WebMD Medical News
Louise Chang, MD
Jan. 4, 2010 -- Older men with restless legs syndrome may have an increased
risk for erectile dysfunction (ED), new research from Boston's Harvard Medical
School and Brigham and Women's Hospital suggests.
Men in the study who most often experienced symptoms of restless legs
syndrome (RLS) were the most likely to also report problems getting and
The finding does not prove that RLS causes ED, but it raises the possibility
that the two conditions share one or more common causes, study researcher Xiang
Gao, MD, PhD, tells WebMD.
"This is the first study to look at this, so there is still a lot we don't
know," he says, adding that the next step would be to follow older men to see
if those with RLS have a higher risk for developing ED, or vice versa.
It is estimated that around 12 million Americans have restless legs
syndrome. The numbers may be much higher, however, because the condition is
believed to be both underdiagnosed and frequently misdiagnosed.
RLS is characterized by an uncontrollable urge to move the legs when at rest
in an effort to relieve unpleasant sensations often described as feelings of
burning, tugging, pins and needles, or the feeling that insects are crawling
inside the legs.
It affects both men and women, and the most severe cases tend to occur in
people who are middle-aged or older.
In an earlier analysis, Gao and colleagues reported that men with erectile
dysfunction were four times as likely to develop Parkinson's disease over 16
years of follow-up as men without ED.
Because Parkinson's and restless legs syndrome are both neurological
movement disorders, the researchers decided to study RLS and ED.
The analysis included more than 23,000 men enrolled in the Health
Professionals Follow-up study, which is a large, ongoing study of male
dentists, optometrists, osteopaths, podiatrists, pharmacists, and
In a 2002 survey, about 4% of the men reported having a diagnosis of RLS and
41% reported having erectile dysfunction.
Not surprisingly, the prevalence of both RLS and ED increased with age.
Men with RLS who had five to 14 restless leg episodes a month were 16% more
likely to report ED than men without RLS; men with 15 or more RLS-related
episodes a month were 78% more likely to report having problems getting or
maintaining an erection.
The study appears in the January issue of the American Academy of Sleep
Medicine journal Sleep.
If RLS and ED are related, the chemical dopamine, which helps regulate both
movement and mood, may be the common link.
A shortage of natural dopamine in the brain is believed to play a role in
Parkinson's disease and restless legs syndrome; drugs that activate brain
receptors that produce dopamine are used to treat both conditions.
Low dopamine levels are also thought to be a contributing factor in erectile
Another potential explanation for the observed association may be lack of
People with RLS commonly experience sleep deprivation due to their
involuntary nighttime limb movements, and sleep deprivation is known to
decrease circulating testosterone levels, which can lead to ED.
"Anything that disrupts sleep can cause ED," says David Schulman, MD, MPH,
who directs the Emory Sleep Disorders Laboratory in Atlanta. "I don't think it
is possible in a study like this one to adjust for that."
Schulman says more study is needed to determine if restless legs syndrome
and erectile dysfunction share a common cause.
"I don't look at this as something that will change the way I or anyone else
practices medicine right now," he says.
SOURCES:Gao, X. Sleep, Jan. 1, 2010; vol 33: pp 75-79.Xiang Gao, MD, PhD, instructor in medicine, Harvard Medical School;
associate epidemiologist, Brigham and Women's Hospital; research scientist,
Harvard School of Public Health.David Schulman, MD, director, Emory Sleep Disorders Laboratory, Emory
University, Atlanta.National Institute of Neurological Disorders and Stroke: "Restless Leg
Syndrome Fact Sheet."Gao, X. American Journal of Epidemiology, Sept. 17, 2007; vol 166: pp
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