Poor Pregnancy Sleep Quality Linked to Untreated RLS

A good night’s sleep can be elusive during pregnancy. But women — and their physicians — shouldn’t dismiss the symptoms of poor sleep as typical pregnancy complaints. Nor should they assume the problem can’t be fixed just because many medications are off-limits during pregnancy.

That’s according to a new study in the Journal of Clinical Sleep Medicine  by a team led by IHPI member Louise O'Brien, Ph.D., a research associate professor of neurology and obstetrics and gynecology at U-M. The research confirms a higher burden of restless leg syndrome among pregnant women. O'Brien and colleagues, including lead author and postdoctoral research fellow Galit Dunietz, Ph.D., MPH,  report that more than a quarter of pregnant women with RLS had severe RLS symptoms, which are strongly related to poor sleep quality.

“A lot of the time when women report or experience sleep issues, they attribute those symptoms to the pregnancy,” says Dunietz, who works with U-M's Sleep Disorders Center. “However, we report RLS may be an additional contributor to these symptoms. With RLS as a predictor, we may be able to alleviate some of the sleep disturbances by treating RLS.”

RLS, a neurological condition with symptoms including uncomfortable or unpleasant tickling or twitching in the legs, is also associated with excessive daytime sleepiness and poor daytime function.

“The more severe the RLS is, the more likely you are to have sleep disturbances during pregnancy,” Dunietz says. “The observed positive dose-response relationship between frequency of RLS symptoms and sleep disturbances is a unique feature of this study.”

This sheds a light on a topic to address in prenatal care, Dunietz says.

‘Opportunity for clinicians’

Researchers already knew RLS during pregnancy is more frequent than for the general population, with prevalence estimates of up to a third in pregnancy compared with 5 percent in the general worldwide population.

But the extent to which RLS affected pregnant women with RLS is surprising, the authors say. The research team, also including IHPI member Lynda Lisabeth, Ph.D., M.P.H. from U-M’s School of Public Health and departments of Statistics, Anesthesiology, and Obstetrics and Gynecology, studied 1,563 women who were in their third trimesters of pregnancy between March 2007 and December 2010. Thirty-six percent of the women had RLS, and half of those with RLS had moderate to severe symptoms, meaning symptoms appeared more than four times a week.

“This is a good opportunity for clinicians to screen their pregnant patients for RLS,” Dunietz says. “While all sleep disturbances during pregnancy may not be avoidable, clinicians can pursue a nonpharmacological treatment of RLS to help pregnant women feel less sleepy during the day.”

No association with delivery outcomes

The study, the largest to date that investigates RLS in pregnant women in the U.S. using standard diagnostic criteria, found no evidence of an association between RLS and delivery outcomes, including cesarean section delivery and mean birth weight. Although RLS has the largest effect during the third trimester, it usually subsides after delivery, Dunietz says.

Typical treatments include moderate exercise; massage; hot baths; compression devices; elimination of caffeine, alcohol and tobacco; and pharmacological therapies, such as over-the-counter pain medication. Iron supplements may also be a good idea for some pregnant women.

The causes of RLS are not fully known, though a genetic component plays a part. In addition to pregnancy, RLS is associated with Parkinson’s disease, diabetes mellitus, anemia and kidney failure.