ORIGINAL ARTICLE Clinical presentation of restless legs syndrome: Does the gender matter? Ravi GUPTA, 1,2 Sohaib AHMAD, 3 Minakshi DHAR, 3 Deepak GOEL 2,4 and Vivekananda LAHAN 1,2 Departments of 1 Psychiatry, 3 Medicine, 4 Neurology and 2 Sleep Clinic, Himalayan Institute of Medical Sciences, Dehradun, India Abstract This study was conducted to find out whether higher prevalence of females among restless legs syndrome (RLS) patients in a clinical setting is related to clinical presentation and co-morbid conditions. A total of 173 consecutive patients with idiopathic RLS were included in this study after obtaining permission from the institutional ethics committee. Their demographic data, history of RLS, associated sleep problems and family history were gathered. Severity of RLS was also measured with the help of IRLS. Results have shown that out of 173 subjects, 29.6% were males. Male subjects in this study were nearly 4 years older than females (P = 0.04). Symptoms were experienced in both legs in all subjects except 3% of females who reported involvement of one leg. Some of the patients reported symptoms in other parts of body as well! 27.5% of males and 33.6% of females reported involvement of other parts of body in addition to the legs (χ 2 = 0.62; P = 0.27). Explanations of sensory symptoms e.g., “tingling”, “restlessness”, “tickling” were two times more common in females while males reported “pricking”, “just pain” and “stretching” twice as commonly as females. Severity of RLS did not differ between groups (χ 2 = 1.51; P = 0.67). Similarly, sleep problems were comparable across genders (88.2% males vs. 93.4% females; χ 2 = 1.31; P = 0.25). Family history was comparable across genders. In conclusion, clinical presentation of RLS did not differ across genders. The observed female predominance in the RLS is not related to clinical presentation. Key words: gender, prevalence, restless legs syndrome, symptoms. INTRODUCTION Restless legs syndrome (RLS) is the most common nervous system related sleep disorder. 1 However, it is frequently missed or mistaken for other disorders leading to a delay in the treatment initiation. 2 Gender plays a role in the occurrence of RLS and it has been described to occur more commonly in females as com- pared to males. 3,4 A recent review suggests that RLS is approximately two times more common in females as compared to males. 5 Population based studies have found that the preva- lence of the RLS varies across gender. Some of the studies have reported a female preponderance, while others have failed to find it. 6–8 Similarly, the prevalence of RLS varied across studies and this could be related to difference in methodologies. 8,9 The prevalence of RLS has been found to be higher in clinic-based samples as compared to epidemiological studies. 9 A number of reasons might explain the higher preva- lence of RLS among females. One possibility is that females are biologically predisposed to RLS by virtue of their hormones or status of iron stores in the substantia Correspondence: Dr Ravi Gupta, Associate Professor, Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, Dehradun 248140, India. Email: sleepdoc.ravi@gmail.com Conflict of interest: None to disclose. Accepted 17 March 2014. Sleep and Biological Rhythms 2014; 12: 180–186 doi:10.1111/sbr.12059 180 © 2014 The Authors Sleep and Biological Rhythms © 2014 Japanese Society of Sleep Research