Partial endorsement of "Treatment of restless legs syndrome and periodic limb movement disorder: an AmericanAcademy ofSleep Medicine clinical practice guideline" by the World Sleep Society.

BACKGROUND

The 2025 American Academy of Sleep Medicine (AASM) clinical practice guideline for the treatment of Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) provides updated, evidence-based recommendations. The World Sleep Society (WSS) conducted an international review to assess the guideline's global applicability and implementation feasibility.

METHODS

A structured questionnaire was distributed to representatives of 53 national sleep societies affiliated with the WSS. The survey addressed guideline familiarity, perceived applicability, agreement with 20 treatment recommendations, and availability of key therapies. Responses were analyzed using descriptive statistics and the within-group interrater agreement coefficient (rWG) to assess consensus levels.

RESULTS

Twenty-three national societies (43.9 %) from all inhabited continents responded. The AASM guideline was perceived as fully or partially applicable in most countries. Twelve recommendations were fully supported by the WSS, five partially supported, two (regarding dopamine agonists) endorsed with caveats, and one (dipyridamole) not supported. Key barriers included limited access to certain medications (e.g., IV iron, gabapentin enacarbil), regulatory restrictions, and divergent treatment traditions. There was strong global consensus on discouraging ineffective or harmful treatments (e.g., cabergoline, valproic acid), while the avoidance of dopaminergic agents generated regional disagreement.

CONCLUSIONS

The AASM guidelines received broad international support but require region-specific adaptation for optimal implementation. The WSS endorses the guideline's structure and scientific foundation while recommending flexible dissemination strategies and greater clarity in therapeutic algorithms. These findings support the development of globally relevant, context-sensitive guidance in sleep medicine.