Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), is a common neurological disorder affecting up to 5-10% of the population, but it still remains an underdiagnosed condition. RLS/WED is characterized by uncomfortable sensations, mainly in the legs, which appear during inactivity and worsen in the evening or at night. The prevalence of RLS/WED and periodic leg movements (PLMs) is increased in sleep-disordered-breathing patients, particularly in those with obstructive sleep apnoea (OSA), the most common sleep disorder encountered in sleep centres. New advances in the pathophysiology of RLS/WED have shown important implications for various genetic markers, neurotransmitter dysfunction, and iron deficiency. A practical approach to RLS/WED management includes an accurate diagnosis, the identification of reversible contributing factors, and the use of non-pharmacological therapies, including iron substitution (oral or intravenous) therapy. Many pharmacological agents are effective for the treatment of RLS/WED. Until recently, the first-line treatment of RLS/WED consisted of low-dose dopamine agonists (DA). However, given the fact that DA cause high rates of augmentation of symptoms, international guidelines recommend that whenever possible the initial treatment of choice should be an α2δ ligand, and the avoidance of dopaminergic agents unless absolutely necessary. If necessary, the lowest effective dose should be used for only the shortest possible period of time. The symptoms of RLS/WED can disrupt the quality of sleep as well as the quality of life. Intravenous iron therapy may be considered in patients with refractory RLS. A better understanding of RLS/WED pathophysiology will allow patients to receive tailored therapy, resulting in an improved quality of life.

中文翻译：

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不安腿综合征病理生理学和不良后果的新兴概念

不宁腿综合征 (RLS)，也称为 Willis-Ekbom 病 (WED)，是一种常见的神经系统疾病，影响多达 5-10% 的人口，但它仍然是一种未被确诊的疾病。RLS/WED 的特点是不舒服的感觉，主要出现在腿部，在不活动时出现，并在晚上或夜间恶化。RLS/WED 和周期性腿部运动 (PLM) 的患病率在睡眠呼吸障碍患者中有所增加，特别是在患有阻塞性睡眠呼吸暂停 (OSA) 的患者中，这是睡眠中心最常见的睡眠障碍。RLS/WED 病理生理学的新进展已显示出对各种遗传标记、神经递质功能障碍和缺铁的重要影响。RLS/WED 管理的实用方法包括准确的诊断、确定可逆的促成因素，以及使用非药物疗法，包括铁替代（口服或静脉）疗法。许多药剂对治疗 RLS/WED 有效。直到最近，RLS/WED 的一线治疗还包括低剂量多巴胺激动剂 (DA)。然而，鉴于 DA 会导致症状的高增加率，国际指南建议尽可能选择α2δ 配体作为初始治疗，除非绝对必要，否则应避免使用多巴胺能药物。如有必要，最低有效剂量应仅在尽可能短的时间内使用。RLS/WED 的症状会破坏睡眠质量和生活质量。难治性 RLS 患者可考虑静脉补铁。