Restless legs syndrome (RLS) affects ~3% of U.S. adults to a clinically significant extent, and risk is higher with family history, older age (10% prevalence in adults ≥65), and female sex (2:1 vs male). This clinical review notes RLS is also associated with elevated cardiovascular disease rates (29.6% with coronary artery disease, stroke, or heart failure) and is diagnosed clinically—polysomnography isn’t recommended.

Why It Matters To Your Practice

• RLS commonly disrupts sleep (sleep onset and maintenance insomnia), impairing quality of life and functioning.

• High comorbidity burden is common (e.g., depression 30.4%; cardiovascular disease 29.6%), so screening can uncover broader risk—including heart disease.

• RLS is prevalent in several high-risk groups you may routinely see: pregnancy (22%, especially 3rd trimester), end-stage kidney disease (24%), iron deficiency anemia (23.9%), peripheral neuropathy (21.5%), Parkinson disease (20%), and multiple sclerosis (27.5%).

Clinical Benefits

• Diagnosis is history-based (urge to move, worse at rest, relief with movement, evening/night predominance), helping avoid unnecessary sleep testing.

• Addressing reversible drivers can reduce symptoms quickly: stop/replace triggering meds and correct low-normal iron indices.

• If pharmacotherapy is needed, gabapentinoids are first-line; randomized trials show ~70% “much/very much improved” vs ~40% with placebo.

Managing Risks

• Check iron indices and treat when ferritin ≤100 ng/mL or transferrin saturation <20%: oral ferrous sulfate 325–650 mg daily or every other day, or IV iron 1000 mg when indicated.

• Review and deprescribe/avoid common exacerbators when possible: serotonergic antidepressants, dopamine antagonists, and centrally acting H1 antihistamines (e.g., diphenhydramine).

• Assess comorbid conditions and contributors that raise RLS likelihood and symptom burden (kidney disease, neuropathy/diabetes, pregnancy, neurologic disease), and coordinate care accordingly.

The Bottom Line

• Think RLS in patients with insomnia plus an evening-predominant urge to move—especially with family history, older age, or female sex.

• Diagnose clinically (no routine polysomnography), correct iron deficiency/low-normal stores, remove offending meds, and use gabapentinoids first-line when medication is warranted.