Summary
Definition
History and exam
Key diagnostic factors
- poor sleep
- daytime somnolence and fatigue
- periodic limb movements (mostly legs)
Other diagnostic factors
- age >70 years
- re-enactment of dreams during the night
- irresistible urge to move legs, and abnormal sensations in lower limbs
- snoring
- early-morning dry mouth
- headache
- elevated body mass index
- withdrawal from benzodiazepines or barbiturates
- history of neuroleptic medication
- history of dopaminergic medication
- pallor
- iron deficiency
- diabetes mellitus
- spinal cord injury
- episodes of sudden onset of sleep during the day; may or may not be associated with loss of muscle tone
Diagnostic investigations
1st investigations to order
- polysomnography: electromyography (EMG) evaluation of limb movements
- polysomnography: EEG evaluation
- polysomnography: assessment of sleep-disordered breathing
- CBC
- serum ferritin
- BUN
- Epworth Sleepiness Scale
Treatment algorithm
Contributors
Authors
Neurology Registrar
Department of Clinical Neurosciences
Western General Hospital
Edinburgh
UK
Disclosures
TS has been reimbursed for travel and attendance to the Multiple Sclerosis Academy MasterClass by Biogen.

Consultant Neurologist and Honorary Senior Lecturer
Department of Clinical Neurosciences
Western General Hospital
Edinburgh
UK
Disclosures
SP declares that he has no competing interests.

Consultant Neurologist and Honorary Senior Lecturer
Department of Clinical Neurosciences
Western General Hospital
Edinburgh
UK
Disclosures
RD declares that he has no competing interests.
Peer reviewers
Consultant Neurologist
James Cook University Hospital
Middlesbrough
UK
Disclosures
PR declares that he has no competing interests.
Director
Sleep Disorders Center
Thomas Jefferson University Hospital
Philadelphia
PA
Disclosures
KD is a speaker for Sanofi-Aventis, King Pharmaceuticals, Takeda Pharmaceuticals, Sepracor, and Pfizer; a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, Sepracor, Pfizer, and Neurocrine Biosciences; and has stock in Merck.
Consultant Neurologist
Department of Neurology
Freeman Hospital
Newcastle upon Tyne
UK
Disclosures
KA declares that she has no competing interests.
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