When gender matters: Restless Legs Syndrome. Report of the “RLS and Woman” workshop endorsed by the European RLS Study Group

ArticleinSleep Medicine Reviews 16(4):297-307 · November 2011with24 Reads
DOI: 10.1016/j.smrv.2011.08.006 · Source: PubMed
Abstract
Sleep is an essential human behavior that shows prominent gender differences. Disturbed sleep, in particular, is much more prevalent in females than males. Restless legs syndrome (RLS) as one cause of disturbed sleep was observed to be somewhat more common among women than men in Ekbom's 1945 seminal series of clinical cases with the disease. He, however, reported this gender difference mainly for those with more severe symptoms. Since then numerous studies have reported that women are affected by RLS about twice as often as males for mild as well as moderate to severe RLS. The present review focuses on RLS in females from the perspectives of both epidemiology and pathophysiology. RLS will generally become worse or might appear for the first time during pregnancy. Parity increases the risk of RLS later in life suggesting that pregnancy is a specific behavioral risk factor for developing RLS. Some evidence suggests that dysfunction in iron metabolism and high estrogen levels might contribute to RLS during pregnancy. But, menopause does not lower the incidence of RLS nor does hormone replacement therapy lead to an increase, suggesting a quite complex uncertain role of hormones in the pathophysiology of RLS. Therefore, further, preferably longitudinal studies are needed to unravel the factors causing RLS in women. These studies should include genetic, clinical and polysomnographic variables, as well as hormonal measures and variables assessing iron metabolism.
    • "Dopaminergic medications currently are considered the treatment of choice for RLS [5,6] . In pregnancy oral (or intravenous) iron supplementation is recommended [15]. For oral supplementation, there is no evidence for any benefit on RLS. "
    Full-text · Dataset · Mar 2016 · Archives italiennes de biologie
    • "From a pathophysiological point of view, respiratory events in female subjects may be less severe, with more common partial upper-airway obstruction accounting for the differential impact on EDS (Anttalainen et al., 2007). RLS Similarly to what has been observed in relation to migraines, RLS has been associated with high estrogen levels (Manconi et al., 2012). Accordingly, it is well known that RLS is more common in women than in men (Berger et al., 2004). "
    [Show abstract] [Hide abstract] ABSTRACT: Menopause in the female life cycle is a special period due to important hormonal, physical and psychological changes. Sleep disruption represents a common complaint for midlife and menopausal women, related to primary sleep disorders, including insomnia, sleep disordered breathing, and restless legs syndrome (RLS), mood and anxiety disorder, other medical illness, hormonal-related vasomotor symptoms, and aging per se. Aims of our study were to evaluate the prevalence of sleep disorders in a sample of pre and post menopausal women, and to investigate the relationship between them and other medical disorders, and life habits. Among workers in the six participant centers, we enrolled 334 women, aged between 40 and 60 years, that completed a questionnaire included screening on menarche, menstrual cycle, fertility, parity, menopause, life habits, personal medical and sleep history and related treatment, and self-administered scales for sleep quality (PSQI), excessive daytime sleepiness [Epworth Sleepiness Scale (ESS)], mood disorder [Beck Depression Inventory (BDI)], Berlin Questionnaire for sleep disordered breathing (SDB), IRLS diagnostic interview and Rating Scale. Menopausal and perimenopausal women showed an increased prevalence of poor sleep, high risk of SDB, and mood disorder; menopausal women also reported increased RLS severity. Mood disorder had a significant impact on night sleep measures and excessive daytime sleepiness, as well as on RLS severity, and had a greater prevalence in hypertensive women. Sleep disturbances are frequent in menopausal status. Their aetiology is unclear, but probably multifactorial, and many factors contribute to the sleep disruption. Our data suggest the importance of correctly investigating and addressing sleep problems associated with menopause, through sleep history, possibly carring out a sleep study if clinically warranted. Pharmacological and behavioural treatment strategies should then be aimed to improve sleep and life quality in perimenopausal and menopausal women.
    Full-text · Article · Sep 2015
    Fabbrini MFabbrini MAricò IAricò ITramonti FTramonti F+1more author...[...]
    • "However, one of the recent studies did not find any difference between the sleep difficulties across genders, despite higher prevalence of RLS among females [66]. In addition, although hormone replacement therapy (HRT) improves vasomotor symptoms, this has not been found to influence the WED/RLS in any manner [18,59,62,67]. Considering the above facts, it may be worthwhile to systematically assess the role of HRT in the management of RLS reported by menopausal women. "
    [Show abstract] [Hide abstract] ABSTRACT: One of the core symptoms of the menopausal transition is sleep disturbance. Peri-menopausal women often complain of difficulties initiating and/or maintaining sleep with frequent nocturnal and early morning awakenings. Factors that may play a role in this type of insomnia include vasomotor symptoms, changing reproductive hormone levels, circadian rhythm abnormalities, mood disorders, coexistent medical conditions, and lifestyle. Other common sleep problems in this age group, such as obstructive sleep apnea and restless leg syndrome, can also worsen the sleep quality. Exogenous melatonin use reportedly induces drowsiness and sleep and may ameliorate sleep disturbances, including the nocturnal awakenings associated with old age and the menopausal transition. Recently, more potent melatonin analogs (selective melatonin-1 (MT1) and melatonin-2 (MT2) receptor agonists) with prolonged effects and slow-release melatonin preparations have been developed. They were found effective in increasing total sleep time and sleep efficiency as well as in reducing sleep latency in insomnia patients. The purpose of this review is to give an overview on the changes in hormonal status to sleep problems among menopausal and postmenopausal women.
    Full-text · Article · Aug 2015 · Archives italiennes de biologie
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