Screening for Iron Deficiency in Restless Leg Syndrome Open Access

Abstract

Restless Legs Syndrome (RLS) is a sensorimotor neurological disorder primarily manifesting in the lower limbs in at least 5% of adult Americans that is associated with significant disability and increased risk for cardiovascular disease. Altered iron homeostatic mechanisms appear to play a key role in the underlying pathology of RLS. A high prevalence of iron deficiency has been found among patients with RLS and treatment of the deficiency has been reported to improve or ameliorate symptoms. A low serum ferritin level (less than 50 μg/L) has been associated with greater
severity of RLS and with a reduction in sleep. Iron deficiency is a recognizable and reversible state that appears to modulate expression of RLS in a proportion of individuals with RLS. Despite the high prevalence of iron deficiency amongst subjects seeking treatment, there is still little data
to go on to guide one's selection of patients deserving of iron testing, which test to rely upon, and who might benefit from iron treatment. Using data collected from a population based genetic study of RLS in Iceland; this analysis examines potential screens constructed from RLS signs and
symptoms to develop a simple, observational screening algorithm that can aid clinicians in the management of RLS patients. A combination of sensitivity/specificity analyses and regression analyses were performed on the data set. A superior screen of testing all RLS subjects was
dominant against other strategies identified. Test all strategies are highly sensitive to the derivation of estimated costs and are difficult to demonstrate medical utility. With that the second most dominant screen identified included test all with a history of anemia and test only women
under 45 for those without a history of anemia.

Table of Contents

Introduction ................................................................................................................................. 11
Research Question .................................................................................................................... 12
Literature Review ........................................................................................................................ 13
Epidemiology ............................................................................................................................ 14
RLS and Iron ............................................................................................................................. 14
RLS and Iron - Supporting Evidence.................................................................................... 15
RLS and Iron - Opposing Evidence ...................................................................................... 17
Genetic Studies ..................................................................................................................... 19
Methods ........................................................................................................................................ 21
Study Population ....................................................................................................................... 21
Sample Population- RLS Diagnosis .......................................................................................... 21
Variables ................................................................................................................................... 22
Dependent Variable .............................................................................................................. 22
Data Analysis ............................................................................................................................ 29
Missing Data ............................................................................................................................. 30
Multiple Imputations ............................................................................................................. 30
Logistic Regression Analysis ................................................................................................ 30
Sensitivity, Specificity, PV+, PV-, FPR, FNR, Analysis with Cost Consideration ............... 33
Results........................................................................................................................................... 37

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Restless Legs Syndrome Algorithm Ferritin Iron Deficiency Periodic Limb Movements PLMs RLS
Committee Chair / Thesis Advisor	Rask, Kimberly J, Emory University
Committee Members	Gaydos, Laura, Emory University Trotti, Lynn Marie, Emory University Rye, David, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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