Visual abstract

Introduction

Willis-Ekbom disease, commonly called Restless Legs Syndrome (RLS), is a chronic neurological disorder. Its primary symptom is an irresistible urge to move the legs, which is usually accompanied by uncomfortable sensations, especially during periods of rest or inactivity, often worsening in the evening or through night, and partially or wholly relieved by movement [1,2]. RLS impacts 5–10% of the population, with higher rates observed in older adults, pregnant women, and people with an iron deficiency [3,4]. RLS symptoms significantly impair sleep quality, daytime functioning, mood, and overall quality of life [5,6]. People with RLS are also at a higher risk of depression [7], suicide and self-harm [8], and cardiovascular diseases [9]. In 2016, due to its high prevalence and significant impact on individuals and society, the estimated economic impact of RLS in France, Germany and Italy was €20,188.68 [10].

There are concerns about the long-term treatment side effects (e.g., augmentation syndrome) of conventional interventions for RLS, namely dopaminergic agents (e.g., levodopa, dopamine agonists), anticonvulsants [10], and iron supplementation [11]. Augmentation syndrome (i.e., iatrogenic aggravation of RLS symptoms) and impulse-control disorders are the main concerns regarding the use of dopaminergic agents, in addition to nausea, and somnolence [12]. Anticonvulsant medications, such as pregabalin and gabapentin, can cause somnolence, dizziness, and unsteadiness [10]. Oral iron supplementation is not always tolerated by patients due to symptoms of gastrointestinal discomfort [13], and intravenous iron supplementation is associated with potentially life-threatening allergic reactions, and hypophosphatemia [14]. In addition, around 40% of people with RLS who use pharmacotherapy conventional treatments do not have a clinically significant response [10]. In this context, well-tolerated, effective complementary and alternative interventions for RLS are desirable.

For thousands of years, Chinese herbal medicine (CHM) has been employed as a therapeutic intervention for RLS [15]. In the classic Chinese medicine text, Shang Han Lun, “leg convulsion and tension” is described and the treatment is Shao Yao Gan Cao Tang, which is a CHM formula still used today to treat RLS. CHM is widely used in East Asian countries for managing RLS as either an alternative or adjunct to conventional therapies [15]. The mechanism of action of CHM for RLS is not fully known, but experimental studies have determined that the CHMs used for RLS have anticonvulsive, neuroprotective, and anti-inflammatory effects, and this may explain some of their effects on RLS [16–20]. Formulas such as Shao Yao Tang and Mai Men Dong Tang affect some of the pathological mechanisms of RLS through their antispasmodic/muscle-relaxant effects, inhibition of neuronal excitability, regulation of calcium channels, anti-inflammatory, and analgesic effects [21,22].

In many East Asian countries such as China, Japan, and Korea, CHM (and associated modalities such as Korean and Japanese herbal medicine) are integrated within conventional medicine treatments. However, in many other countries, CHM is mainly used outside of mainstream conventional medical institutions, for conditions such as RLS [23]. One of the barriers that prevents the use of CHM for conditions such as RLS in conventional medicine is the lack of high-quality evidence [24].

Despite the popularity of CHM, evidence supporting its efficacy and safety remains fragmented. RLS has been treated successfully with CHM [25]. A narrative review of CHM for RLS identified 3 randomized controlled trials (RCTs), which all showed a significant reduction in RLS symptoms compared with dopaminergic and anticonvulsive medications [15,26]. A systematic review of studies, in which Paeoniae Radix-containing CHM formulas were used, found that these formulas were more effective than levodopa/benserazide [RLS rating score reduction, mean difference (MD) = −3.72 points] and that the combination of these formulas with conventional therapies was more effective than conventional therapies alone (RLS rating score reduction, MD = −2.82 points) [27]. Although all the studies included in that systematic review had a “high” risk of bias, which may indicate an overestimate or underestimate of the true effect of the intervention. Importantly, formulas that did not contain Paeoniae Radix, and studies published after October 2017 were not included in the review. There is a need to assess the effectiveness of all CHM formulas for which evidence is available, as they may be either more or less effective than formulas that contain Paeoniae Radix. To address this gap a systematic review will be conducted of RCTs where the effect of CHM was evaluated. This review will address gaps in the understanding of the role of CHM, and the potential benefits and risks, whilst highlighting integrative treatment strategies. It will aim to provide evidence for the role of CHM (if any) in the treatment of RLS within an integrative medicine framework (e.g., during a conventional pharmacotherapy intervention). It will also aim to provide guidance on herb selection in personalized CHM, as well as raise awareness about the herbs used by CHM clinicians to treat RLS to facilitate safety monitoring by CHM, and biomedical (conventional medicine) professionals.

Materials and Methods

This is a protocol for a systematic review of the RCTs evaluating the effect of CHM on individuals with RLS. A meta-analysis will be conducted to evaluate the pooled effect of CHM. The primary outcome comparisons will be: (1) between CHM and placebo (to explore the efficacy and safety profile of CHM to evaluate if CHM has a place in the treatment of RLS); and (2) between CHM and conventional interventions (to evaluate the relative effectiveness and safety profile of CHM and assess if CHM should be prioritised over conventional interventions). The primary outcomes will be RLS symptom severity as measured with a validated scale [e.g., International Restless Legs Syndrome Study Group (IRLSSG) rating scale] [2] for effectiveness of treatment, and the number of adverse events to determine the safety of treatment. The systematic review was registered with the international Prospective Register of Systematic Reviews (whose acronym is PROSPERO; CRD420251037758). The publication of the systematic review will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines [28]

1. Search strategy

The literature databases (Cochrane Central Register of Controlled Trials, Excerpta Medica Base, PubMed, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Wanfang, and Chongqing Value-added Information Platform) will be searched from inception to the date of the search. Clinical trial registries [US based-(featuring trials globally) and Chinese based-clinical trial registry] will also be searched on the same day as the database search.

Search filters will be developed by using MeSH terms/keywords related to the core themes of RLS, CHM, and RCTs, and with the use of a chatbot (ChatGPT) where the prompt was “terms related with [theme].” The AI-generated search terms will be critically evaluated and refined by the review team. Search terms within the same conceptual theme will be combined using the Boolean operator OR, while the results from different themes will be combined using the Boolean operator AND (Appendix A). There will be no restrictions in terms of language and publication type. In case the language of the publication is not understood by the team members, academic professionals who are fluent in the language of the publication will be asked to support the review team for data collection and risk of bias assessment. In addition, the reference list of the included articles will be screened during the review process. Furthermore, a forward search, in which articles that have been referenced the included studies, will be retrieved from the China National Knowledge Infrastructure (for studies published in Chinese) and PubMed (for studies published in English) databases. Finally, any relevant studies not retrieved via the database search, that were already known by the authors, and met the eligibility criteria, will be included in this review.

2. Study eligibility criteria

2.1. Population

The target population will be adults (≥ 18 years) who were diagnosed with RLS using validated criteria (e.g., IRLSSG criteria [2]). Studies which focus on participants with RLS refractory to conventional therapies (e.g., dopaminergic agents), and studies which included participants with comorbid conditions (e.g., iron deficiency, insomnia) will be included.

2.2. Intervention

The studies which will be included in the review will be studies where the experimental intervention is CHM (herbal, animal, and mineral therapeutic materials and their extracts used within the framework of Chinese medicine). Only CHMs that were administered orally (either single-herb or compound formulations), and only proprietary CHM products (also known as cheng yao; standardized herbal extracts and patented formulations) will be included in the review. There will be no limitations in the oral form of CHM delivery (e.g., decoctions, granules, capsules).

2.3. Comparison

All forms of placebo and sham CHM interventions will be accepted. Conventional pharmacological treatments such as dopaminergic agents, alpha-2-delta ligands, and iron supplementation will be accepted as control interventions. No treatment or standard care (for comorbid conditions) will both be accepted as comparators. Other comparisons, identified during the review process and judged suitable by the review team, may be included.

2.4. Outcomes

The primary outcomes will be RLS symptom severity as assessed using a validated scale such as the IRLSSG rating scale [2] for effectiveness and the frequency of adverse events observed in the participants throughout the intervention phase of the trial.

The measurement of secondary outcomes will utilize validated scales to evaluate several domains: including, but not limited to, the Clinical Global Impression scale [29] for symptom improvement, Pittsburgh Sleep Quality Index [30] for sleep quality, RLS QoL questionnaire [31] for quality of life, Epworth Sleepiness Scale [32] for sleepiness, and the Hamilton Scales for anxiety and depression [33].

The number of serious adverse events and adverse events (i.e., adverse events caused by the intervention), and the number of participants who experienced adverse events in the included studies will also be documented.

Studies using any of the outcomes described will be included in the review, regardless of whether these were primary or secondary outcomes in the original study.

2.5. Study design

Only RCTs for which the randomization method is known (either by reviewing the manuscript or by contacting the authors) will be included. Studies with a cross-over design will be excluded from the review, because CHM may have long-lasting effects that continue during the following intervention phase. In addition, studies will not be excluded due to the published language. If the language is not spoken by the review team, the help of fellow academics (fluent in the required language) will be sought to ensure the content is fully understood.

3. Study eligibility assessment

The studies will be independently screened by 2 reviewers. This process will involve an initial title and abstract review, followed by a full-text assessment. All exclusion reasons will be documented. Disagreements will be resolved by discussion, and a 3^rd reviewer will make the final decision if consensus is not reached. The screening process is presented in Figure 1.

4. Data collection

Two independent reviewers will extract data to input into a standardized collection form. The data to be extracted will include: 1^st author and publication year; country where the RCT was performed; treatment arm details and sample size; participant demographics (e.g., gender, mean age, comorbidities, and diagnostic patterns); specifics of the experimental and control interventions (including product, manufacturer, and dosage); treatment duration; the diagnostic approach used (disease-based or pattern-based); the dosage of the oral form of the CHM; whether the formula was modified; and outcome measures at the end of the intervention and any follow-up assessments. In addition, all reported events associated with CHM interventions will be systematically identified, and reported to comprehensively assess the safety profile.

5. Risk of bias assessment

The risk of bias will be appraised by 2 reviewers working independently, utilizing Version 2 of the Cochrane Risk of Bias tool. The assessed domains are the randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. Each domain and the overall study will be rated as having a “low” risk of bias, “some concerns,” or a “high” risk of bias. Disagreements will be discussed until resolution, or with a 3^rd reviewer to make the final decision if needed.

6. Data analysis

Meta-analyses will be performed for all prespecified comparisons and outcomes where there are at least 2 eligible studies. The primary endpoint will be the severity of RLS symptoms as assessed using a validated rating scale. The principal comparisons will evaluate CHM as compared with placebo controls, and conventional therapies.

For continuous outcomes, the MD will be reported when studies use the same measurement tool, and standardized MDs will be reported when multiple scales are employed. Each effect estimate will be presented with a 95% confidence interval (CI), Cohen’s d, and corresponding p values. Effect sizes will be interpreted as small (d > 0.2), moderate (d > 0.5), or large (d > 0.8), and a random-effects model, using the DerSimonian-Laird method, will be applied to estimate pooled effects.

For dichotomous outcomes, including the incidence of serious adverse events, and the number of participants experiencing adverse events, incidence rate ratios and risk ratios with 95% CI and p values will be calculated. Between-group differences will be assessed using generic inverse-variance analysis. In addition, adverse event profiles will be reported by type and frequency for both CHM and pharmacotherapy conventional medicine groups.

For all meta-analyses, the number of included studies and total participants will be reported. Statistical heterogeneity will be quantified using the I² statistic, with values ≥ 50% considered indicative of substantial heterogeneity [28]. Where heterogeneity is detected, potential sources will be explored (e.g., participant characteristics such as age, sex, and comorbidities; or intervention characteristics such as duration and dosage of the oral form). Sensitivity analyses will be performed by sequentially excluding outlier studies until heterogeneity is reduced to an acceptable level (I² < 50%). For meta-analyses including at least 10 studies, publication bias will be evaluated using the Egger’s test and a visual inspection of funnel plots symmetry will be assessed [34].

The robustness of the findings will be further assessed through sensitivity analyses restricted to RCTs judged as having a “low” risk of bias. Subgroup analyses and meta-regression will be conducted to explore the influence of factors such as intervention duration, dosage of the oral form (e.g., granules vs. decoction), diagnostic approach (pattern-based vs. disease-based), and whether CHM formulas were standardized or modified. Additional subgroup analyses will focus on RCTs involving patients with RLS refractory to conventional therapies and on special populations, including pregnant women and individuals receiving dialysis. Subgroup analyses will be performed only when at least 2 RCTs are eligible for a given category. This aims to inform the decision-making process of CHM clinicians and provide evidence about the optimal implementation method (e.g., biomedical conventional medicine doctor using a disease-based approach or CHM clinician in traditional medicine using a pattern-based approach).

All statistical tests will be 2-tailed, with significance set at p < 0.05. Analyses will be conducted using RevMan Version 5.4 and JASP Version 0.18.1.0.

7. Evidence strength assessment

The Grading of Recommendations, Assessment, Development, and Evaluation system will be used by 2 reviewers working independently to assess the strength of the evidence in the included RCTs. All disagreements will be resolved by discussion or with a 3^rd reviewer. Based on the literature, a difference in IRLS score of 3 will be considered clinically significant. The questions asked will be: (1) Is the difference in RLS symptom severity between CHM and placebo clinically significant at the end-of-intervention; (2) Is the difference in adverse events occurring throughout the intervention period between CHM and placebo statistically significant; (3) Is CHM equivalent or better than conventional treatment in terms of RLS severity at the end-of-intervention; and (4) Is the difference in adverse events occurring throughout the intervention period between CHM and conventional treatment statistically significant?

8. Hypotheses

Based on the statistical and clinical significance of the differences between experimental groups and control groups, the risk of bias of the included studies, as well as the results of the sensitivity analyses, and with the evidence strength of findings according to the Grading of Recommendations, Assessment, Development, and Evaluations assessment, we may conclude: (1) CHM is more effective than the placebo in reducing RLS symptoms, or there was insufficient evidence, or the evidence was inconclusive; (2) CHM does not provoke more adverse events than the placebo, or there was insufficient evidence, or the evidence is inconclusive; (3) CHM is equivalent to conventional treatments in reducing RLS symptoms, or there was insufficient evidence, or the evidence was inconclusive; and (4) CHM has a lower incidence of adverse events compared with conventional therapies, or there was insufficient evidence, or the evidence is inconclusive.

Discussion

RLS is a chronic neurological disorder which significantly impairs sleep and daily life [1,2]. Conventional treatments often cause side effects leading patients to seek alternative treatments. CHM provides both a complementary pathway for patients unresponsive to conventional care, and a rationale for personalized treatment beyond a single diagnosis. Integrative medicine combines conventional and complementary medicine. CHM may contribute to the treatment of neurological conditions, such as RLS, by offering a personalized strategy with focus on the underlying framework that conventional medicine may overlook. By embracing this personalized strategy, clinicians can move towards a more patient-based treatment that mitigates the limitations of a single-modality treatment, and may achieve a better outcome [35].

The results of the review may affect the clinical decisions of clinicians who treat RLS such as general practitioners, neurologists, and Chinese medicine practitioners. For example, if the results support the use of CHM for the treatment of RLS, clinicians can consider prescribing CHM treatment or referring their patients to a Chinese medicine practitioner to receive CHM. However, if the results do not support the use of CHM for RLS, Chinese medicine practitioners should refer their patients to receive treatments other rather than CHM. The results will also inform funding bodies about the usefulness of research into the effect of CHM on RLS and supporting this work.

This protocol for a review may subject the study to limitations. Although most studies that assess CHM are published in English or Chinese databases, there is a possibility that studies published in databases of other languages, especially Korean and Japanese databases, will be missed. Secondly, CHM intervention often varies in herbal formula and dosage, leading to heterogeneity in the outcomes, which may impact the interpretation of the results and their clinical application.

Supplementary Materials

Article information

Acknowledgments

The advice from Dr Arthur Yin Fan regarding the non-inferiority margin was much appreciated.

Author Contributions

Conceptualization: YB. Methodology: YL, XW, GY, and YB. Formal investigation: YL, YW, and DW. Writing – original draft: YL, XW, and YB. Writing - review and editing: YL, XW, and YB.

Conflicts of Interest

There are no conflicts of interest to declare.

Author Use of AI Tools Statement

No generative AI tool was used to write or edit this manuscript.

Funding

This research was supported by the Sydney Institute of Traditional Chinese Medicine student-led academic projects funding.

Ethical Statement

Ethics approval is not required for systematic reviews.

Data Availability

All relevant data are included in this manuscript.

Figure 1

Study flow diagram of the screening process. CCTR = Chinese Clinical Trial Registry; CENTRAL = Cochrane Central Register of Controlled Trials; CINAHL = Cumulative Index to Nursing and Allied Health Literature; CNKI = China National Knowledge Infrastructure; CQVIP = Chongqing Value-added Information Platform; RCT = randomized-controlled trial; RLS = restless legs syndrome.

References

• [1] Sateia MJ. International classification of sleep disorders-third edition. Chest 2014;146(5):1387−94.ArticlePubMedPMC
• [2] Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: Updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria - history, rationale, description, and significance. Sleep Med 2014;15(8):860−73.ArticlePubMedPMC
• [3] Ohayon MM, O’Hara R, Vitiello MV. Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 2012;16(4):283−95.ArticlePubMedPMC
• [4] Song P, Wu J, Cao J, Sun W, Li X, Zhou T, et al. The global and regional prevalence of restless legs syndrome among adults: a systematic review and modelling analysis. J Glob Health 2024;14:04113. ArticlePubMedPMC
• [5] Earley CJ, Silber MH. Restless legs syndrome: understanding its consequences and the need for better treatment. Sleep Med 2010;11(9):807−15.ArticlePubMed
• [6] Trenkwalder C, Allen R, Högl B, Paulus W, Winkelmann J. Restless legs syndrome associated with major diseases: a systematic review and new concept. Neurology 2016;86(14):1336−43.ArticlePubMedPMC
• [7] Li Y, Mirzaei F, O’Reilly EJ, Winkelman J, Malhotra A, Okereke OI, et al. Prospective study of restless legs syndrome and risk of depression in women. Am J Epidemiol 2012;176(4):279−88.ArticlePubMedPMC
• [8] Para KS, Chow CA, Nalamada K, Kakade VM, Chilakamarri P, Louis ED, et al. Suicidal thought and behavior in individuals with restless legs syndrome. Sleep Med 2019;54:1−7.ArticlePubMed
• [9] Van Den Eeden SK, Albers KB, Davidson JE, Kushida CA, Leimpeter AD, Nelson LM, et al. Risk of cardiovascular disease associated with a restless legs syndrome diagnosis in a retrospective cohort study from Kaiser Permanente Northern California. Sleep 2015;38(7):1009−15.ArticlePubMedPMC
• [10] Wilt TJ, MacDonald R, Ouellette J, Khawaja IS, Rutks I, Butler M, et al. Pharmacologic therapy for primary restless legs syndrome: a systematic review and meta-analysis. JAMA Intern Med 2013;173(7):496−505.ArticlePubMed
• [11] Silber MH, Becker PM, Earley C, Garcia-Borreguero D, Ondo WG. Willis-Ekbom disease foundation revised consensus statement on the management of restless legs syndrome. Mayo Clin Proc 2013;88(9):977−86.ArticlePubMed
• [12] Moore TJ, Glenmullen J, Mattison DR. Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugs. JAMA Intern Med 2014;174(12):1930−33.ArticlePubMed
• [13] Tolkien Z, Stecher L, Mander AP, Pereira DIA, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: A systematic review and meta-analysis. PLoS One 2015;10(2):e0117383. ArticlePubMedPMC
• [14] Earley CJ, García-Borreguero D, Falone M, Winkelman JW. Clinical efficacy and safety of intravenous ferric carboxymaltose for treatment of restless legs syndrome: a multicenter, randomized, placebo-controlled clinical trial. Sleep 2024;47(7):zsae095.. ArticlePubMedPDF
• [15] Yan X, Wang WD, Walters AS, Wang Q, Liu YJ, Chu FY. Traditional Chinese medicine herbal preparations in restless legs syndrome (RLS) treatment: a review and probable first description of RLS in 1529. Sleep Med Rev 2012;16(6):509−18.ArticlePubMed
• [16] Lai CW, Hsu FL, Cheng JT. Stimulatory effect of paeoniflorin on adenosine A-1 receptors to increase the translocation of protein kinase C (PKC) and glucose transporter (GLUT 4) in isolated rat white adipocytes. Life Sci 1998;62(17–18):1591−5.ArticlePubMed
• [17] Chen IC, Lin TH, Hsieh YH, Chao CY, Wu YR, Chang KH, et al. Formulated Chinese medicine Shaoyao Gancao Tang reduces Tau aggregation and exerts neuroprotection through anti-oxidation and anti-inflammation. Oxid Med Cell Longev 2018;2018(1):9595741. ArticlePubMedPMCPDF
• [18] Bi X, Gong M, Di L. Review on prescription compatibility of Shaoyao Gancao Decoction and reflection on pharmacokinetic compatibility mechanism of traditional Chinese medicine prescription based on in vivo drug interaction of main efficacious components. Evid Based Complement Alternat Med 2014;2014(1):208129. ArticlePubMedPMCPDF
• [19] Lee KK, Omiya Y, Yuzurihara M, Kase Y, Kobayashi H. Antispasmodic effect of shakuyakukanzoto extract on experimental muscle cramps in vivo: Role of the active constituents of glycyrrhizae radix. J Ethnopharmacol 2013;145(1):286−93.ArticlePubMed
• [20] Liu H, Zhang W, Luo X, Ye Y, Zhu X. Paeoniflorin attenuates neuroinflammation and dopaminergic neurodegeneration in the MPTP model of Parkinson’s disease by activation of adenosine A1 receptor. Br J Pharmacol 2006;148(3):314−25.ArticlePubMedPMCPDF
• [21] Xu Y, Li C, Chen T, Li X, Wu X, Zhang Q, et al. Quantitative analysis of the multicomponent and spectrum-effect correlation of the antispasmodic activity of Shaoyao-Gancao decoction. J Anal Methods Chem 2022;2022(1):2279404. ArticlePubMedPMCPDF
• [22] Lao Q, Wang X, Zhu G, Yuan H, Ma T, Wang N. A Chinese classical prescription Maimendong decoction in treatment of pulmonary fibrosis: an overview. Front Pharmacol 2024;15:1329743. ArticlePubMedPMC
• [23] Efferth T. Establishing traditional Chinese medicine in Europe. Chin Herb Med 2025;17(3):409−13.ArticlePubMedPMC
• [24] Fung FY, Linn YC. Developing traditional Chinese medicine in the era of evidence-based medicine: current evidences and challenges. Evid Based Complement Alternat Med 2015;2015:425037. ArticlePubMedPMCPDF
• [25] Lee HG, Kwon S, Goto H, Fujimoto M, Kainuma M, Cho KH. Successful treatment of restless legs syndrome accompanied by headaches for 30 years with herbal prescriptions containing paeoniae radix: a case report. Explore 2024;20(6):103003. ArticlePubMed
• [26] Trenkwalder C, Tinelli M, Sakkas GK, Dauvilliers Y, Ferri R, Rijsman R, et al. Socioeconomic impact of restless legs syndrome and inadequate restless legs syndrome management across European settings. Eur J Neurol 2021;28(2):691−706.ArticlePubMedPDF
• [27] Kwon S, Jin C, Cho SY, Park SU, Jung WS, Moon SK, et al. Paeoniae radix-containing herbal medicine for patients with restless legs syndrome: A systematic review and meta-analysis. Complement Ther Clin Pract 2019;35:329−41.ArticlePubMed
• [28] Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M, et al. Cochrane handbook for systematic reviews of interventions. 2nd Edition. Hoboken, NJ West Sussex (UK), Wiley-Blackwell, 2019.
• [29] Hamieh F, Hallit S, Haddad C, Obeid S, Kazour F. Correlates of severity in a clinical staging model of schizophrenia: a cross-sectional study among 158 subjects. BMC Psychiatry 2023;23:648. ArticlePubMedPMCPDF
• [30] Jiang L, Yoo Y. Adolescents’ short-form video addiction and sleep quality: the mediating role of social anxiety. BMC Psychol 2024;12:369. ArticlePubMedPMCPDF
• [31] Broström A, Alimoradi Z, Odzakovic E, Kaldo V, Jernelöv S, Lind J, et al. Quality of life among patients with restless legs syndrome: a systematic review and meta-analysis. J Clin Neurosci 2024;122:80−91.ArticlePubMed
• [32] Feng X, Shi Y, Zhang Y, Lei F, Ren R, Tang X. Test-retest reliability of Epworth Sleepiness Scale score in patients with untreated obstructive sleep apnea. Nat Sci Sleep 2024;16:2299−309.ArticlePubMedPMCPDF
• [33] Gao W, Deng Z, Cai X, Zhang D, Xiao H, Zhang X. Gender differences in prevalence and clinical correlates of anxiety in first-episode and drug naïve patients with major depressive disorder comorbid with metabolic syndrome. BMC Psychiatry 2024;24:156. ArticlePubMedPMCPDF
• [34] Stuck AE, Rubenstein LZ, Wieland D. Bias in meta-analysis detected by a simple, graphical test. Asymmetry detected in funnel plot was probably due to true heterogeneity. BMJ 1998;316(7129):469author reply 470-1Article
• [35] Park HL, Lee HS, Shin BC, Liu JP, Shang Q, Yamashita H, et al. Traditional medicine in China, Korea, and Japan: a brief introduction and comparison. Evid Based Complement Alternat Med 2012;2012:429103. ArticlePubMedPMCPDF

Figure & Data

References

Citations

Citations to this article as recorded by