What is the management approach for RESLEG (Rapid Eye Movement Sleep Leg) syndrome?

From the Guidelines

The management approach for RESLEG (Rapid Eye Movement Sleep Leg) syndrome, also known as Restless Legs Syndrome (RLS), primarily involves the use of ferrous sulfate, dipyridamole, extended-release oxycodone, and bilateral high-frequency peroneal nerve stimulation, as suggested by the American Academy of Sleep Medicine (AASM) in their 2025 clinical practice guideline 1.

Key Recommendations

• The AASM suggests the use of ferrous sulfate over no ferrous sulfate in patients with appropriate iron status (conditional recommendation, moderate certainty of evidence) 1.
• The use of dipyridamole is also suggested over no dipyridamole (conditional recommendation, low certainty of evidence) 1.
• Extended-release oxycodone and other opioids are recommended over no opioids (conditional recommendation, moderate certainty of evidence) 1.
• Bilateral high-frequency peroneal nerve stimulation is suggested over no peroneal nerve stimulation (conditional recommendation, moderate certainty of evidence) 1.

Medications to Avoid

• The AASM suggests against the standard use of levodopa, pramipexole, transdermal rotigotine, and ropinirole due to the risk of augmentation and other adverse effects (conditional recommendation, varying levels of certainty of evidence) 1.
• Other medications to avoid include bupropion, carbamazepine, clonazepam, valproic acid, and cabergoline (conditional recommendation, varying levels of certainty of evidence) 1.

Special Considerations

• In adults with RLS and end-stage renal disease (ESRD), the AASM suggests the use of gabapentin, IV iron sucrose, and vitamin C (conditional recommendation, varying levels of certainty of evidence) 1.
• In children with RLS, the use of ferrous sulfate is suggested over no ferrous sulfate in patients with appropriate iron status (conditional recommendation, very low certainty of evidence) 1.

From the Research

Management Approach for RESLEG (Rapid Eye Movement Sleep Leg) Syndrome

It appears that the term "RESLEG" is not a recognized medical term, and the provided studies focus on Restless Legs Syndrome (RLS). Assuming the user is referring to RLS, here are the management approaches:

• Non-pharmacological measures: Some people with RLS have adequate symptom control with non-pharmacological measures such as massage or temperate baths 2.
• First-line management options:
  • Iron-replacement therapy in those with evidence for reduced body-iron stores 2, 3.
  • Gabapentin or pregabalin 2, 3.
  • Dopamine agonists such as pramipexole, ropinirole, and rotigotine 2, 3, 4.
• Second-line therapies:
  • Intravenous iron infusion in those who are intolerant of oral iron and/or those having augmentation with intense, severe RLS symptoms 2, 3.
  • Opioids including tramadol, oxycodone, and methadone 2, 3, 5.

Special Considerations

• Augmentation: A significant long-term treatment complication for pramipexole and possibly for all dopaminergic agents more than α2δ ligands, requiring special monitoring 3, 4.
• Opioid use: May be life-transforming with a favorable risk-benefit ratio in selected patients with refractory RLS, but requires sensible precautions such as assessing opioid risk and frequent reevaluation of effectiveness and side effects 5.