Restless Leg Syndrome & Chronic Venous Disorders

McDonagh B^*, King T+, Guptan RC++ ^*Illinois Phlebology group; + Indiana Phlebology; ++The Department of Clinical Research, Venous Research Foundation, Schaumburg, IL, USA.

Objectives:To perform a prospective study of the occurrence of Restless Legs Syndrome (SLS) in patients who are evaluated in a phlebology practice.

Methods: A prospective questionnaire and clinical evaluation were used. In total, 174 consecutive patients and 174 matched controls were included in the study. The International RLS Study Group (IRLSSG) 4-point criteria were used to objectively establish the diagnosis of RLS. The symptom severity of those who had RLS was assessed with the 10-point IRLSSG severity questionnaire. Detailed history, physical, and Duplex ultrasound evaluations were performed to establish the presence or absence of venous insufficiency (reflux > 0.5 seconds on compression/augmentation) and chronic venous disorder (CVD), according to current clinical, etiologic, anatomic, and pathologic (CEAP) criteria.

Results: Of the 174 consecutive patients studied (22M: 152F), 63 (36%) met the clinical criteria for having RLS. This compared with only 34 of 174 (19%) in the control group (P<0.05). In the RLS-positive study group, 62 of 63 (98%) were found to have venous insufficiency and CVD. By comparison, 31 of 34 (91%) of the RLS-positive control group were found to have CVD. Thus, the prevalence of CVD in both the RLS-positive study and control groups was similar; however, this was significantly more than the prevalence of CVD in the RLS-negative controls (P<0.01). There were only 3 (9%) of the RLS-negative controls who had CVD. RLS-positive patients were typically women (P<0.01 vs. men) who were more than 40 years of age (P<0.01 vs. less than 40). It should be noted that a history of leg cramps was significantly more common in the RLS-positive patients (P<0.01). It should also be noted that none of the RLS patients gave a history of anemia, chronic renal failure, or had an established psychiatric or neurologic disorder that others have described as being highly associated with the diagnosis of RLS.

Conclusion: RLS appears to be a clinical syndrome that commonly overlaps in patients with venous insufficiency and CVD. Prospective, blinded therapeutic trials are underway to evaluate the effect of definitive treatment for CVD on sequential RLS scores.

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