Sleep Disorders

Restless Legs Syndrome and Periodic Limb Movement Disorder

Clinical Characteristics
Restless legs syndrome (RLS) is a disorder that is characterized by disagreeable leg sensations that usually occur at night and cause an almost irresistible urge to move the legs. RLS is commonly associated with periodic limb movements. RLS can cause sleep-onset insomnia and/or unrefreshing sleep, resulting in excessive daytime sleepiness. There is no data about the effects of untreated RLS on performance or driving. RLS and/or PLMs have been associated with mood disturbance, notably depression.31,32,33

Periodic limb movements (PLMs) are episodes of repetitive and highly stereotyped limb movements that occur during sleep.23(p 65) PLMs, a nonspecific finding on polysomnogram, are associated with a variety of conditions, including sleep-disordered breathing, aging, and narcolepsy. Many medications, including anti-depressants, may exacerbate the condition. A majority of patients who have RLS have PLMs, but most patients who have PLMs do not have RLS. The presence of PLMs is neither necessary nor sufficient to make a diagnosis of RLS.

Diagnostic Criteria
RLS is generally a diagnosis based upon the history provided by the patient and does not need further diagnostic testing. A polysomnogram is not indicated to make the diagnosis. The URGE acronym for the four symptoms of RLS include Urge or sensation to move the legs; Rest or stillness of the legs worsens the urge to move; Going is good (movement may alleviate symptoms) and Evening or nighttime worsening of symptoms.

Treatment of RLS
Treatment of RLS is determined by severity of symptoms. Among the classes of medications that have been used are dopaminergic agents, benzodiazepine receptor agonists, anticonvulsants, and opiates. There is no indication for pharmacologic treatment of PLMs in the absence of RLS symptoms.

LEO-Specific Clinical Studies and Reports
None identified.

Fitness-for-Duty Criteria
The diagnosis of RLS or PLM, in the absence of performance issues, should not require restrictions. Medications used to treat RLS may impair alertness and should be evaluated as indicated in the Medications section of this guidance document.