADHD and RLS in the German population., Method: Self-rating instruments to assess RLS, childhood ADHD, and adult ADHD were administered to a community-based sample ( N = 1,632). In addition, current depression and anxiety, sleep disturbances, weight, and height were assessed by self-report., Results: Adult ADHD was associated with statistically significant increases in the odds of meeting diagnostic criteria for RLS even when adjusting for potential confounding variables such as weight (odds ratio [OR] = 3.18, 95% confidence interval [CI] = [1.29, 7.63], p< .001). However, the association did not hold true after adjusting for the presence of sleep disturbances (OR = 2.02, 95% CI = [0.82, 4.96], p = .13)., Conclusion: The findings suggest a strong link between RLS and adult ADHD symptoms. Clinicians should be aware of RLS among adult ADHD patients, especially as there might be a negative interactive effect.

Background: Restless legs syndrome (RLS) is characterized by unpleasant sensations in the legs and an uncontrollable urge to move them in order to gain relief. Higher frequencies of RLS have been reported in systemic lupus, multiple sclerosis, rheumatoid arthritis and atopic dermatitis., Objectives: Since the disease-related stress present in psoriasis is similar to the stress of those diseases, we aimed to study the frequency of RLS in a German cohort of patients with psoriasis., Methods: 300 patients with psoriasis and 300 healthy controls were evaluated for RLS symptoms in this study., Results: While 17% (n = 51) of patients with psoriasis reported symptoms of RLS, only 4% (n = 12) of individuals without psoriasis suffered from RLS symptoms (95% confidence interval: 0.08 - 0.18, p<0.01). In patients with psoriasis and RLS the average RLS score was 16.0 ± 9.2 whereas individuals with RLS in the control group had an average RLS score of 13.5 ± 7.1., Conclusions: Our findings indicate an increased frequency of RLS in patients with psoriasis, suggesting screening patients with psoriasis for the presence of RLS as a well-treatable co-morbidity.

Previous cross-sectional studies regarding the association of restless legs syndrome (RLS) with cardiovascular morbidity are controversial. Our aim was to evaluate prospectively the relationship of cardiovascular risk factors and vascular diseases with incident RLS in the general population. The results are from two prospective population-based cohort studies: the Dortmund Health Study (n = 1312, median follow-up of 2.1 years) and the Study of Health in Pomerania (n = 4308, median follow-up of 5.0 years). RLS status was assessed twice according to the minimal criteria. Diabetes, hypertension, myocardial infarction and stroke, as well as currently taken medications, were assessed as self-reports. Body mass index and serum total cholesterol were also measured. The independent risks associated with each outcome were estimated by multivariable logistic regression models adjusted for comorbidities and behavioural factors. Obesity was an independent risk factor of incident RLS in the Dortmund Health Study, and higher body mass index was an independent risk factor in both studies. Diabetes, hypertension and hypercholesterolaemia were independent predictors of incident RLS in the Study of Health in Pomerania. The vascular comorbidity index, defined by the number of concurrent cardiovascular risk factors and vascular diseases, showed a positive association with incident RLS in both studies. RLS at baseline was not a significant predictor of any subsequent cardiovascular risk factors and/or vascular diseases in any of the studies. Cardiovascular risk factors and diseases predict the subsequent development of RLS in the general population. The presence of RLS is not a significant risk factor of cardiovascular morbidity., (© 2013 European Sleep Research Society.)

Objective: Cross-sectional studies suggest a strong association between depression and restless legs syndrome (RLS); however, the temporal relationship between the two disorders remains unknown. We tested whether the presence of clinically relevant depressive symptoms (CRDS) is a risk factor for subsequent RLS in the general population. The relationship between prevalent RLS and incident CRDS was also examined., Methods: Two independent, prospective cohort studies with representative, age-stratified random samples, the Dortmund Health Study (DHS; n = 1312/1122 [baseline/follow-up], median follow-up time = 2.1 years) and the Study of Health in Pomerania (SHIP; n = 4308/3300, median follow-up time = 5.0 years) were analyzed. RLS was assessed in both studies according to the RLS minimal criteria, at baseline and at follow-up. CRDS were assessed by the Center for Epidemiologic Studies-Depression scale (a score of ≥16) in DHS only at baseline and by the Munich-Composite International Diagnostic-Screener in SHIP at baseline and at follow-up., Results: Clinically relevant depressive symptoms at baseline were associated new-onset RLS in both studies (DHS: odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.09-3.44; SHIP: OR = 2.37, 95% CI = 1.65-3.40) after adjustment for age, sex, education, body mass index, smoking, physical activity, and the presence of various comorbidities. RLS at baseline was an independent risk factor of incident CRDS in SHIP (OR = 1.82, 95% CI = 1.10-3.00)., Conclusions: The presence of CRDS may be a risk factor for subsequent RLS. The relationship between the two disorders might be bidirectional because RLS also predicts incident depressive symptoms.