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Mayer-Suess L, Ibrahim A, Moelgg K, Cesari M, Knoflach M, Högl B, Stefani A, Kiechl S, Heidbreder A. Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review. Int J Stroke 2024; 19:490-498. [PMID: 37885093 PMCID: PMC11134986 DOI: 10.1177/17474930231212349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome. They can also occur secondary to the stroke itself. In this review, we describe the variety of different sleep disorders associated with stroke and analyze their effect on stroke risk and outcome. METHODS A search term-based literature review ("sleep," "insomnia," "narcolepsy," "restless legs syndrome," "periodic limb movements during sleep," "excessive daytime sleepiness" AND "stroke" OR "cerebrovascular" in PubMed; "stroke" and "sleep" in ClinicalTrials.gov) was performed. English articles from 1990 to March 2023 were considered. RESULTS Increasing evidence suggests that sleep disorders are risk factors for stroke. In addition, sleep disturbance has been reported in half of all stroke sufferers; specifically, an increase is not only sleep-related breathing disorders but also periodic limb movements during sleep, narcolepsy, rapid eye movement (REM) sleep behavior disorder, insomnia, sleep duration, and circadian rhythm sleep-wake disorders. Poststroke sleep disturbance has been associated with worse outcome. CONCLUSION Sleep disorders are risk factors for stroke and associated with worse stroke outcome. They are also a common consequence of stroke. Recent guidelines suggest screening for sleep disorders after stroke. It is possible that treatment of sleep disorders could both reduce stroke risk and improve stroke outcome, although further data from clinical trials are required.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
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Tutan D, Ulfberg J, Aydemir N, Eser B, Doğan İ. The Relationship between Serum Selenium Levels and Restless Leg Syndrome in Chronic Kidney Disease Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1795. [PMID: 37893513 PMCID: PMC10608171 DOI: 10.3390/medicina59101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Chronic kidney disease (CKD) is a global public health issue with rising incidence linked to substantial morbidity and mortality. Selenium, an antioxidant trace element, has been linked to low serum levels in end-stage renal disease. Restless Leg Syndrome (RLS), a sleep disorder, is prevalent in CKD patients and significantly impacts their quality of life. The objective of this study was to examine the correlation between serum selenium levels and the prevalence of restless leg syndrome in individuals with chronic kidney disease. Materials and Methods: Forty-six CKD patients undergoing serum selenium level assessments between 1 January 2020 and 28 February 2022, at the Hitit University Faculty of Medicine Department of Nephrology Outpatient Clinic or Hemodialysis Unit, were included. Patients over 18 years of age with no history of hematological or oncological diseases or acute or chronic inflammatory conditions were included in the study groups. Patients taking selenium supplements were excluded. Demographic data, comorbidities, and laboratory values were collected, and RLS presence and severity were evaluated. Statistical analyses include descriptive statistics, correlation analysis, the Mann-Whitney U test, Student's t test, and Chi-square test. Results: Among the 46 patients, 16 (34.78%) had RLS symptoms. The patient group included 34.78% predialysis, 34.78% peritoneal dialysis, and 30.44% hemodialysis patients, with a median age of 47.98 years. There was no difference in age, gender, and Charlson comorbidity between patients with or without RLS (p = 0.881, p = 0.702, p = 0.650). RLS prevalence varied across CKD subgroups, with hemodialysis patients having a higher prevalence (p = 0.036). Clinical parameters such as blood urea nitrogen, creatinine, calcium, phosphorus, platelet counts, and parathyroid hormone levels exhibited significant differences between patients with and without RLS (p < 0.05). Serum selenium levels were not significantly different between patients with and without RLS (p = 0.327). Conclusions: With an increased comorbidity burden, CKD poses a significant healthcare challenge. When accompanied by RLS, this burden can be debilitating. The difference in CKD stages between groups has shed light on a critical determinant of RLS in this population, emphasizing the role of the chronic kidney disease stage. In our study, serum selenium levels were not associated with the presence and severity of RLS. However, prospective studies with larger numbers of participants are needed to draw a definitive conclusion.
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Affiliation(s)
- Duygu Tutan
- Department of Internal Medicine, Erol Olçok Training and Research Hospital, 19040 Çorum, Turkey
| | | | - Nihal Aydemir
- Department of Nephrology, Hitit University Faculty of Medicine, 19030 Çorum, Turkey; (N.A.); (B.E.); (İ.D.)
| | - Barış Eser
- Department of Nephrology, Hitit University Faculty of Medicine, 19030 Çorum, Turkey; (N.A.); (B.E.); (İ.D.)
| | - İbrahim Doğan
- Department of Nephrology, Hitit University Faculty of Medicine, 19030 Çorum, Turkey; (N.A.); (B.E.); (İ.D.)
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Restless Legs Syndrome and Periodic Limb Movements of Sleep: From Neurophysiology to Clinical Practice. J Clin Neurophysiol 2023; 40:215-223. [PMID: 36872500 DOI: 10.1097/wnp.0000000000000934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
SUMMARY This article summarizes restless legs syndrome (RLS), periodic limb movements of sleep, and periodic limb movement disorder. RLS is a common sleep disorder with a prevalence of 5% to 15% in the general population. RLS can present in childhood, and incidence increases with age. RLS can be idiopathic or secondary to iron deficiency, chronic renal failure, peripheral neuropathy, and medications such as antidepressants (with higher rates for mirtazapine and venlafaxine, while bupropion may reduce symptoms at least in the short term), dopamine antagonists (neuroleptic antipsychotic agents and antinausea medications), and possibly antihistamines. Management includes pharmacologic agents (dopaminergic agents, alpha-2 delta calcium channel ligands, opioids, benzodiazepines) and nonpharmacologic therapies (iron supplementation, behavioral management). Periodic limb movements of sleep are an electrophysiologic finding commonly accompanying RLS. On the other hand, most individuals with periodic limb movements of sleep do not have RLS. The clinical significance of the movements has been argued. Periodic limb movement disorder is a distinct sleep disorder that arises in individuals without RLS and is a diagnosis of exclusion.
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Mubeen SM, Ahsan MD. Prevalence and associated factors of restless leg syndrome (RLS) in Pakistani women during pregnancy. J OBSTET GYNAECOL 2022; 42:1829-1834. [PMID: 35476609 DOI: 10.1080/01443615.2022.2040963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is a dearth of literature studying restless leg syndrome (RLS) among pregnant patients in Pakistan. The objective of this study was to determine the prevalence and associated factors of RLS among pregnant Pakistani patients. It was conducted in 2018 among 478 women attending ante-natal check-up in the outpatient department of five hospitals in Karachi, Pakistan. Individuals were interviewed for socio-demographic information, the key criteria for RLS and its associated factors. RLS was reported in 54 (11%) individuals based on International Restless Legs Syndrome Study Group (IRLSSG) criteria. The mean age was 33.44 ± 4.42 years. Association between pregnant women with RLS and those without reveals statistically significant differences with increasing age (p=.01), gravida (p<.01) and para (p<.001). RLS was significant among working women (p=.001), during third trimester (p=.001), with insomnia (p<.001), use of tobacco (p<.001) and among women with gestational diabetes (p<.001), hypertension (p<.001). The study showed a low prevalence of RLS among women during pregnancy. It further reported gestational diabetes, hypertension, insomnia and tobacco use to be independently linked to RLS. Impact StatementWhat is already known on this subject? Pregnancy has been demonstrated to be strongly associated with development of secondary restless leg syndrome (RLS). RLS in pregnancy has also been shown to portend poor maternal and neonatal outcomes such as postpartum depression and preterm birth. Various conditions and lifestyle factors in pregnancy have been shown to be associated with the development of RLS, but there are variations in these across different populations.What do the results of this study add? The prevalence of RLS was only reported twice in pregnant patients in Pakistan and our research helps to address this data shortage. In addition, the results of our study document a strong association of RLS with gestational hypertension and gestational diabetes and also show that smoking and exercise were correlated with RLS during pregnancy, both of which were previously unstudied in the pregnant Pakistani population.What are the implications of these findings for clinical practice and/or further research? Demonstrating the prevalence of RLS in pregnant Pakistani patients highlights the need to screen these patients, particularly those with associated conditions identified in our findings, for RLS during antenatal visits and to treat their condition to improve maternal and neonatal outcomes.
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Affiliation(s)
- Syed Muhammad Mubeen
- Department of Community Health Sciences, Hamdard College of Medicine & Dentistry, Hamdard University, Karachi, Pakistan
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Ning P, Mu X, Yang X, Li T, Xu Y. Prevalence of restless legs syndrome in people with diabetes mellitus: A pooling analysis of observational studies. EClinicalMedicine 2022; 46:101357. [PMID: 35345532 PMCID: PMC8956955 DOI: 10.1016/j.eclinm.2022.101357] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with different clinical complications. The aim of this study was to explore the prevalence of RLS in people with diabetes mellitus and compare the risk of restless leg syndrome (RLS) between diabetic and non-diabetic population. METHODS We searched for studies of RLS prevalence in DM through PubMed, Embase, and Web of Science. Two authors independently completed the literature screening, data extraction, and bias risk assessment of eligible studies. All observational studies that assessed the prevalence or risk of RLS in DM were included, where the diagnosis of RLS was based on the International Restless Legs Syndrome Study Group (IRLSSG). Percentages, odds ratio (OR) with 95% confidence intervals (CI) were used to assess pooled estimates of RLS prevalence and risk based on random-effects models. Newcastle-Ottawa-scale (NOS) or a modified NOS were used to evaluate the quality of studies. FINDINGS A total of 42 studies, including 835,986 participants, met the eligibility criteria for the meta-analysis. Among them, 30 studies were included in meta-analysis to analyze the prevalence of RLS. A second meta-analysis was conducted using 31 studies to determine RLS risk between diabetes and non-diabetes. The results indicate that between 25% (95% confidence interval 21%-29%) of people with diabetes showed signs of RLS, and people with diabetes had an increased risk of developing RLS compare to people without diabetes (OR 1.98, 95%CI 1.66- 2.34, p < 0.001). However, the available evidence was limited due to potential risk of bias and variability between studies (I2 >75%), all of observational design. INTERPRETATION Our study suggests that the prevalence and risk of RLS might be higher in DM patients than in non-diabetes population. However, given limitations in the analysis and study design, the findings need to be corroborated in future studies. FUNDING This work was supported by the Basic Conditions Platform Construction Project of Sichuan Science and Technology Department (2019JDPT0015), and the "1・3・5 project for disciplines of excellence, West China Hospital, Sichuan University" (ZYJC18003).
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Affiliation(s)
- Pingping Ning
- Department of Neurology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, PR China
| | - Xin Mu
- Department of Neurology, Chengdu First People's Hospital, 18 Wanxiang North Road, Chengdu, Sichuan 610041, PR China
| | - Xinglong Yang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, 295 Xi Change Road, Kunming, Yunnan 650032, PR China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, No. 169 Changle West Rd, Xi'an 710032, PR China
- Corresponding authors.
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, PR China
- Corresponding authors.
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Weber FC, Danker-Hopfe H, Dogan-Sander E, Frase L, Hansel A, Mauche N, Mikutta C, Nemeth D, Richter K, Schilling C, Sebestova M, Spath MM, Nissen C, Wetter TC. Restless Legs Syndrome Prevalence and Clinical Correlates Among Psychiatric Inpatients: A Multicenter Study. Front Psychiatry 2022; 13:846165. [PMID: 35370821 PMCID: PMC8967168 DOI: 10.3389/fpsyt.2022.846165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background There are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders. The present study aimed to evaluate the prevalence and clinical correlates in psychiatric inpatients in Germany and Switzerland. Methods This is a multicenter cross-sectional study of psychiatric inpatients with an age above 18 years that were diagnosed and evaluated face-to-face using the International RLS Study Group criteria (IRLSSG) and the International RLS severity scale (IRLS). In addition to sociodemographic and biometric data, sleep quality and mood were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). In addition to univariate statistics used to describe and statistically analyze differences in variables of interest between patients with and without RLS, a logistic model was employed to identify predictors for the occurrence of RLS. Results The prevalence of RLS in a sample of 317 psychiatric inpatients was 16.4%, and 76.9% of these were diagnosed with RLS for the first time. RLS severity was moderate to severe (IRLS ± SD: 20.3 ± 8.4). The prevalences in women (p = 0.0036) and in first-degree relatives with RLS (p = 0.0108) as well as the body mass index (BMI, p = 0.0161) were significantly higher among patients with RLS, while alcohol consumption was significantly lower in the RLS group. With the exception of atypical antipsychotics, treatment with psychotropic drugs was not associated with RLS symptoms. Regarding subjective sleep quality and mood, scores of the PSQI (p = 0.0007), ISI (p = 0.0003), and ESS (p = 0.0005) were higher in patients with RLS, while PHQ-9 scores were not different. A logistic regression analysis identified gender (OR 2.67; 95% CI [1.25; 5.72]), first-degree relatives with RLS (OR 3.29; 95% CI [1.11; 9.73], ESS score (OR 1.09; 95% CI [1.01; 1.17]), and rare alcohol consumption (OR 0.45; 95% CI [0.22; 0.94] as predictors for RLS. Conclusions Clinically significant RLS had a high prevalence in psychiatric patients. RLS was associated with higher BMI, impaired sleep quality, and lower alcohol consumption. A systematic assessment of restless legs symptoms might contribute to improve the treatment of psychiatric patients.
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Affiliation(s)
- Franziska C. Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Heidi Danker-Hopfe
- Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Competence Center of Sleep Medicine Berlin, Berlin, Germany
| | - Ezgi Dogan-Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg – Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Hansel
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg – Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicole Mauche
- Department of Psychiatry and Psychotherapy, University Leipzig, Medical Faculty, Leipzig, Germany
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Privatklinik Meiringen, Meiringen, Switzerland
| | - Diana Nemeth
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Kneginja Richter
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Claudia Schilling
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Marian M. Spath
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas C. Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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7
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Sum-Ping O, Geng YJ. Impact of Sleep on Cardiovascular Health: A Narrative Review. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wipper B, Winkelman JW. The Long-Term Psychiatric and Cardiovascular Morbidity and Mortality of Restless Legs Syndrome and Periodic Limb Movements of Sleep. Sleep Med Clin 2021; 16:279-288. [PMID: 33985653 DOI: 10.1016/j.jsmc.2021.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Restless legs syndrome (RLS) is a sensory-motor neurological disorder that is associated with high levels of distress and sleep disturbance. Cross-sectional and longitudinal evidence suggests that individuals suffering from RLS may be at an increased risk of certain psychiatric illnesses and cardiovascular diseases. There also is evidence for increased mortality rates in RLS patients, although contrasting results do exist. Periodic limb movements of sleep (PLMS), repetitive leg movement observed in most RLS patients, and sleep disturbance may mediate the relationship between RLS and long-term morbidity. This article summarizes the literature investigating the potential consequences of both RLS and PLMS.
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Affiliation(s)
- Benjamin Wipper
- Sleep Disorders Clinical Research Program, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 10th Floor, Boston, MA 02114, USA
| | - John W Winkelman
- Sleep Disorders Clinical Research Program, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 10th Floor, Boston, MA 02114, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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9
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Reimers AK, Heidenreich V, Bittermann HJ, Knapp G, Reimers CD. Accelerometer-measured physical activity and its impact on sleep quality in patients suffering from restless legs syndrome. BMC Neurol 2021; 21:90. [PMID: 33632158 PMCID: PMC7908727 DOI: 10.1186/s12883-021-02115-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/15/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The primary symptoms of restless legs syndrome (RLS) are sleep onset insomnia and difficulty to maintain sleep. Previous studies have shown that regular physical activity can reduce the risk of developing RLS. However, the relationship between physical activity and sleep quality parameters in individuals suffering from RLS has not yet been investigated by applying accelerometry. Thus, the present study investigates the impact of physical activity (measuring both intensity levels and duration of physical activity) during the day (7-12 h, 12-18 h, 18-23 h) on sleep quality in patients suffering from idiopathic RLS by applying a real-time approach. METHODS In a sample of 47 participants suffering from idiopathic RLS, physical activity and sleep quality were measured over one week using accelerometers. For data analysis, physical activity levels and step counts during three periods of the day (morning, afternoon, evening) were correlated with sleep quality parameters of the subsequent night. RESULTS This observational study revealed that in most instances physical activity was not correlated with sleep parameters (two exceptions exist: steps taken in the morning were negatively correlated with periodic leg movements during sleep, and physical activity in the evening was negatively correlated with total sleep time). The physical activity levels of the participants in this study, however, were unexpectedly high compared to population-level data and variance in physical activity was low. The average activity was 13,817 (SD = 4086) steps and 347 (SD = 117) minutes of moderate physical activity per day in females, and 10,636 (SD = 3748) steps and 269 (SD = 69) minutes of moderate physical activity in males, respectively. Participants did not engage in any vigorous physical activity. CONCLUSIONS Further interventional studies are needed to investigate the daily effects of different intensities of physical activity on RLS symptoms.
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Affiliation(s)
- A K Reimers
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Gebbertstraße 123b, 91058, Erlangen, Germany.
| | - V Heidenreich
- Practice for Neurology, Damm 49, 25421, Pinneberg, Germany
| | - H-J Bittermann
- Practice for Neurology, Harksheider Str. 3, 22399, Hamburg, Germany
| | - G Knapp
- Department of Statistics, TU Dortmund University, Vogelpothsweg 87, 44227, Dortmund, Germany
| | - C D Reimers
- Practice for Neurology, Paracelsus-Klinik, In der Vahr 65, 28329, Bremen, Germany
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Chenini S, Barateau L, Rassu AL, Lopez R, Guiraud L, Cavaillès C, Jaussent I, Dauvilliers Y. Systematic assessment of autonomic symptoms in restless legs syndrome. Sleep Med 2021; 80:30-38. [PMID: 33548567 DOI: 10.1016/j.sleep.2021.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare the clinical features of autonomic dysfunction using the SCOPA-AUT questionnaire in untreated patients with restless legs syndrome (RLS) with controls, to identify factors associated with more severe autonomic symptoms, and to assess the effect of medication in patients. METHODS The SCOPA-AUT questionnaire that evaluates cardiovascular, gastrointestinal, urinary, thermoregulatory, pupillomotor, and sexual dysfunctions was completed by 409 consecutive untreated patients with RLS (54.1 ± 14.5 y.o; 265 women) and 331 controls (59.0 ± 17.0; 161 women). Clinical and polysomnographic data were assessed in all patients. A subgroup of 57 patients were evaluated a second time after treatment (mostly dopaminergic agonist) after an interval of 0.88 ± 1.42 year. RESULTS Compared to controls, untreated patients with RLS were younger, more often women, obese, with increased cardiovascular diseases (CVD). The SCOPA-AUT total score was higher in patients than controls in unadjusted and adjusted models. Patients had more autonomic symptoms in all subdomains of the scale (except for sexual dysfunction in men). These results were confirmed in a subgroup of 259 cases and age-sex-matched controls. Female gender, obesity, RLS severity, diabetes mellitus, CVD, sleepiness, insomnia and depressive symptoms but neither periodic legs movements during sleep (PLMS) nor objective sleep parameters were associated with high scores. Despite RLS and PLMS improvement, medication did not change total and subdomain scores. CONCLUSIONS Patients with RLS have frequent and large spectrum of autonomic symptoms, without effect of PLMS, sleep fragmentation and medication. These results suggest a global autonomic dysfunction in RLS that should be assessed more systematically in severe patients.
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Affiliation(s)
- Sofiène Chenini
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Anna Laura Rassu
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France
| | - Regis Lopez
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Lily Guiraud
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
| | - Clémence Cavaillès
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Isabelle Jaussent
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
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11
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Gossard TR, Trotti LM, Videnovic A, St Louis EK. Restless Legs Syndrome: Contemporary Diagnosis and Treatment. Neurotherapeutics 2021; 18:140-155. [PMID: 33880737 PMCID: PMC8116476 DOI: 10.1007/s13311-021-01019-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
Restless legs syndrome (RLS) is characterized by an uncomfortable urge to move the legs while at rest, relief upon movement or getting up to walk, and worsened symptom severity at night. RLS may be primary (idiopathic) or secondary to pregnancy or a variety of systemic disorders, especially iron deficiency, and chronic renal insufficiency. Genetic predisposition with a family history is common. The pathogenesis of RLS remains unclear but is likely to involve central nervous system dopaminergic dysfunction, as well as other, undefined contributing mechanisms. Evaluation begins with a thorough history and examination, and iron measures, including ferritin and transferrin saturation, should be checked at presentation and with worsened symptoms, especially when augmentation develops. Augmentation is characterized by more intense symptom severity, earlier symptom occurrence, and often, symptom spread from the legs to the arms or other body regions. Some people with RLS have adequate symptom control with non-pharmacological measures such as massage or temperate baths. First-line management options include iron-replacement therapy in those with evidence for reduced body-iron stores or, alternatively, with prescribed gabapentin or pregabalin, and dopamine agonists such as pramipexole, ropinirole, and rotigotine. Second-line therapies include intravenous iron infusion in those who are intolerant of oral iron and/or those having augmentation with intense, severe RLS symptoms, and opioids including tramadol, oxycodone, and methadone. RLS significantly impacts patients' quality of life and remains a therapeutic area sorely in need of innovation and a further pipeline of new, biologically informed therapies.
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Affiliation(s)
- Thomas R Gossard
- Mayo Center for Sleep Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Erik K St Louis
- Mayo Center for Sleep Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
- Departments of Neurology and Clinical and Translational Research, Mayo Clinic Southwest Wisconsin, La Crosse, Wisconsin, USA.
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Guney I, Biyik Z, Gencer V, Akgül YSS. Restless legs syndrome and arterial stiffness in pre-dialysis chronic kidney disease. Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Jin B, Wang A, Earley C, Allen R. Moderate to severe but not mild RLS is associated with greater sleep-related sympathetic autonomic activation than healthy adults without RLS. Sleep Med 2019; 68:89-95. [PMID: 32028231 DOI: 10.1016/j.sleep.2019.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Restless legs syndrome (RLS) patients have been found to have high rates of transitory increases in the activity of the sympathetic autonomic nervous system with increases in heart rate and blood pressure. These were identified by evaluating heart rate or blood pressure changes independent of any leg movement analyses. There has been an implicit assumption this high rate of sympathetic activations is abnormal, but there has been no direct comparison for similar measures with a healthy population free of RLS. Thus, it is not known if during sleep the rates of sympathetic nervous system activation are greater for RLS than for a healthy population. The objectives of this study were to determine if: (1) RLS patients compared to healthy controls have a greater frequency of sympathetic nervous system activation (significant heart rate increases) with a higher percentage of leg movements associated with these activations; (2) the sympathetic activation frequency and its relation to leg movements correlate significantly with RLS severity in RLS patients; and (3) there is some minimum threshold for RLS severity defining an RLS population where most (eg 85%) have abnormally high rates of sympathetic activation. METHODS Sleep data on 32 RLS patients and 21 matched healthy controls were obtained from a prior study. All leg movements during sleep (LMS) and periodic leg movements in sleep (PLMS) were identified following the new WASM criteria; LMS that were not PLMS were considered isolated leg movements in sleep (ILMS). All episodes with significant heart rate increases were identified following procedures established by Cassel et al., (2016, see further on for citation) ie a slope of linear regression ≥2.5 beats per minute over five consecutive heartbeats. Severity of RLS was evaluated using the International Restless Legs Study Group Scale (IRLS). RESULTS RLS patients had significantly more heart rate increases than controls (67.88/hr vs. 9.87/hr). RLS patients had a significantly greater percentage of both LMS and PLMS occurring with heart rate increases than controls (44% vs. 30%; 48% vs. 18%, respectively). These measures correlated significantly with IRLS and also PLMS/hr. 85% of the RLS patients with IRLS scores >22 or PLMS >50/hr had rates of sympathetic activation that were >90th percentile for the healthy controls. CONCLUSION This is the first paper documenting that RLS patients showed clearly increased sympathetic activation when identified independent of PLMS. This, however, occurs for more severe RLS and not milder RLS. It has been proposed that the abnormally high rate of sympathetic activation for RLS patients relates to development of adverse cardiovascular health consequences observed in some studies. Thus, these data may provide a basic standard for possible use in epidemiological studies to identify the level of RLS severity more likely to have adverse health consequences (eg, cardiovascular disease). Since two-thirds of RLS patients have mild to even intermittent disease, including all RLS is likely to miss the potential health consequences of RLS.
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Affiliation(s)
- Byungjoo Jin
- School of Arts and Sciences, Johns Hopkins University, USA
| | - Allan Wang
- Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Christopher Earley
- Dept of Neurology, Hopkins Bayview Medical Center, Johns Hopkins University, USA
| | - Richard Allen
- Dept of Neurology, Hopkins Bayview Medical Center, Johns Hopkins University, USA.
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14
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Han SH, Park KY, Kim JM, Youn YC, Shin HW. Restless legs syndrome is associated with arterial stiffness and clinical outcome in stroke patients. Sleep Med 2019; 60:219-223. [PMID: 31186216 DOI: 10.1016/j.sleep.2019.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Restless legs syndrome (RLS) has been associated with vascular diseases, including cerebrovascular and cardiovascular diseases. Among the various mechanisms in RLS, peripheral vascular endothelial dysfunction in patients with RLS has recently been proposed as a vascular pathophysiology of RLS. This study investigated arterial stiffness related to RLS in acute ischemic stroke patients and its influence on stroke outcome. METHODS RLS in patients with acute ischemic stroke was assessed based on the four essential criteria of the International Restless Legs Syndrome Study Group described in 2003. The patients' clinical and laboratory characteristics, arterial stiffness, small vessel disease occurrence, and burden on brain MRI were recorded. Stroke severity was determined using the National Institute of Health Stroke Scale (NIHSS), and clinical outcomes were determined using the modified Rankin Scale. RESULTS Of 296 patients with acute ischemic stroke, 16 (5.4%) were diagnosed with restless legs syndrome. Logistic regression analysis showed that a 1 m/s increase in brachial arterial pulse wave velocity was associated with the diagnosis of RLS (odds ratio, 1.092; 95% confidence interval, 1.019-1.170, p = 0.012). Diagnosis of RLS in patients with acute ischemic stroke was associated with poor clinical outcome three months after stroke (modified Rankin Scale 3-6) (odds ratio, 4.263; 95% confidence interval, 1.229-14.792, p = 0.022) along with initial NIHSS score. CONCLUSION RLS in patients with acute ischemic stroke is associated with increased arterial stiffness and poor clinical outcomes.
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Affiliation(s)
- Su-Hyun Han
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Young Chul Youn
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea.
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15
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Roshi, Tandon VR, Mahajan A, Sharma S, Khajuria V. Comparative Efficacy and Safety of Clonazepam versus Nortriptyline in Restless Leg Syndrome among Forty Plus Women: A Prospective, Open-Label Randomized Study. J Midlife Health 2019; 10:197-203. [PMID: 31942156 PMCID: PMC6947720 DOI: 10.4103/jmh.jmh_26_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Aims and Objectives: The aim of this study is to compare the effect of clonazepam and nortriptyline on rate, frequency, and severity of restless leg syndrome (RLS) in above 40 years women suffering from RLS. Materials and Methods: A prospective, randomized, open-label comparative study was conducted at a tertiary care teaching hospital for 1 year. Restless legs syndrome (RLS) diagnosis was based on four essential clinical criteria established by the International RLS Study Group in 2003. Patients were randomized into two groups. Group 1 received tablet clonazepam 0.5 mg bedtime orally daily. Group 2 received tablet nortriptyline 25 mg bedtime orally daily. The primary efficacy endpoints by the International Restless leg Syndrome Scale (IRLS) were evaluated at 0, 4, and 8 weeks. Adverse drug events and safety assessment for vital signs such as blood pressure, pulse, heart rate, waist circumference, and body mass index were compared between two groups. Results: Effect on mean IRLSS was statistically more in clonazepam group in comparison to nortriptyline group with comparable results at 8 weeks (P < 0.001), but at 4 weeks, nortriptyline showed less improvement (P < 0.01) versus P < 0.001 in nortriptyline group. Thus, nortriptyline reported relatively more improvement on IRLSS numerically in comparison to clonazepam. Nortriptyline proved to be statistically better in improving the frequency of RLS with comparison to clonazepam, whereas the results were comparable with regard to rate and the severity of RLS. Both the groups were relatively safe and did not produce any change in biochemical parameters and were free from any serious or severe adverse events and overall, both the treatments were well tolerated. Conclusion: Both the drugs provided clinically and statistical significant effect on RLS when compared with their respective baselines. However, nortriptyline proved to be statistically better in improving the frequency of RLS in comparison to clonazepam, whereas the results were comparable with regard to rate and the severity of RLS on intergroup comparison. Both the drugs were well tolerated.
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Affiliation(s)
- Roshi
- Department of Pharmacology and Therapeutic, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Vishal R Tandon
- Department of Pharmacology and Therapeutic, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Annil Mahajan
- Department of General Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Sudhaa Sharma
- Department of Obstetrics and Gynecology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Vijay Khajuria
- Department of Pharmacology and Therapeutic, Government Medical College, Jammu, Jammu and Kashmir, India
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16
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Lin S, Zhang H, Gao T, Zhong F, Sun Y, Cai J, Ma A. The association between obesity and restless legs syndrome: A systemic review and meta-analysis of observational studies. J Affect Disord 2018; 235:384-391. [PMID: 29674254 DOI: 10.1016/j.jad.2018.04.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/19/2018] [Accepted: 04/04/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Restless legs syndrome (RLS) has been reported to occur more frequently in obese individuals than in those with normal weight. In this study, a systematic review and meta-analysis was performed to explore the relationship between obesity and RLS. METHODS Published articles were identified through a comprehensive review of PUBMED and EMBASE from inception to the 16th December 2017. Data from studies reporting relative risks, odds ratios, or hazard ratios comparing the risk of RLS among individuals with obesity versus people with normal weight were analyzed. A random-effect model was used to calculate pooled odds ratios and 95% confident intervals (CI) for the association between obesity and RLS. RESULTS Findings for a total of 197,204 participants were pooled across 15 studies and were examined. Our analyses demonstrated a positive association between obesity and RLS, with an odds ratio (OR) of 1.44 (95%CI: 1.31-1.58, I2 = 62.3%). Overweight subjects were also likely to have RLS, with an odds ratio of 1.29 (95%CI: 1.22-1.36, I2 = 0). In subgroup analysis, women (OR = 1.42) with obesity were more likely to have RLS as compared with men (OR = 1.19). CONCLUSIONS Adults with obesity are more likely to suffer from RLS, with women at higher risk.
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Affiliation(s)
- Song Lin
- The ColleSge of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China
| | - Huaqi Zhang
- The ColleSge of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China
| | - Tianlin Gao
- The ColleSge of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China
| | - Feng Zhong
- The ColleSge of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China
| | - Yongye Sun
- The ColleSge of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China
| | - Jing Cai
- The ColleSge of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China
| | - Aiguo Ma
- The ColleSge of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China.
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Hwang IC, Na KS, Lee YJ, Kang SG. Higher Prevalence of Hypertension among Individuals with Restless Legs Syndrome: A Meta-Analysis. Psychiatry Investig 2018; 15:701-709. [PMID: 29898579 PMCID: PMC6056689 DOI: 10.30773/pi.2018.02.26] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/14/2018] [Accepted: 02/26/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study investigated the proposed association between restless legs syndrome (RLS) and the prevalence of hypertension. METHODS A meta-analysis was conducted based on searches of the PUBMED, EMBASE, Cochrane Library, and Korean electronic databases. Cohort and cross-sectional studies reporting the incidence of hypertension in individuals with RLS were included. Dichotomous data were pooled to obtain an odds ratio (OR) and 95% confidence interval (CI) for the prevalence of hypertension in individuals with RLS. The main outcome measure of the study was prevalence of hypertension in patients with RLS compared with a control group. RESULTS One cohort study and eight cross-sectional studies were included in the meta-analysis. Individuals with RLS had an increased prevalence of hypertension (all studies: OR=1.13, 95% CI=1.04-1.23; cross-sectional studies: OR=1.12, 95% CI=1.01-1.24). However, in subgroup analyses controlling for cardiovascular risk factors, such as diabetes mellitus and dyslipidemia, the differences in the prevalence of hypertension between RLS and control patients were no longer significant. CONCLUSION Patients with RLS may have a higher prevalence of hypertension, according to a pooled analysis, but the results remain to be confirmed in well-designed prospective studies.
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Affiliation(s)
- In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Didriksen M, Hansen TF, Thørner LW, Burgdorf KS, Erikstrup C, Pedersen OB, Paarup HM, Nielsen KR, Hjalgrim H, Sørensen E, Ullum H. Restless legs syndrome is associated with increased risk of migraine. CEPHALALGIA REPORTS 2018. [DOI: 10.1177/2515816318780743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Migraine and restless legs syndrome (RLS) are common disorders that are associated with a high level of individual suffering and major comorbidities. The aetiologies of the disorders are largely unknown, although both migraine and RLS have been linked to disturbances in the dopaminergic system and sleep issues, suggesting a relationship between the disorders. This study examines the association between RLS and migraine in a large population of otherwise healthy adults who are not taking medication. Cross-sectional study that included 20,938 participants enrolled in the Danish Blood Donor Study from 1 May 2015 to 1 February 2017. The study included complete information on migraines, the Cambridge-Hopkins RLS questionnaire, the Major Depression Inventory Scale, sex, age, body mass index (BMI), educational level, smoking status and alcohol consumption. Associations between RLS and migraine, with and without aura, were examined using multivariable logistic regression analysis. Among the participants, 4827 were self-reported migraine sufferers and 1091 were classified as suffering from RLS. Individuals with RLS had an increased risk of migraine compared to non-RLS sufferers, with an odds ratio (OR) = 1.52 (95% confidence interval: 1.33–1.73). For the investigated subtypes of migraine, this association was found to be OR = 1.55 (1.31–1.83) for migraines with aura and OR = 1.29 (1.09–1.52) for migraines without aura. We found a significantly increased occurrence of migraine in individuals with RLS. This risk was independent of sex, age, BMI, educational level, smoking status, alcohol consumption and depressive disorder. Our findings suggest that RLS and migraine may have a common aetiology.
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Affiliation(s)
- Maria Didriksen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas F Hansen
- Department of Neurology, Danish Headache Center, Glostrup Research Institute, Copenhagen University Hospital Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Lise W Thørner
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristoffer S Burgdorf
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole B Pedersen
- Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - Helene M Paarup
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Kaspar R Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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19
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Giannaki CD, Aristotelous P, Stefanakis M, Hadjigeorgiou GM, Manconi M, Leonidou E, Sakkas GK, Pantzaris M. Restless legs syndrome in Multiple Sclerosis patients: a contributing factor for fatigue, impaired functional capacity, and diminished health-related quality of life. Neurol Res 2018; 40:586-592. [DOI: 10.1080/01616412.2018.1454719] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Christoforos D. Giannaki
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - Manos Stefanakis
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
- Neurology Department Inselspital, Bern University Hospital, Bern, Switzerland
| | - Eleni Leonidou
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Giorgos K. Sakkas
- Faculty of Sport and Health Sciences, University of St Mark & St John, Plymouth, UK
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Liu Y, Liu G, Li L, Yang J, Ma S. Evaluation of Cardiovascular Risk Factors and Restless Legs Syndrome in Women and Men: A Preliminary Population-Based Study in China. J Clin Sleep Med 2018; 14:445-450. [PMID: 29458704 DOI: 10.5664/jcsm.6996] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/12/2017] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES Many studies have investigated the association between restless legs syndrome (RLS) and cardiovascular risk factors, leading to conflicting results. Therefore, the aim of the current study was to determine whether RLS is associated with cardiovascular risk factors and disease. METHODS This cross-sectional study included 5,324 consecutive subjects who visited the Physical Examination Center of The First Affiliated Hospital of Zhengzhou University for their yearly routine physical examination. Participants underwent a face-to-face interview with a neurologist for the assessment of RLS, based on the International Restless Legs Study Group criteria. They also completed a questionnaire related to cardiovascular risk factors and other health-related and demographic information. Logistic regression was used to assess which of the demographic and cardiovascular risk factors increased the odds of RLS. Then, unadjusted and adjusted models were designed to determine whether RLS was associated with increased odds of cardiovascular disease, coronary artery disease, or hypertension. RESULTS RLS was observed in 9.2% of the participants. Multivariable logistic regression models, which included the covariates age, sex, body mass index, smoking status, hypercholesterolemia, and Pittsburgh Sleep Quality Index score (dichotomized at 5), demonstrated that female sex (odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.99-2.95), smoking (OR: 1.96, 95% CI: 1.31-2.92), high cholesterol (OR: 1.30, 95% CI: 1.03-1.64), and PSQI score > 5 (OR: 5.61, 95% CI: 2.14-14.69) are significantly associated with RLS. Additionally, RLS was associated with hypertension, after adjusting for age, sex, body mass index, smoking, hypercholesterolemia, Pittsburgh Sleep Quality Index score > 5, diabetes, anemia, and decreased renal function. CONCLUSIONS RLS is associated with the prevalence of hypertension but not with that of cardiovascular disease or coronary artery disease.
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Affiliation(s)
- Yuqiong Liu
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.,Department of Pathology, School of Basic Medicine, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Gangqiong Liu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Ling Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jing Yang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shengli Ma
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
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21
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Calviño J, Cigarrán S, Gonzalez-Tabares L, Guijarro M, Millán B, Cobelo C, Cillero S, Sobrido MJ. Restless Legs Syndrome: An Unresolved Uremic Disorder after Renal Transplantation. Nephron Clin Pract 2018; 139:23-29. [DOI: 10.1159/000486401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/17/2017] [Indexed: 11/19/2022] Open
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Cholley-Roulleau M, Chenini S, Béziat S, Guiraud L, Jaussent I, Dauvilliers Y. Restless legs syndrome and cardiovascular diseases: A case-control study. PLoS One 2017; 12:e0176552. [PMID: 28445539 PMCID: PMC5406016 DOI: 10.1371/journal.pone.0176552] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/12/2017] [Indexed: 01/18/2023] Open
Abstract
Objective The association between restless legs syndrome (RLS), cardiovascular diseases (CVD) and hypertension is inconsistent. This case-control study examined i) the association between primary RLS, CVD and hypertension by taking into account many potential confounders and ii) the influence of RLS duration, severity and treatment, sleep and depressive symptoms on CVD and hypertension in primary RLS. Methods A standardized questionnaire to assess the RLS phenotype, history of CVD and hypertension, sleep and depressive symptoms, drug intake and demographic/clinical features was sent to the France-Ekbom Patients Association members. A CVD event was defined as a self-reported history of coronary heart disease, heart failure, arrhythmia or stroke. Hypertension was also self-assessed. Current treatment for hypertension and arrhythmia also defined underlying hypertension and arrhythmia. Controls without RLS and without consanguinity were chosen by the patients. Results 487 patients with primary RLS (median age 71 years; 67.4% women) and 354 controls (68 years, 47.7% women) were included. Most of the patients (91.7%) were treated for RLS, especially with dopaminergic agonists. The median age of RLS onset was 45 years. CVD and hypertension were associated with RLS in unadjusted association, but not after adjustment for age, sex and body mass index. Patients with RLS and with CVD and/or hypertension were significantly older, with hypercholesterolemia, sleep apnea and older age at RLS and at daily RLS onset compared with patients without CVD and/or hypertension. No significant difference was found for other RLS features, ferritin levels, daytime sleepiness, insomnia and depressive symptoms. Conclusion Despite some limitations in the design of this study, we found that most of the treated patients for primary RLS had no association with CVD and hypertension after controlling for key potential confounders. Comorbid CVD or hypertension was associated with cardiovascular risk factors, but not with RLS features except for older age at onset.
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Affiliation(s)
| | - Sofiene Chenini
- Unité des Troubles du Sommeil, Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Séverine Béziat
- Inserm, U1061, Montpellier, France
- Université Montpellier, Montpellier, France
| | - Lily Guiraud
- Unité des Troubles du Sommeil, Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Isabelle Jaussent
- Inserm, U1061, Montpellier, France
- Université Montpellier, Montpellier, France
| | - Yves Dauvilliers
- Unité des Troubles du Sommeil, Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
- Inserm, U1061, Montpellier, France
- Université Montpellier, Montpellier, France
- * E-mail:
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Winkelman JW, Blackwell T, Stone K, Ancoli-Israel S, Redline S. Associations of Incident Cardiovascular Events With Restless Legs Syndrome and Periodic Leg Movements of Sleep in Older Men, for the Outcomes of Sleep Disorders in Older Men Study (MrOS Sleep Study). Sleep 2017; 40:2982980. [PMID: 28199705 PMCID: PMC5806566 DOI: 10.1093/sleep/zsx023] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Study Objectives Both restless legs syndrome (RLS) and periodic leg movements in sleep (PLMS) may be associated with incident cardiovascular disease (CVD). However, the individual contributions of these factors to adverse CVD outcomes are unknown. Methods During the MrOS Sleep Study, 2823 men (mean age = 76.3 years) participated in a comprehensive sleep assessment from 2000 to 2002. RLS was identified by self-report of a physician diagnosis of RLS. A periodic limb movement of sleep index (PLMI) was derived from unattended in-home polysomnography. Incident cardiovascular events were centrally adjudicated during 8.7 ± 2.6 years of follow-up. The primary outcome was all-cause CVD; secondary outcomes included incident myocardial infarction (MI) and cerebrovascular disease. Cox proportional hazards regression models were adjusted for multiple covariates, including PLMI, to examine if there were independent associations of RLS and PLMI to the outcomes. Results Physician-diagnosed RLS was reported by 2.2% and a PLMI ≥ 15 was found in 59.6% of men. RLS was not associated with the composite CVD outcome. RLS was significantly associated with incident MI (Hazard ratio [HR] = 2.02, 95% CI, 1.04-3.91) even after adjustment for multiple covariates. Results were only modestly attenuated when PLMI was added to the model. PLMI also was found to predict incident MI (per SD increase in PLMI, HR = 1.14, 95% CI, 1.00-1.30, p = .05), and was materially unchanged after addition of RLS. Conclusions The independent risk that RLS confers for MI suggests a role for non-PLMS factors such as sleep disturbance, shared genetic factors, or PLM-independent sympathetic hyperactivity.
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Affiliation(s)
- John W Winkelman
- Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School,Boston, MA
| | - Terri Blackwell
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Sonia Ancoli-Israel
- Departments of Psychiatry and Medicine, University of California, San Diego, CA
| | - Susan Redline
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Kendzerska T, Kamra M, Murray BJ, Boulos MI. Incident Cardiovascular Events and Death in Individuals With Restless Legs Syndrome or Periodic Limb Movements in Sleep: A Systematic Review. Sleep 2017; 40:2979287. [DOI: 10.1093/sleep/zsx013] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Özsimsek A, Koyuncuoglu HR. Electrophysiological findings of Turkish patients with restless legs syndrome. Neuropsychiatr Dis Treat 2017; 13:2005-2010. [PMID: 28794635 PMCID: PMC5538691 DOI: 10.2147/ndt.s132903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We aimed to investigate changes in electrophysiological findings in Turkish patients with restless legs syndrome (RLS), including F-wave latency (FWL), peripheral silent period (PSP), and Hoffmann reflex. The study took place in a university hospital in Turkey and involved 30 newly diagnosed RLS patients and 30 healthy controls who were matched for age and gender. Participant's demographics (age, gender, weight, and height), laboratory findings, and electrophysiological test outcomes were gathered and analyzed. There was no significant difference in the FWL of the median and ulnar nerves, whereas the H-wave maximum amplitude and H/M ratio were significantly higher in the RLS patients than in the controls at rest. All of the PSP parameters were similar between patients and controls for the abductor pollicis brevis and gastrocnemius muscles. However, for the tibialis anterior muscle, all the PSP duration parameters were shorter in the RLS patients, whereas the PSP latency parameters were similar. The data suggest that there may be a reduction in spinal segmental inhibition at the L4-L5-S1 level, but the mechanisms of inhibition at the L4-L5 and S1 levels may be different; furthermore, there may be no pathology in the peripheral nerves. Further prospective studies with larger cohorts are now needed to evaluate the pathophysiology of RLS with different neurophysiological assessment tools.
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Restless legs syndrome and cardiovascular disease: a research roadmap. Sleep Med 2016; 31:10-17. [PMID: 28065687 DOI: 10.1016/j.sleep.2016.08.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 12/14/2022]
Abstract
In this paper, we first critically appraise the epidemiologic literature examining the association of restless legs syndrome (RLS) with cardiovascular disease (CVD) and then consider whether lessons learned from the study of cardiovascular consequences of other sleep disorders might inform a research agenda to examine the potential mechanisms of cardiovascular morbidity of RLS. Cross-sectional and longitudinal studies are both mixed as to whether there is a meaningful association of RLS and CVD. On the other hand, numerous cross-sectional and longitudinal observational studies have shown a strong association of obstructive sleep apnea (OSA) with CVD risk. Each of the potential mediating mechanisms in OSA may also be assessed in RLS, including 1) neural mechanisms such as increased central sympathetic outflow, impaired baroreflex function, diminished heart rate and blood pressure variability, and increased chemoreflex sensitivity, 2) metabolic mechanisms such as glucose intolerance and reduced insulin sensitivity/diabetes as a result of sleep disturbance in RLS, 3) oxidative stress, 4) systemic or vascular inflammatory mechanisms, and 5) vascular mechanisms including impaired endothelial functioning, increased aortic stiffness, hypothalamic-pituitary axis activation or renin-angiotensin-aldosterone activation. Three known characteristics of RLS may contribute to these specific mechanisms of increased cardiovascular risk: 1) periodic limb movements of sleep, which are associated with large increases in heart rate and blood pressure, 2) sleep fragmentation and sleep deprivation, which are known to produce adverse consequences for neural, metabolic, oxidative, inflammatory, and vascular systems, and 3) iron deficiency, which is an emerging risk for cardiovascular disease. Future research priorities include additional epidemiologic studies which characterize multiple CVD risk factors, case-control studies which examine known markers of cardiovascular risk, and small clinical trials which assess the effects of RLS treatment on intermediate physiological markers such as sympathetic activity or baroreflex control, measures of vascular stiffness and reactivity, or measures of insulin sensitivity and glucose tolerance.
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Longitudinal relationships of periodic limb movements during sleep and incident atrial fibrillation. Sleep Med 2016; 25:78-86. [PMID: 27823721 DOI: 10.1016/j.sleep.2016.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/17/2016] [Accepted: 08/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to examine relationship between periodic limb movements during sleep (PLMS) and incident atrial fibrillation/flutter (AF). METHODS Prospective multicenter cohort (n = 2273: adjudicated AF group; n = 843: self-reported AF group) of community-dwelling men without prevalent AF were followed for an average of 8.3 years (adjudicated) and 6.5 years (self-reported). PLMS index (PLMI, <5 (ref), ≥5 to <30, ≥30) and PLM arousal index (PLMAI, <1 (ref), ≥1 to <5, ≥5) were measured by polysomnography. Incident adjudicated and self-reported AF were analyzed by Cox proportional hazards and logistic regression, respectively, and adjusted for age, clinic, race, body mass index (BMI), alcohol use, cholesterol level, cardiac medications, pacemaker, apnea-hypopnea index, renal function, and cardiac risk. The interaction of age and PLMS was examined. RESULTS In this primarily Caucasian (89.8%) cohort of older men (mean age 76.1 ± 5.5 years) with BMI of 27.2 ± 3.7, there were 261 cases (11.5%) of adjudicated and 85 cases (10.1%) of self-reported incident AF. In the overall cohort, PLMI and PLMAI were not associated with adjudicated or self-reported AF. There was some evidence of an interaction of age and PLMI (p = 0.08, adjudicated AF) and PLMAI (p ≤ 0.06, both outcomes). Among men aged ≥76 years, the highest PLMI tertile was at increased risk of adjudicated AF (≥30 vs. <5; hazard ratio (HR) = 1.63, 1.01-2.63) and the middle PLMAI tertile predicted increased risk of both outcomes (1 to <5 vs. <1; adjudicated, HR = 1.65, 1.05-2.58; self-reported HR = 5.76, 1.76-18.84). No such associations were found in men aged <76 years. CONCLUSIONS Although PLMS do not predict AF incidence in the overall cohort, the findings suggest PLMS increases incident AF risk in the older subgroup.
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Safak ED, Gocer S, Mucuk S, Ozturk A, Akin S, Arguvanli S, Mazicioglu MM. The prevalence and related factors of restless leg syndrome in the community dwelling elderly; in Kayseri, Turkey: A cross-sectional study. Arch Gerontol Geriatr 2016; 65:29-35. [DOI: 10.1016/j.archger.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/17/2015] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
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Calandra-Buonaura G, Provini F, Guaraldi P, Plazzi G, Cortelli P. Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev 2016; 26:43-56. [DOI: 10.1016/j.smrv.2015.05.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/08/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
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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; 86:1336-1343. [PMID: 26944272 DOI: 10.1212/wnl.0000000000002542] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/10/2015] [Indexed: 12/21/2022] Open
Abstract
Recent publications on both the genetics and environmental factors of restless legs syndrome (RLS) defined as a clinical disorder suggest that overlapping genetic risk factors may play a role in primary (idiopathic) and secondary (symptomatic) RLS. Following a systematic literature search of RLS associated with comorbidities, we identified an increased prevalence of RLS only in iron deficiency and kidney disease. In cardiovascular disease, arterial hypertension, diabetes, migraine, and Parkinson disease, the methodology of studies was poor, but an association might be possible. There is insufficient evidence for conditions such as anemia (without iron deficiency), chronic obstructive pulmonary disease, multiple sclerosis, headache, stroke, narcolepsy, and ataxias. Based on possible gene-microenvironmental interaction, the classifications primary and secondary RLS may suggest an inappropriate causal relation. We recognize that in some conditions, treatment of the underlying disease should be achieved as far as possible to reduce or eliminate RLS symptoms. RLS might be seen as a continuous spectrum with a major genetic contribution at one end and a major environmental or comorbid disease contribution at the other.
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Affiliation(s)
- Claudia Trenkwalder
- From Center of Parkinsonism and Movement Disorders (C.T.), Paracelsus-Elena Hospital, Kassel; Departments of Neurosurgery (C.T.) and Clinical Neurophysiology (W.P.), University Medical Center, Göttingen, Germany; Department of Neurology (R.A.), The Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (B.H.), Medical University of Innsbruck, Austria; Institute for Neurogenomic (J.W.), Helmholtz Zentrum München, Neuherberg; Neurologische Klinik und Poliklinik (J.W.), Klinikum rechts der Isar, Technische Universität München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (J.W.), Munich, Germany.
| | - Richard Allen
- From Center of Parkinsonism and Movement Disorders (C.T.), Paracelsus-Elena Hospital, Kassel; Departments of Neurosurgery (C.T.) and Clinical Neurophysiology (W.P.), University Medical Center, Göttingen, Germany; Department of Neurology (R.A.), The Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (B.H.), Medical University of Innsbruck, Austria; Institute for Neurogenomic (J.W.), Helmholtz Zentrum München, Neuherberg; Neurologische Klinik und Poliklinik (J.W.), Klinikum rechts der Isar, Technische Universität München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (J.W.), Munich, Germany
| | - Birgit Högl
- From Center of Parkinsonism and Movement Disorders (C.T.), Paracelsus-Elena Hospital, Kassel; Departments of Neurosurgery (C.T.) and Clinical Neurophysiology (W.P.), University Medical Center, Göttingen, Germany; Department of Neurology (R.A.), The Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (B.H.), Medical University of Innsbruck, Austria; Institute for Neurogenomic (J.W.), Helmholtz Zentrum München, Neuherberg; Neurologische Klinik und Poliklinik (J.W.), Klinikum rechts der Isar, Technische Universität München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (J.W.), Munich, Germany
| | - Walter Paulus
- From Center of Parkinsonism and Movement Disorders (C.T.), Paracelsus-Elena Hospital, Kassel; Departments of Neurosurgery (C.T.) and Clinical Neurophysiology (W.P.), University Medical Center, Göttingen, Germany; Department of Neurology (R.A.), The Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (B.H.), Medical University of Innsbruck, Austria; Institute for Neurogenomic (J.W.), Helmholtz Zentrum München, Neuherberg; Neurologische Klinik und Poliklinik (J.W.), Klinikum rechts der Isar, Technische Universität München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (J.W.), Munich, Germany
| | - Juliane Winkelmann
- From Center of Parkinsonism and Movement Disorders (C.T.), Paracelsus-Elena Hospital, Kassel; Departments of Neurosurgery (C.T.) and Clinical Neurophysiology (W.P.), University Medical Center, Göttingen, Germany; Department of Neurology (R.A.), The Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Neurology (B.H.), Medical University of Innsbruck, Austria; Institute for Neurogenomic (J.W.), Helmholtz Zentrum München, Neuherberg; Neurologische Klinik und Poliklinik (J.W.), Klinikum rechts der Isar, Technische Universität München, Munich; and Munich Cluster for Systems Neurology (SyNergy) (J.W.), Munich, Germany.
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Bertisch SM, Muresan C, Schoerning L, Winkelman JW, Taylor JA. Impact of Restless Legs Syndrome on Cardiovascular Autonomic Control. Sleep 2016; 39:565-71. [PMID: 26564128 DOI: 10.5665/sleep.5528] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/01/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To examine whether patients with restless legs syndrome demonstrate specific alterations in cardiovascular autonomic control. METHODS Patients with moderate-severe restless legs syndrome (n = 20, 80% female) and controls (n = 20) matched for age, sex, body mass index, and free of hypertension and cardiovascular disease were enrolled. We assessed cardiovagal baroreflex gain via the modified Oxford technique, sympathetically mediated vascular responses to isometric exercise to fatigue, bradycardiac response to Valsalva maneuver, and respiratory sinus arrhythmia during paced breathing. Standard electrocardiography, beat-by-beat arterial pressure, respiration, and popliteal blood flow velocity were recorded continuously. RESULTS Resting blood pressure and heart rate were similar between groups. However, baroreflex gain averaged 14.3 ± 1.4 msec/mm Hg in restless legs syndrome and was lower than in controls (22.6 ± 3.5 msec/mm Hg, P = 0.04). Hemodynamic responses to isometric exercise were similar between groups, though participants with restless legs syndrome had lower leg blood flow (P < 0.001), with greater leg vascular resistance (P < 0.0001), before and during isometric exercise. Respiratory sinus arrhythmia and Valsalva ratios were similar between groups. Neither baroreflex gain nor vascular resistance was correlated with sleep duration, sleep quality, or symptom duration. CONCLUSION Patients with restless legs syndrome demonstrate compromised cardiovagal control, specific to the arterial baroreflex, with greater peripheral vascular resistance, potentially due to heightened sympathetic outflow. These autonomic alterations may directly relate to the higher prevalence of cardiovascular disease in restless legs syndrome.
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Affiliation(s)
- Suzanne M Bertisch
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA
| | - Cristen Muresan
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA
| | - Laura Schoerning
- Departments of Psychiatry and Neurology, Sleep Disorders Clinical Research Program, Massachusetts General Hospital, Boston, MA
| | - John W Winkelman
- Departments of Psychiatry and Neurology, Sleep Disorders Clinical Research Program, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - J Andrew Taylor
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
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Hoogwout SJ, Paananen MV, Smith AJ, Beales DJ, O'Sullivan PB, Straker LM, Eastwood PR, McArdle N, Champion D. Musculoskeletal pain is associated with restless legs syndrome in young adults. BMC Musculoskelet Disord 2015; 16:294. [PMID: 26467305 PMCID: PMC4607251 DOI: 10.1186/s12891-015-0765-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 10/08/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In recent years, there is considerable evidence of a relationship between the sensorimotor disorder restless legs syndrome (RLS) and pain disorders, including migraine and fibromyalgia. An association between multi-site pain and RLS has been reported in adult women. In the current study, we explored the association between musculoskeletal (MSK) pain and RLS in a large cohort of young adults. METHODS Twenty two year olds (n = 1072), followed since birth of part of the Western Australian Pregnancy Cohort (Raine) Study, provided data on MSK pain (duration, severity, frequency, number of pain sites). RLS was considered present when 4 diagnostic criteria recommended by the International Restless Legs Syndrome Study Group were met (urge to move, dysaesthesia, relief by movement, worsening symptoms during the evening/night) and participants had these symptoms at least 5 times per month. Associations between MSK pain and RLS were analyzed by multivariable logistic regression with bias-corrected bootstrapped confidence intervals, with final models adjusted for sex, psychological distress and sleep quality. RESULTS The prevalence of RLS was 3.0 % and MSK pain was reported by 37.4 % of the participants. In multivariable logistic regression models, strong associations were found between RLS-diagnosis and long duration (three months or more) of MSK pain (odds ratio 3.6, 95 % confidence interval 1.4-9.2) and reporting three or more pain sites (4.9, 1.6-14.6). CONCLUSIONS Different dimensions of MSK pain were associated with RLS in young adults, suggestive of shared pathophysiological mechanisms. Overlap between these conditions requires more clinical and research attention.
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Affiliation(s)
- Stijn J Hoogwout
- Faculty of Medical Sciences, University of Groningen, PO Box 72, 9700 AB, Groningen, The Netherlands.
- , Offenbachlaan 14, 2253 CR, Voorschoten, The Netherlands.
| | - Markus V Paananen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland.
| | - Anne J Smith
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Darren J Beales
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Peter B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Peter R Eastwood
- Centre for Sleep Science, School of Anatomy, Physiology & Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Nigel McArdle
- Centre for Sleep Science, School of Anatomy, Physiology & Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - David Champion
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia.
- University of New South Wales, UNSW, Sydney, NSW, 2052, Australia.
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33
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Rist PM, Elbaz A, Dufouil C, Tzourio C, Kurth T. Restless Legs Syndrome and Cognitive Function: A Population-based Cross-sectional Study. Am J Med 2015; 128:1023.e33-9. [PMID: 25912201 DOI: 10.1016/j.amjmed.2015.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/17/2015] [Accepted: 04/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Restless legs syndrome has been speculated to be linked to cognitive impairment through vascular risk factors or through its effect on sleep deprivation. Previous studies on the association between restless legs syndrome and cognitive function have been inconclusive. We performed a cross-sectional analysis of the association between restless legs syndrome and cognitive function using data from a large population-based study of elderly individuals residing in France. METHODS We used information from 2070 individuals from the Dijon, France center of the Three-City study who had available information on restless legs syndrome and cognitive functioning measures. Restless legs syndrome was assessed using the 4 minimal diagnostic criteria of the International Restless Legs Study Group. During the same wave in which restless legs syndrome status was assessed, cognitive functions also were assessed using 4 tests: Isaacs' test of verbal/category fluency, the Benton Visual Retention Test, the Trail Making Test B, and the Mini-Mental State Examination. We created a summary global cognitive score by summing the z scores for the 4 tests and used analysis of covariance to explore the association between restless legs syndrome and cognitive function. RESULTS We did not observe any statistically significant differences in any cognitive z-score between those with restless legs syndrome and those without restless legs syndrome. The mean global z-score after multivariate adjustment was -0.003 (SE 0.173) for those with restless legs syndrome and -0.007 (SE 0.129) for those without restless legs syndrome (P-value = .98). CONCLUSION Data from this large, population-based study do not suggest that restless legs syndrome is associated with prevalent cognitive deficits in elderly individuals.
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Affiliation(s)
- Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Mass
| | - Alexis Elbaz
- Social and Occupational Determinants of Health, INSERM Centre for Research in Epidemiology and Population Health, Villejuif, France; Université de Versailles St-Quentin, UMRS 1018, Versailles, France
| | - Carole Dufouil
- Team Neuroepidemiology, INSERM Research Center for Epidemiology and Biostatistics, Bordeaux, France; College of Health Sciences, University of Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- Team Neuroepidemiology, INSERM Research Center for Epidemiology and Biostatistics, Bordeaux, France; College of Health Sciences, University of Bordeaux, Bordeaux, France
| | - Tobias Kurth
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Mass; Team Neuroepidemiology, INSERM Research Center for Epidemiology and Biostatistics, Bordeaux, France; College of Health Sciences, University of Bordeaux, Bordeaux, France.
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34
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Wong JC, Li W, Gao X. Restless Legs Syndrome as a Prognostic Tool for Cardiovascular Disease. Sleep 2015; 38:995-6. [PMID: 26085294 DOI: 10.5665/sleep.4790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 11/03/2022] Open
Affiliation(s)
- Janice C Wong
- Department of Neurology, Brigham and Women's Hospital; Department of Neurology, Massachusetts General Hospital; Harvard Medical School, Boston, MA
| | - Weijuan Li
- Department of Medicine, Albert Einstein College of Medicine
| | - Xiang Gao
- Department of Nutritional Health, Pennsylvania State University, University Park, PA
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35
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Catzín-Kuhlmann A, Juárez-Armenta A, Ortiz-Panozo E, Monge-Urrea A, Puchner KP, Cantú-Brito C, López-Ridaura R, Rice MS, Kurth T, Lajous M. Restless Legs Syndrome and Hypertension in Mexican Women. Mov Disord Clin Pract 2015; 2:274-279. [PMID: 30363504 DOI: 10.1002/mdc3.12201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 03/25/2015] [Accepted: 04/07/2015] [Indexed: 12/21/2022] Open
Abstract
Background RLS is a common chronic disorder characterized by an irresistible need to move the lower limbs that affects sleep. Poor sleep has been associated with increased blood pressure (BP). Thus, we evaluated the cross-sectional relationship between RLS and hypertension (HTN) in a large cohort study in Mexico. Methods In 2011, 54,925 female participants from the Mexican Teachers' Cohort responded to a four-item questionnaire based on the International Restless Legs Syndrome Study Group's minimal diagnostic criteria. Women also reported diagnosis and treatment of HTN. We used multivariable logistic regression models to estimate prevalence odds ratios (ORs) for HTN, adjusting for lifestyle and dietary factors. We also estimated adjusted prevalence ORs for HTN by frequency of RLS symptoms. Results We identified 9,230 cases (17%) of RLS, and the prevalence of HTN was 13.1% among women with RLS and 9.4% among those without RLS. The multivariable-adjusted prevalence OR for HTN comparing women with to those without RLS was 1.18 (95% confidence interval [CI]: 1.10-1.26). Compared to those without RLS, the prevalence OR of HTN in women reporting a symptom frequency of once a month or less was 1.14 (95% CI: 1.00-1.30); among those with symptoms two to four times a month, the OR was 1.17 (95% CI: 1.05-1.30); and for those with symptoms at least two times a week, the OR was 1.22 (95% CI: 1.10-1.35). Conclusion We observed an association between RLS and HTN. Future studies should evaluate the impact of treating RLS on BP.
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Affiliation(s)
- Andrés Catzín-Kuhlmann
- Department of Medicine National Institute of Medical Sciences and Nutrition Mexico City Mexico
| | - Alma Juárez-Armenta
- Center for Research on Population Health National Institute of Public Health Cuernavaca Mexico
| | - Eduardo Ortiz-Panozo
- Center for Research on Population Health National Institute of Public Health Cuernavaca Mexico
| | - Adriana Monge-Urrea
- Center for Research on Population Health National Institute of Public Health Cuernavaca Mexico
| | - Karl P Puchner
- Center for Research on Population Health National Institute of Public Health Cuernavaca Mexico.,Institute of Tropical Medicine and International Health Charité-Universitätsmedizin Berlin Germany
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry National Institute of Medical Sciences and Nutrition Mexico City Mexico
| | - Ruy López-Ridaura
- Center for Research on Population Health National Institute of Public Health Cuernavaca Mexico
| | - Megan S Rice
- Department of Epidemiology Harvard School of Public Health Boston Massachusetts USA.,Channing Division of Network Medicine Brigham & Women's Hospital Boston Massachusetts USA
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics (U897)-Team Neuroepidemiology Bordeaux France.,University of Bordeaux Bordeaux France
| | - Martín Lajous
- Center for Research on Population Health National Institute of Public Health Cuernavaca Mexico.,Inserm, Center for Research in Epidemiology and Population Health (CESP) U1018 Gustave-Roussy Cancer Institute Villejuif France
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Abstract
Restless legs syndrome is a common sensorimotor disorder characterized by an urge to move, and associated with uncomfortable sensations in the legs (limbs). Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Brain iron deficiency and dopaminergic neurotransmission abnormalities play a central role in the pathogenesis of this disorder, along with other nondopaminergic systems, although the exact mechanisms are still. Intensive care unit patients are especially vulnerable to have unmasking or exacerbation of restless legs syndrome because of sleep deprivation, circadian rhythm disturbance, immobilization, iron deficiency, and use of multiple medications that can antagonize dopamine.
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Affiliation(s)
- Saiprakash B Venkateshiah
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Octavian C Ioachimescu
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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37
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Schlesinger I, Erikh I, Nassar M, Sprecher E. Restless legs syndrome in stroke patients. Sleep Med 2015; 16:1006-10. [PMID: 26116464 DOI: 10.1016/j.sleep.2014.12.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/20/2014] [Accepted: 12/19/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) is associated with cerebrovascular risk factors, but its possible association with cerebrovascular disease has yielded conflicting results. OBJECTIVE This was a case-control, in-hospital study to evaluate the association between RLS and acute stroke or transient ischemic attack (TIA). METHODS We evaluated patients hospitalized with acute stroke/TIA and an age and gender 2:1 frequency-matched control group, for the presence of RLS. RESULTS Twenty-two of 149 patients (15%) and 10 of 298 controls (3%) suffered from RLS (p <0.0001). A multivariate logistic regression model employing cerebrovascular risk factors as predictors, that is, hypertension, hyperlipidemia, diabetes, and body mass index (BMI), determined that stroke/TIA was significantly associated with RLS with odds ratio for RLS among patients with stroke/TIA versus controls of 7.60 (95% confidence interval (CI): 2.07-27.87; p = 0.002). Another multivariate logistic regression model adjusting for possible RLS risk factors, that is, hypertension, hyperlipidemia, diabetes, BMI, anemia, and reduced renal function, determined that stroke/TIA was significantly associated with RLS with odds ratio of 6.85 (95% CI: 6.85-1.79; p = 0.005). Stepwise logistic regression with hypertension, hyperlipidemia, diabetes, BMI, anemia, and reduced renal function as potential predictors revealed that only stroke/TIA predicted RLS with similar odds ratio to the RLS-based multivariate model of 6.54 (95% CI: 2.63-16.27; p <0.0001). CONCLUSIONS Examining stroke patients while in hospital allowed us to conclude that RLS and acute stroke/TIA are significantly associated. However, the cross-sectional design did not allow for the determination of a causative relationship between the two.
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Affiliation(s)
- I Schlesinger
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel; Technion Faculty of Medicine, Haifa, Israel.
| | - I Erikh
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - M Nassar
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - E Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
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Fröhlich AC, Eckeli AL, Bacelar A, Poyares D, Pachito DV, Stelzer FG, Coelho FMS, Rizzo GNV, Prado GFD, Sander HH, Goulart LI, Lucchesi LM, Gitai LLG, Prado LBFD, Ataíde-Junior L, Bezerra MLDS, Lopes MC, Trentin MM, Rodrigues RND, Hasan R, Alves RSC, Schönwald SV, Moraes WADS. Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:260-280. [PMID: 25807136 DOI: 10.1590/0004-282x20140239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.
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Affiliation(s)
| | - Alan Luiz Eckeli
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirao Preto, SP, Brazil
| | | | - Dalva Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | | | | | | | | | | | - Heidi Haueisen Sander
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirao Preto, SP, Brazil
| | | | | | | | | | | | | | - Maria Cecília Lopes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Celik K, Cikrikcioglu MA, Halac G, Kilic E, Ayhan S, Ozaras N, Yildiz K, Yildiz RS, Zorlu M, Karatoprak C, Cakirca M, Kiskac M. Serum endocan levels in women with restless legs syndrome. Neuropsychiatr Dis Treat 2015; 11:2919-25. [PMID: 26640378 PMCID: PMC4657799 DOI: 10.2147/ndt.s92771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Endocan is a recently introduced marker of endothelial dysfunction. The objective of this study was to compare serum endocan levels in patients with restless legs syndrome (RLS) and control subjects in order to elucidate whether RLS is associated with endothelial dysfunction. METHODS A total of 31 drug naïve female patients with RLS and 31 age- and BMI-matched women were included in the study. Patients with pathological or physiological conditions or with a history of medication use that could potentially influence endothelial functions were excluded, as well as those with alcohol or drug abuse history. The two groups were compared with routine blood tests and serum endocan levels. RESULTS Patients with RLS had lower serum endocan levels than the controls (P=0.037). There was a negative bivariate correlation between RLS severity score and serum endocan levels (r=-0.406, P=0.023). While white blood cell count was significantly higher in RLS group, 25-hydroxy vitamin D3, vitamin B12, transferrin saturation rate, and HDL-cholesterol were significantly lower. Creatininemia and diastolic blood pressure were also marginally insignificantly lower in RLS group. Due to the presence of differences between two groups in these variables, a linear regression analysis was performed that showed a positive association between endocan and creatininemia (β=0.310, P=0.022), and a negative association between endocan and RLS (β=-0.502, P<0.001). CONCLUSION The results of this study seem to suggest that patients with RLS may have better endothelial functions when compared with the general population and that these patients may be better protected against atherosclerosis.
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Affiliation(s)
- Kenan Celik
- Department of Internal Medicine, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Mehmet A Cikrikcioglu
- Department of Internal Medicine, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Gulistan Halac
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Elif Kilic
- Department of Biochemistry, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Siddika Ayhan
- Department of Biochemistry, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Nihal Ozaras
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Kemal Yildiz
- Department of Internal Medicine, Private Medicana International Istanbul Hospital, Beylikdüzü, Istanbul, Turkey
| | - Rabia S Yildiz
- Department of Internal Medicine, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Mehmet Zorlu
- Department of Internal Medicine, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Cumali Karatoprak
- Department of Internal Medicine, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Mustafa Cakirca
- Department of Internal Medicine, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
| | - Muharrem Kiskac
- Department of Internal Medicine, Medical Faculty, Bezmialem Vakif University, Fatih, Turkey
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Abstract
OBJECTIVES To determine the prevalence of restless legs syndrome (RLS) in Saudi patients with end-stage renal disease (ESRD) on hemodialysis. METHODS A cross-sectional study was carried out in 3 hemodialysis centers in Jeddah, Saudi Arabia, between June 2012 and September 2013. All patients were individually interviewed and data was collected on the following: demographic features, medical history, laboratory test, the International Restless Legs Syndrome Study Group questionnaire, Epworth Sleepiness Scale (ESS), and Berlin Questionnaire. RESULTS Three hundred and fifty-five patients were recruited. The prevalence of RLS among ESRD patients was 19.4%, with most patients having moderate to severe disease. The RLS was significantly associated with obstructive sleep apnea (p<0.0001) and excessive daytime sleepiness based on the ESS (p=0.009). The RLS showed no correlation with hemodialysis adequacy, chronicity, frequency per week, and hemodialysis duration per session; however, there was a weak negative relation between adequacy of hemodialysis and RLS severity. None of the comorbidities showed any association with RLS. The odds of developing RLS increased significantly with an increasing body mass index (p=0.001). Administration of aspirin (p=0.037) and anticoagulants (p=0.035) were also associated with increased risk of RLS. CONCLUSION Restless legs syndrome is common in ESRD patients on hemodialysis, and it is an important source of sleep disruption. In addition to body mass index, Aspirin and anticoagulants may be important risk factors.
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Affiliation(s)
- Siraj O Wali
- Sleep Medicine and Research Center, King Abdulaziz University Hospital, Jeddah 21589, PO Box 80215, Kingdom of Saudi Arabia. Fax. +966 (12) 6408315. E-mail.
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Rist PM, Tzourio C, Elbaz A, Soumaré A, Dufouil C, Mazoyer B, Kurth T. Structural brain lesions and restless legs syndrome: a cross-sectional population-based study. BMJ Open 2014; 4:e005938. [PMID: 25421338 PMCID: PMC4244423 DOI: 10.1136/bmjopen-2014-005938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the association between white matter lesion (WML) volume, silent infarcts and restless legs syndrome (RLS) in a population-based study of elderly individuals. DESIGN Cross-sectional study. SETTING Population-based Three-City study. PARTICIPANTS 1035 individuals from the Dijon, France, centre of the Three-City study who had available information on volume of WMLs from MRIs and who answered questions about the prevalence of RLS. PRIMARY OUTCOME MEASURE Prevalence of RLS. RESULTS WML volume was measured using an automated tissue segmentation method. Logistic regression was used to evaluate adjusted associations between tertiles of WML volume and RLS and between silent infarcts and RLS. 218 individuals (21.1%) were determined to have RLS. Compared with those in the first tertile of WML volume, individuals in the second tertile (OR=1.09; 95% CI 0.75 to 1.60) or third tertile (OR=1.17; 95% CI 0.79 to 1.74) did not have an increased prevalence of RLS. We also did not observe associations between the volume of deep or periventricular WML and RLS; nor did we observe an association between silent brain infarcts and RLS (OR=0.74; 95% CI 0.40 to 1.39). These findings were not modified by age or gender. CONCLUSIONS Higher volume of WML and the presence of silent infarcts were not associated with an increased prevalence of RLS in this population-based cohort of elderly individuals.
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Affiliation(s)
- Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology,Harvard School of Public Health, Boston, Massachusetts, USA
| | - Christophe Tzourio
- INSERM Research Center for Epidemiology and Biostatistics (U897) Team Neuroepidemiology, Bordeaux, France
- College of Health Sciences, University of Bordeaux, Bordeaux, France
| | - Alexis Elbaz
- Social and Occupational Determinants of Health, INSERM, Centre for Research in Epidemiology and Population Health, U1018, Villejuif, France
- Université de Versailles St-Quentin, Versailles, France
| | - Aïcha Soumaré
- INSERM Research Center for Epidemiology and Biostatistics (U897) Team Neuroepidemiology, Bordeaux, France
| | - Carole Dufouil
- INSERM Research Center for Epidemiology and Biostatistics (U897) Team Neuroepidemiology, Bordeaux, France
- College of Health Sciences, University of Bordeaux, Bordeaux, France
| | - Bernard Mazoyer
- College of Health Sciences, University of Bordeaux, Bordeaux, France
- CNRS CEA (UMR5296) Neurofunctional Imaging Group, University of Bordeaux, Bordeaux, France
| | - Tobias Kurth
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology,Harvard School of Public Health, Boston, Massachusetts, USA
- INSERM Research Center for Epidemiology and Biostatistics (U897) Team Neuroepidemiology, Bordeaux, France
- College of Health Sciences, University of Bordeaux, Bordeaux, France
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Abstract
OBJECTIVE This narrative review describes the differential diagnosis of restless legs syndrome, and provides an overview of the evidence for the associations between RLS and potential comorbidities. Secondary causes of RLS and the characteristics of pediatric RLS are also discussed. Finally, management strategies for RLS are summarized. METHODS The review began with a comprehensive PubMed search for 'restless legs syndrome/Willis-Ekbom disease' in combination with the following: anxiety, arthritis, attention-deficit hyperactivity disorder, cardiac, cardiovascular disease, comorbidities, depression, end-stage renal disease, erectile dysfunction, fibromyalgia, insomnia, kidney disease, liver disease, migraine, mood disorder, multiple sclerosis, narcolepsy, neuropathy, obesity, pain, Parkinson's disease, polyneuropathy, pregnancy, psychiatric disorder, sleep disorder, somatoform pain disorder, and uremia. Additional papers were identified by reviewing the reference lists of retrieved publications. RESULTS AND CONCLUSIONS Although clinical diagnosis of RLS can be straightforward, diagnostic challenges may arise when patients present with comorbid conditions. Comorbidities of RLS include insomnia, depressive and anxiety disorders, and pain disorders. Differential diagnosis is particularly important, as some of the medications used to treat insomnia and depression may exacerbate RLS symptoms. Appropriate diagnosis and management of RLS symptoms may benefit patient well-being and, in some cases, may lessen comorbid disease burden. Therefore, it is important that physicians are aware of the presence of RLS when treating patients with conditions that commonly co-occur with the disorder.
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De Vito K, Li Y, Batool-Anwar S, Ning Y, Han J, Gao X. Prospective study of obesity, hypertension, high cholesterol, and risk of restless legs syndrome. Mov Disord 2014; 29:1044-52. [PMID: 24753235 PMCID: PMC4501395 DOI: 10.1002/mds.25860] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 01/23/2014] [Accepted: 02/03/2014] [Indexed: 11/12/2022] Open
Abstract
Because previous cross-sectional studies suggest an association between metabolic disorders and restless legs syndrome (RLS), we prospectively evaluated whether obesity, hypercholesterolemia, and hypertension were associated with increased risk of RLS. Our study consisted of 42,728 female participants from the Nurses' Health Study II and 12,812 male participants from the Health Professionals Follow-up Study, free of RLS at baseline (2002 for men and 2005 for women), and free of diabetes and arthritis through follow-up (2002-2008 for men and 2005-2009 for women). RLS symptoms were assessed using the International RLS Study Group's standardized questionnaire. We considered RLS symptoms a "case" if the symptoms occurred ≥5 times/month and met International RLS Study Group criteria. We found that obesity was associated with an increased risk RLS among both men and women (P difference for sex >0.5). The pooled multivariate-adjusted odds ratio (OR) for RLS was 1.57 (95% confidence interval [CI]: 1.33-1.85; P trend <0.0001) for body mass index >30 versus ≤23 kg/m(2) and 1.56 (95% CI: 1.29-1.89; P trend = 0.0001) comparing two extreme waist circumference quintiles, adjusting for age, ethnicity, smoking, physical activity, use of antidepressant, and other covariates. A similar significant association was found for high cholesterol; the pooled adjusted OR for total serum cholesterol >240 versus <159 mg/dL was 1.33 (95% CI: 1.11-1.60; P trend = 0.002). There was no significant association between hypertension and RLS risk (adjusted OR: 0.90; 95% CI: 0.79-1.02). In this large, prospective study, we found that obesity and high cholesterol, but not high blood pressure, were significantly associated with an increased risk of developing RLS. © 2014 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Yanping Li
- The Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Salma Batool-Anwar
- Division of Sleep Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Yi Ning
- Department of Epidemiology and Community Health, Virginia Commonwealth University
| | - Jiali Han
- The Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Xiang Gao
- The Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
- Department of Nutrition, Harvard School of Public Health
- School of Public Health, Peking Union Medical College, Beijing
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Ferini-Strambi L, Marelli S. Pharmacotherapy for restless legs syndrome. Expert Opin Pharmacother 2014; 15:1127-38. [DOI: 10.1517/14656566.2014.908850] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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The relationship among restless legs syndrome (Willis-Ekbom Disease), hypertension, cardiovascular disease, and cerebrovascular disease. J Neurol 2013; 261:1051-68. [PMID: 23963470 PMCID: PMC4057632 DOI: 10.1007/s00415-013-7065-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 08/02/2013] [Accepted: 08/03/2013] [Indexed: 01/12/2023]
Abstract
Untreated sleep disorders may contribute to secondary causes of uncontrolled hypertension, cardiovascular disease (CVD), and stroke. Restless legs syndrome, or Willis–Ekbom Disease (RLS/WED), is a common sensorimotor disorder with a circadian rhythmicity defined by an uncontrollable urge to move the legs that worsens during periods of inactivity or at rest in the evening, often resulting in sleep disruptions. Sleep disorders such as insomnia and obstructive sleep apnea (OSA) are established risk factors for increased risk of hypertension and vascular diseases. This literature review outlines the lessons learned from studies demonstrating insomnia and OSA as risk factors for hypertension and vascular diseases to support the epidemiologic and physiologic evidence suggesting a similar increase in hypertension and vascular disease risk due to RLS. Understanding the relationships between RLS and hypertension, CVD, and stroke has important implications for reducing the risks associated with these diseases.
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Budhiraja R, Quan SF. Is restless legs syndrome associated with cardiovascular disease? Am J Med 2013; 126:189-90. [PMID: 23410556 DOI: 10.1016/j.amjmed.2012.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 11/09/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
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