Validation of the restless legs syndrome screening questionnaire (RLSSQ) (original) (raw)
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Movement Disorders, 2007
Restless legs syndrome (RLS) is a clinical diagnosis based primarily on self-reports of individuals. The International RLS Study Group has published diagnostic criteria that are essential for an operational diagnosis of RLS; further clinical features are considered by the group supportive for or associated with RLS. However, sensitivity and specificity are not perfect and "mimics" of RLS have been reported, i.e., other conditions like nocturnal cramps sometimes can appear to fulfill the essential diagnostic criteria indicating the need for more thorough understanding of the diagnostic criteria and better differential diagnoses. To contribute to the accuracy of diagnostic processes in RLS, we recapitulate the definition of RLS as an urge to move focused on the legs (and arms in some patients). This urge to move often but not always occurs together with dysesthesia, i.e. unpleasant abnormal sensations appearing without any apparent sensory stimulation. The urge to move and any accompanying dysesthesia must be engendered by rest, relieved by movement and worse in the evening or night. Succinctly, RLS can be summarized in medical terminology as a "movement-responsive quiescegenic nocturnal focal akathisia usually with dysesthesias." Empirical approaches to investigate the independence of the essential criteria "worsening at night" and "worsening at rest" are reported. Possible differential diagnoses of RLS are discussed under the perspective of the NIH diagnostic criteria of RLS. Standardized methods to assess a RLS diagnosis are presented which might improve differential diagnosis and in general the reliability and validity of RLS diagnosis.
Sleep Medicine, 2009
Background and purpose: Epidemiological studies of restless legs syndrome (RLS) have been limited by lack of a well validated patient-completed diagnostic questionnaire that has a high enough specificity to provide a reasonable positive predictive value. Most of the currently used patient completed diagnostic questionnaires have neither been validated nor included items facilitating the differential diagnosis of RLS from conditions producing similar symptoms. The Cambridge-Hopkins diagnostic questionnaire for RLS (CH-RLSq) was developed with several iterations to include items covering the basic diagnostic features of RLS and to provide some basic differential diagnosis. This validation study sought to determine the sensitivity and specificity of the RLS diagnosis based on this questionnaire. Patients and methods: The CH-RLSq was completed by 2005 blood donors who were asked to consent to being contacted for a telephone diagnostic interview. A scoring criterion was established for ascertainment of RLS based on the clinical definition of the disorder and the exclusion of ''mimic" conditions. A weighted sample (N = 185) of all completed questionnaires was selected for expert clinical diagnosis of RLS using the validated Hopkins Telephone Diagnostic Interview (HDTI). The telephone interviewers were blinded to all questionnaire responses. Results: A telephone diagnosis was obtained on 183 of the sample's 185 questionnaires. The questionnaire's normalized sensitivity and specificity were 87.2% and 94.4%, respectively, for RLS compared to not RLS. The positive predictive values in this sample were 85.5%. Conclusions: The Cambridge-Hopkins RLS questionnaire provides a reasonable level of sensitivity and specificity for ascertainment of RLS in population-based studies.
Refining duration and frequency thresholds of restless legs syndrome diagnosis criteria
Neurology, 2016
Objective: This study assesses the prevalence of restless legs syndrome (RLS) using DSM-5 criteria and determines what is the most appropriate threshold for the frequency and duration of RLS symptoms. Methods: The Sleep-EVAL knowledge base system queried the interviewed subjects on life, sleeping habits, and health. Questions on sleep and mental and organic disorders (DSM-5, ICD-10) were also asked. A representative sample of 19,136 noninstitutionalized individuals older than 18 years living in the United States was interviewed through a cross-sectional telephone survey. The participation rate was 83.2%. Results: The prevalence of the 4 leg symptoms describing RLS occurring at least 1 d/wk varied between 5.7% and 12.3%. When the frequency was set to at least 3 d/wk, the prevalence dropped and varied between 1.8% and 4.5% for the 4 leg symptoms. Higher frequency of leg symptoms was associated with greater distress and impairment with a marked increase at 3 d/wk. Symptoms were mostly chronic, lasting for more than 3 months in about 97% of the cases. The prevalence of RLS according to DSM-5 was 1.6% (95% confidence interval 1.4%-1.8%) when frequency was set at 3 d/wk. Stricter criteria for frequency of restless legs symptoms resulted in a reduction of prevalence of the disorder. The prevalence was further reduced when clinical impact was taken into consideration. Conclusions: In order to avoid inflation of case rates and to identify patients in whom treatment is truly warranted, using a more conservative threshold of 3 times or greater per week appears the most appropriate. Neurology ® 2016;87:1-8 GLOSSARY DSM-5 5 Diagnostic and Statistical Manual of Mental Disorders, 5th edition; ICSD-3 5 International Classification of Sleep Disorders, third edition; IRLSSG 5 International Restless Legs Syndrome Study Group; OR 5 odds ratio; RL 5 restless legs; RLS 5 restless legs syndrome. Restless legs syndrome (RLS) was first described by Thomas Willis in 1685 1 and named by Karl Axel Ekbom in 1945. 2 RLS is characterized by a desire to move the legs or arms, usually associated with uncomfortable sensations such as creeping, crawling, tingling, or itching. Symptoms worsen in the evening or night and while lying down or sitting. Activity such as walking provides at least partial or temporary relief. RLS can result in substantial sleep disruption, including delayed sleep onset and awakenings, and significant fatigue. Genetic studies suggest that pathophysiologic pathways subserve RLS. 3-6 The initial set of diagnostic criteria (1995) of the International Restless Legs Syndrome Study Group (IRLSSG) 7 were revised in 2002 8 by recommending a 3 or 4 minimum question set to encourage their inclusion in large studies. 9 Using IRLSSG criteria, the prevalence ranged from 3.9% to 14.3%. 10 The DSM-5 11 worked with the International Classification of Sleep Disorders, third edition (ICSD-3) 12 to identify RLS as an independent sleep disorder regardless of mental or medical disorders. 13 The updated classifications (table e-1 at Neurology.org) share
European Journal of Neurology, 2007
The purposes of this study were to validate the use of a single standard question for the rapid screening of restless legs syndrome (RLS) and to analyze the eventual effects of the presence of RLS on self-assessed daytime sleepiness, global clinical severity and cognitive functioning. We evaluated a group of 521 consecutive patients who accessed our neurology clinic for different reasons. Beside the answer to the single question and age, sex, and clinical diagnosis, the following items were collected from all patients and normal controls: the four criteria for RLS, the Epworth Sleepiness Scale (ESS), the Clinical Global Impression of Severity (CGI-S), and the Mini-Mental State evaluation. RLS was found in 112 patients (70 idiopathic). The single question had 100% sensitivity and 96.8% specificity for the diagnosis of RLS. ESS and CGI-S were significantly higher in both RLS patient groups than in normal controls. RLS severity was significantly higher in idiopathic than in associated/symptomatic RLS patients. RLS can be screened with high sensitivity and good reliability in large patient groups by means of the single question; however, the final diagnosis should always be confirmed by the diagnostic features of RLS and accompanied by a careful search for comorbid conditions.
Sleep Medicine, 2003
Background: There is a need for an easily administered instrument which can be applied to all patients with restless legs syndrome (RLS) to measure disease severity for clinical assessment, research, or therapeutic trials. The pathophysiology of RLS is not clear and no objective measure so far devised can apply to all patients or accurately reflect severity. Moreover, RLS is primarily a subjective disorder. Therefore, a subjective scale is at present the optimal instrument to meet this need. Methods: Twenty centers from six countries participated in an initial reliability and validation study of a rating scale for the severity of RLS designed by the International RLS study group (IRLSSG). A ten-question scale was developed on the basis of repeated expert evaluation of potential items. This scale, the IRLSSG rating scale (IRLS), was administered to 196 RLS patients, most on some medication, and 209 control subjects. Results: The IRLS was found to have high levels of internal consistency, inter-examiner reliability, test-retest reliability over a 2-4 week period, and convergent validity. It also demonstrated criterion validity when tested against the current criterion of a clinical global impression and readily discriminated patient from control groups. The scale was dominated by a single severity factor that explained at least 59% of the pooled item variance. Conclusions: This scale meets performance criteria for a brief, patient completed instrument that can be used to assess RLS severity for purposes of clinical assessment, research, or therapeutic trials. It supports a finding that RLS is a relatively uniform disorder in which the severity of the basic symptoms is strongly related to their impact on the patient's life. In future studies, the IRLS should be tested against objective measures of RLS severity and its sensitivity should be studied as RLS severity is systematically manipulated by therapeutic interventions.
Childhood and adult factors associated with restless legs syndrome (RLS) diagnosis
Sleep Medicine, 2007
Background and purpose: RLS appears to be caused by a complex interaction of genetic and environmental factors. This study sought to identify some environmental risk factors significantly associated with the occurrence of RLS. Patients and methods: Three adult behaviors and 10 childhood factors potentially related to development of RLS were evaluated for significant association with the occurrence of RLS in a large case-controlled family history study. All available family members of the probands in this study were evaluated for RLS using a validated diagnostic telephone interview that included a background questionnaire covering factors potentially associated with the development of RLS. Where possible, the mothers of the subjects were also interviewed regarding developmental factors that might affect the child's health and perhaps occurrence of RLS. All family members with a definite diagnosis of RLS or Not-RLS were included in the study. Of a total of 973 participants, 262 (27%) had RLS and 711 did not. Results: An odds ratio (OR) with 95% confidence limits (CI) was calculated for the relationship of each factor to RLS diagnosis. Restless sleep in childhood was associated with an increased risk of developing RLS later in life for both men (OR = 2.64; 95% CI: 1.31-5.29) and women (OR = 2.54; 95% CI: 1.41-4.59). Blood donation was also significantly associated with an increased risk of developing RLS among men only (OR = 1.99; 95% CI: 1.10-3.58), which was more pronounced for those donating blood more than the median number of donations for this group of five (OR = 2.3, 95% CI: 1. 16-4.43). No other factor was significantly associated with the occurrence of RLS. Conclusions: This is the first case-controlled study that demonstrates a significant association between blood donation and the occurrence of RLS in males. The association was most significant for those men donating five or more times. Smoking and alcohol use were not related to the occurrence of RLS. Neither childhood growing pains nor attention-deficit hyperactivity disorder (ADHD) was related to RLS. The only consistent factor found related to prevalence of RLS for both men and women was the report of 'restless sleep' in childhood.