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Sato M, Matsui K, Nishimura K, Inoue Y. Coexistence of periodic limb movements during sleep with restless legs syndrome and its association with hypertension in Japanese patients. Sleep Med 2024; 115:187-192. [PMID: 38367361 DOI: 10.1016/j.sleep.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Caucasian patients with restless legs syndrome (RLS) frequently exhibit periodic limb movements during sleep (PLMS), which may increase the risk of hypertension. We evaluated the positivity rate of PLMS and factors associated with positivity in Japanese patients with RLS, and tested whether the complications of PLMS are associated with the presence of hypertension. METHODS We retrospectively investigated polysomnographic data and the presence or absence of hypertension in patients with RLS. Patients with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or those taking antihypertensive medication were categorized as the group with hypertension. RESULTS Among 468 patients, 200 (42.7%) had periodic limb movement index (PLMI) values ≥ 15/h and 108 (23.1%) met the criteria of positivity for hypertension. Multiple logistic regression analysis revealed that only higher age was significantly associated with PLMI values ≥ 15/h. Multiple linear regression analyses of factors associated with an increased PLMI also showed that increased PLMI was significantly correlated with higher age and male sex, but not with the international restless legs scale scores. Multiple logistic regression analysis also revealed that higher age and body mass index, not PLMI values ≥ 15/h, were significantly associated with the presence of hypertension. CONCLUSION The PLMS-positivity rate may be lower in Japanese patients with RLS than in Caucasian patients, and it increases with age and male sex, but not with the severity of the disorder. Furthermore, PLMS complications were not associated with the risk of hypertension in Japanese patients with RLS.
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Affiliation(s)
- Moeko Sato
- Department of Psychiatry, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kentaro Matsui
- Department of Psychiatry, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan; Department of Laboratory Medicine, National Center Hospital, National Center of Neurology & Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan; Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, 4-45-16 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, 4-45-16 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan; Department of Somnology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan.
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2
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Zinchuk A, Srivali N, Qin L, Jeon S, Ibrahim A, Sands SA, Koo B, Yaggi HK. Association of Periodic Limb Movements and Obstructive Sleep Apnea With Risk of Cardiovascular Disease and Mortality. J Am Heart Assoc 2024; 13:e031630. [PMID: 38240208 PMCID: PMC11056155 DOI: 10.1161/jaha.123.031630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Obstructive sleep apnea is a well-established risk factor for cardiovascular disease (CVD). Recent studies have also linked periodic limb movements during sleep to CVD. We aimed to determine whether periodic limb movements during sleep and obstructive sleep apnea are independent or synergistic factors for CVD events or death. METHODS AND RESULTS We examined data from 1049 US veterans with an apnea-hypopnea index (AHI) <30 events/hour. The primary outcome was incident CVD or death. Cox proportional hazards regression assessed the relationships between the AHI, periodic limb movement index (PLMI), and the AHI×PLMI interaction with the primary outcome. We then examined whether AHI and PLMI were associated with primary outcome after adjustment for age, sex, race and ethnicity, obesity, baseline risk of mortality, and Charlson Comorbidity Index. During a median follow-up of 5.1 years, 237 of 1049 participants developed incident CVD or died. Unadjusted analyses showed an increased risk of the primary outcome with every 10-event/hour increase in PLMI (hazard ratio [HR], 1.08 [95% CI, 1.05-1.13]) and AHI (HR, 1.17 [95% CI, 1.01- 1.37]). Assessment associations of AHI and PLMI and their interaction with the primary outcome revealed no significant interaction between PLMI and AHI. In fully adjusted analyses, PLMI, but not AHI, was associated with an increased risk of primary outcome: HR of 1.05 (95% CI, 1.00-1.09) per every 10 events/hour. Results were similar after adjusting with Framingham risk score. CONCLUSIONS Our study revealed periodic limb movements during sleep as a risk factor for incident CVD or death among those who had AHI <30 events/hour, without synergistic association between periodic limb movements during sleep and obstructive sleep apnea.
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Affiliation(s)
- Andrey Zinchuk
- Section of Pulmonary, Critical Care and Sleep MedicineYale University School of MedicineNew HavenCTUSA
| | - Narat Srivali
- Section of Pulmonary, Critical Care and Sleep MedicineYale University School of MedicineNew HavenCTUSA
- Center for Outcomes Research and EvaluationYale University School of MedicineNew HavenCTUSA
| | - Li Qin
- Division of Acute Care/Health SystemsYale School of Nursing, Yale UniversityNew HavenCTUSA
| | | | - Ahmad Ibrahim
- Section of Pulmonary, Critical Care and Sleep MedicineYale University School of MedicineNew HavenCTUSA
| | - Scott A. Sands
- Harvard Medical SchoolBostonMAUSA
- Department of NeurologyYale UniversityNew HavenCTUSA
| | - Brian Koo
- Clinial Epidemiology Research CenterVA CT Health Care SystemWest HavenCTUSA
| | - Henry K. Yaggi
- Section of Pulmonary, Critical Care and Sleep MedicineYale University School of MedicineNew HavenCTUSA
- Clinial Epidemiology Research CenterConnecticut Department of Veterans AffairsWest HavenCTUSA
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3
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Kim J, Kim JR, Park HR, Joo EY. Sex-specific patterns of discomfort in patients with restless legs syndrome. J Clin Sleep Med 2024; 20:253-259. [PMID: 37858283 PMCID: PMC10835774 DOI: 10.5664/jcsm.10848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES Sex differences in the prevalence of restless legs syndrome (RLS) have been reported, with a higher prevalence in women than in men. However, sex differences in clinical presentation remain unclear. We aimed to investigate the phenotypic differences in patients with RLS between sexes by comparing clinical presentations, iron status, polysomnographic parameters, and treatment. METHODS We retrospectively evaluated 614 patients (225 men, 389 women) diagnosed with RLS. To enhance the robustness of the study, an age-matched control group of 179 men and 286 women without sleep disorders was also included. Information on demographics and sleep-related questionnaires were collected. Iron status was evaluated using blood samples, and polysomnography was performed to evaluate periodic leg movements and comorbid sleep disorders. RESULTS Our analysis revealed no sex difference in the severity of RLS but a difference in the pattern of symptoms. Women had more frequent symptoms of pain and awakening during sleep, while men had more common motor symptoms (both self-reported symptoms and periodic leg movement on polysomnography). Women with RLS also had lower iron parameters and received more frequent iron supplementation therapy than men. In contrast to women with RLS, who presented higher sleep disturbances and depressive mood, men with RLS had a higher risk of comorbidities such as hypertension and cardiovascular disease. These sex differences were notably more pronounced than in the control group. CONCLUSIONS This study suggests that sex differences exist in RLS phenotypes, and clinicians should consider these differences for treatment. CITATION Kim J, Kim JR, Park HR, Joo EY. Sex-specific patterns of discomfort in patients with restless legs syndrome. J Clin Sleep Med. 2024;20(2):253-259.
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Affiliation(s)
- Jinhee Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Rim Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hea Ree Park
- Department of Neurology, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Republic of Korea
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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4
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Chenini S, Barateau L, Dauvilliers Y. Restless legs syndrome: From clinic to personalized medicine. Rev Neurol (Paris) 2023; 179:703-714. [PMID: 37689536 DOI: 10.1016/j.neurol.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
Restless legs syndrome (RLS) is a common neurological sensorimotor disorder that impairs sleep, mood and quality of life. RLS is defined by an urge to move the legs at rest that increases in the evening and at night, and is frequently associated with metabolic and cardiovascular diseases. Symptoms frequency, age at RLS onset, severity, familial history and consequences of RLS vary widely between patients. A genetic susceptibility, iron deficiency, dopamine deregulation, and possible hypo-adenosinergic state may play a role in the pathophysiology of RLS. Polysomnographic recordings found often periodic leg movements during sleep and wakefulness in patients with RLS. RLS can be classified as primary or comorbid with major diseases: iron deficiency, renal, neurological, rheumatological and lung diseases. First-line treatments are low-dose dopamine agonists, and alpha-2-delta ligands depending on the clinical context, and second/third line opiates for pharmacoresistant forms of RLS. Augmentation syndrome is a serious complication of dopamine agonists and should be prevented by using the recommended low dose. Despite an increase in knowledge, RLS is still underdiagnosed, poorly recognized, resulting in substantial individual health burden and socioeconomic coast, and education is urgently needed to increase awareness of this disabling disorder.
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Affiliation(s)
- S Chenini
- National Reference Centre for Orphan Diseases Narcolepsy and Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM, Montpellier, France.
| | - L Barateau
- National Reference Centre for Orphan Diseases Narcolepsy and Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM, Montpellier, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases Narcolepsy and Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM, Montpellier, France.
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5
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Baillieul S, Denis C, Barateau L, Arquizan C, Detante O, Pépin JL, Dauvilliers Y, Tamisier R. The multifaceted aspects of sleep and sleep-wake disorders following stroke. Rev Neurol (Paris) 2023; 179:782-792. [PMID: 37612191 DOI: 10.1016/j.neurol.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
Sleep-wake disorders (SWD) are acknowledged risk factors for both ischemic stroke and poor cardiovascular and functional outcome after stroke. SWD are frequent following stroke, with sleep apnea (SA) being the most frequent SWD affecting more than half of stroke survivors. While sleep disturbances and SWD are frequently reported in the acute phase, they may persist in the chronic phase after an ischemic stroke. Despite the frequency and risk associated with SWD following stroke, screening for SWD remains rare in the clinical setting, due to challenges in the assessment of post-stroke SWD, uncertainty regarding the optimal timing for their diagnosis, and a lack of clear treatment guidelines (i.e., when to treat and the optimal treatment strategy). However, little evidence support the feasibility of SWD treatment even in the acute phase of stroke and its favorable effect on long-term cardiovascular and functional outcomes. Thus, sleep health recommendations and SWD treatment should be systematically embedded in secondary stroke prevention strategy. We therefore propose that the management of SWD associated with stroke should rely on a multidisciplinary approach, with an integrated diagnostic, treatment, and follow-up strategy. The challenges in the field are to improve post-stroke SWD diagnosis, prognosis and treatment, through a better appraisal of their pathophysiology and temporal evolution.
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Affiliation(s)
- S Baillieul
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France.
| | - C Denis
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France
| | - L Barateau
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - C Arquizan
- Department of Neurology, Hôpital Gui-de-Chauliac, Montpellier, France; Inserm U1266, Paris, France
| | - O Detante
- Neurology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - J-L Pépin
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - R Tamisier
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France
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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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7
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Srivali N, Thongprayoon C, Tangpanithandee S, Krisanapan P, Mao MA, Zinchuk A, Koo BB, Cheungpasitporn W. Periodic limb movements during sleep and risk of hypertension: A systematic review. Sleep Med 2023; 102:173-179. [PMID: 36701831 PMCID: PMC10388290 DOI: 10.1016/j.sleep.2023.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Several studies suggest an association between periodic limb movements during sleep (PLMS) and hypertension; however, a systematic evaluation of this relationship is lacking. METHODS We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio, comparing the risk of hypertension in persons with PLMS (defined by the level of periodic limb movements per hour of sleep depended on individual studies) versus those without PLMS. After assessing heterogeneity and bias, the pooled risk ratio and 95% confidence intervals (CIs) were determined using a random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS Out of 572 potentially relevant articles, six eligible studies were included in the data analysis. Studies (6 cross-sectional) included 8949 participants. The statistical heterogeneity of this study was insignificant, with an I2 of 0%. A funnel plot and Egger's regression asymmetry test showed no publication bias with P-value ≥0.05. The pooled risk ratio of hypertension in patients with PLMS was 1.26 (95% CI, 1.12-1.41). CONCLUSIONS Our analysis demonstrates an increased hypertension risk among patients with PLMS. Prospective or interventional studies are needed to confirm this association.
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Affiliation(s)
- Narat Srivali
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | | | | | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA; Division of Nephrology, Thammasat University Hospital, Pathum Thani, Thailand
| | - Michael A Mao
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Andrey Zinchuk
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Brain B Koo
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Bansal K, Garcia J, Feltch C, Earley C, Robucci R, Banerjee N, Brooks J. A pilot study to understand the relationship between cortical arousals and leg movements during sleep. Sci Rep 2022; 12:12685. [PMID: 35879382 PMCID: PMC9314423 DOI: 10.1038/s41598-022-16697-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Leg movements during sleep occur in patients with sleep pathology and healthy individuals. Some (but not all) leg movements during sleep are related to cortical arousals which occur without conscious awareness but have a significant effect of sleep fragmentation. Detecting leg movements during sleep that are associated with cortical arousals can provide unique insight into the nature and quality of sleep. In this study, a novel leg movement monitor that uses a unique capacitive displacement sensor and 6-axis inertial measurement unit, is used in conjunction with polysomnography to understand the relationship between leg movement and electroencephalogram (EEG) defined cortical arousals. In an approach that we call neuro-extremity analysis, directed connectivity metrics are used to interrogate causal linkages between EEG and leg movements measured by the leg movement sensors. The capacitive displacement measures were more closely related to EEG-defined cortical arousals than inertial measurements. Second, the neuro-extremity analysis reveals a temporally evolving connectivity pattern that is consistent with a model of cortical arousals in which brainstem dysfunction leads to near-instantaneous leg movements and a delayed, filtered signal to the cortex leading to the cortical arousal during sleep.
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Affiliation(s)
- Kanika Bansal
- US CCDC Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, USA.,Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Javier Garcia
- US CCDC Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, USA
| | | | - Christopher Earley
- Department of Neurology and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ryan Robucci
- Tanzen Medical Inc., Baltimore, MD, USA.,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Catonsville, MD, USA
| | - Nilanjan Banerjee
- Tanzen Medical Inc., Baltimore, MD, USA.,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Catonsville, MD, USA
| | - Justin Brooks
- Tanzen Medical Inc., Baltimore, MD, USA. .,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Catonsville, MD, USA. .,Tanzen Medical Inc, 5926 Lebanon Lane, Elkridge, MD, 21075, USA.
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9
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Patients with a Higher Number of Periodic Limb Movements Have Higher Nocturnal Blood Pressure. J Clin Med 2022; 11:jcm11102829. [PMID: 35628954 PMCID: PMC9146477 DOI: 10.3390/jcm11102829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
There is growing evidence that periodic limb movements in sleep (PLMS) may lead to increased blood pressure (BP) values during the night. The aim of this study was to assess if patients with disordered sleep and an increased number of PLMS have higher BP values at night. We analyzed 100 polysomnographic (PSG) recordings of patients with disordered sleep, with the exclusion of sleep-related breathing disorders. Patients also registered beat-to-beat blood pressure during PSG. We compared the BP of patients with an increased number of PLMS (more than 5 PLMS per hour of sleep) during the night (examined group, n = 50) to the BP of patients with a PLMS number within the normal range (up to 5 PLMS per hour of sleep) (control group, n = 50). Patients from the examined group had significantly higher values of systolic BP during the night (119.7 mmHg vs. 113.3 mmHg, p = 0.04), sleep (119.0 mmHg vs. 113.3 mmHg, p = 0.04), and wake (122.5 mmHg vs. 117.2 mmHg, p = 0.04) periods and of diastolic BP during the night (75.5 mmHg vs. 70.6 mmHg, p = 0.04) and wake (77.6 mmHg vs. 71.5 mmHg, p = 0.01) periods. Our results suggest a relationship between the number of PLMS during the night and the values of nocturnal blood pressure. It is possible that their treatment could lower nocturnal BP in patients with sleep disorders, therefore improving their vascular risk profile.
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Brooks J, Feltch C, Lam J, Earley C, Robucci R, Agarwal S, Banerjee N. RestEaze: An Emerging Technology to Characterize Leg Movements During Sleep. J Med Device 2021. [DOI: 10.1115/1.4053160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Several sleep disorders are characterized by periodic leg movements during sleep including Restless Leg Syndrome, and can indicate disrupted sleep in otherwise healthy individuals. Current technologies to measure periodic leg movements during sleep are limited. Polysomnography and some home sleep tests use surface electromyography to measure electrical activity from the anterior tibilias muscle. Actigraphy uses 3-axis accelerometers to measure movement of the ankle. Electromyography misses periodic leg movements that involve other leg muscles and is obtrusive because of the wires needed to carry the signal. Actigraphy based devices require large amplitude movements of the ankle to detect leg movements (missing the significant number of more subtle leg movements) and can be worn in multiple configurations precluding precision measurement. These limitations have contributed to their lack of adoption as a standard of care for several sleep disorders. In this study, we develop the RestEaze sleep assessment tool as an ankle-worn wearable device that combines capacitive sensors and a 6-axis inertial measurement unit to precisely measure periodic leg movements during sleep. This unique combination of sensors and the form-factor of the device addresses current limitations of periodic leg movements during sleep measurement techniques. Pilot data collected shows high correlation with polysomnography across a heterogeneous participant sample and high usability ratings. RestEaze shows promise in providing ecologically valid, longitudinal measures of leg movements that will be useful for clinicians, researchers, and patients to better understand sleep.
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Affiliation(s)
- Justin Brooks
- University of Maryland, Baltimore County, Department of Computer Science and Electrical Engineering, 1000 Hilltop Circle, Catonsville, MD 21250; Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
| | - Cody Feltch
- Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
| | - Janet Lam
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, 801 N. Broadway, Baltimore, MD 21205
| | - Christopher Earley
- Johns Hopkins School of Medicine, Department for Neurology, 5501 Hopkins Bayview Circle, Baltimore, MD 21224
| | - Ryan Robucci
- University of Maryland, Baltimore County, Department of Computer Science and Electrical Engineering, 1000 Hilltop Circle, Catonsville, MD 21250; Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
| | - Sanjay Agarwal
- Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
| | - Nilanjan Banerjee
- University of Maryland, Baltimore County, Department of Computer Science and Electrical Engineering, 1000 Hilltop Circle, Catonsville, MD 21250; Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
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Abstract
Restless legs syndrome (RLS) is a common sensorimotor disorder characterized by an urge to move that appears during rest or is exacerbated by rest, that occurs in the evening or night and that disappears during movement or is improved by movement. Symptoms vary considerably in age at onset, frequency and severity, with severe forms affecting sleep, quality of life and mood. Patients with RLS often display periodic leg movements during sleep or resting wakefulness. RLS is considered to be a complex condition in which predisposing genetic factors, environmental factors and comorbidities contribute to the expression of the disorder. RLS occurs alone or with comorbidities, for example, iron deficiency and kidney disease, but also with cardiovascular diseases, diabetes mellitus and neurological, rheumatological and respiratory disorders. The pathophysiology is still unclear, with the involvement of brain iron deficiency, dysfunction in the dopaminergic and nociceptive systems and altered adenosine and glutamatergic pathways as hypotheses being investigated. RLS is poorly recognized by physicians and it is accordingly often incorrectly diagnosed and managed. Treatment guidelines recommend initiation of therapy with low doses of dopamine agonists or α2δ ligands in severe forms. Although dopaminergic treatment is initially highly effective, its long-term use can result in a serious worsening of symptoms known as augmentation. Other treatments include opioids and iron preparations.
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12
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Van Overstraeten C, Andreozzi F, Youssef SB, Bold I, Carlier S, Gruwez A, Bruyneel AV, Bruyneel M. Obstructive Sleep Apnea Syndrome Phenotyping by Cluster Analysis: Typical Sleepy, Obese Middle-aged Men with Desaturating Events are A Minority of Patients in A Multi-ethnic Cohort of 33% Women. Curr Med Sci 2021; 41:729-736. [PMID: 34403098 DOI: 10.1007/s11596-021-2388-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Several clinical obstructive sleep apnea syndrome (OSAS) phenotypes associated with heterogeneous cardiovascular risk profiles have been recently identified. The purpose of this study was to identify clusters amongst these profiles that allow for the differentiation of patients. METHODS This retrospective study included all moderate-to-severe OSAS patients referred to the sleep unit over a 5-year period. Demographic, symptom, comorbidity, polysomnographic, and continuous positive airway pressure (CPAP) adherence data were collected. Statistical analyses were performed to identify clusters of patients. RESULTS A total of 567 patients were included (67% men, 54±13 years, body mass index: 32±7 kg/m2, 65% Caucasian, 32% European African). Five clusters were identified: less severe OSAS (n=172); healthier severe OSAS (n=160); poorly sleeping OSAS patients with cardiometabolic comorbidities (n=87); younger obese men with sleepiness at the wheel (n=94); sleepy obese men with very severe desaturating OSAS and cardiometabolic comorbidities (n=54). Patients in clusters 3 and 5 were older than those in clusters 2 and 4 (P=0.034). Patients in clusters 4 and 5 were significantly more obese than those in the other clusters (P=0.04). No significant differences were detected in terms of symptoms and comorbidities. Polysomnographic profiles were very discriminating between clusters. CPAP adherence was similar in all clusters but, among adherent patients, daily usage was more important in cluster 1 (less severe patients) than in cluster 5. CONCLUSION This study highlights that the typical sleepy obese middle-aged men with desaturating events represent only a minority of patients in our multi-ethnic moderate-to-severe OSAS cohort of 33% females.
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Affiliation(s)
- Chloé Van Overstraeten
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, 1000, Belgium
| | - Fabio Andreozzi
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, 1000, Belgium
| | - Sidali Ben Youssef
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, 1000, Belgium
| | - Ionela Bold
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, 1000, Belgium
| | - Sarah Carlier
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, 1000, Belgium.,Department of Pulmonary Medicine, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, 1020, Belgium
| | - Alexia Gruwez
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, 1000, Belgium.,Department of Pulmonary Medicine, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, 1020, Belgium
| | | | - Marie Bruyneel
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, 1000, Belgium. .,Department of Pulmonary Medicine, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, 1020, Belgium.
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13
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Periodic limb movements in patients with obstructive sleep apnea syndrome. Sci Rep 2021; 11:15341. [PMID: 34321577 PMCID: PMC8319330 DOI: 10.1038/s41598-021-95018-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/20/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to assess the factors associated with periodic limb movements during sleep (PLMS) among obstructive sleep apnea syndrome (OSAS) patients and identify the role of PLMS in patients with OSAS. 303 adult patients with OSAS were included in the study. All patients completed physical examination, Epworth sleepiness scale (ESS), and polysomnography. Diagnosis of PLMS was made if the periodic leg movements index (PLMI) was ≥ 15. Chi-square test, ANOVA, univariate and multivariate logistic regression analyses were conducted to identify factors associated with PLMS among OSAS patients. Statistical analyses were performed with SPSS 26.0 for mac. Statistically significant difference was considered if P value < 0 .05. Among the 303 adult patients with OSAS, 98 patients had significant PLMS and the other 205 had no significant PLMS. Compared with OSAS patients without PLMS, OSAS patient with PLMS were older, had shorter REM duration and greater apnea–hypopnea index (AHI) (P < 0.05). The study suggests that PLMS is a matter of concern among patients with OSAS. A better understanding of the role of PLMS among OSAS patients could be useful in better recognition, intervention and treatment of OSAS.
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14
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Abstract
Periodic leg movements during sleep (PLMS) are a frequent finding in nocturnal sleep registrations that include tibialis anterior electromyographic signals. Different PLMS scoring rules exist and can have a major impact on PLMS frequency, which tends to be underappreciated. There is no consistent evidence that frequent PLMS are a causal risk factor for clinically significant outcomes. Several critical open questions are identified that need to be addressed, including but not limited to the consideration of the full range of all sleep-related leg movement activity.
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Affiliation(s)
- Stephany Fulda
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Via Tesserete 46, Lugano 6900, Switzerland.
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15
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Rossi M, Wainsztein N, Merello M. Cardiac Involvement in Movement Disorders. Mov Disord Clin Pract 2021; 8:651-668. [PMID: 34307738 DOI: 10.1002/mdc3.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
Background Several conditions represented mainly by movement disorders are associated with cardiac disease, which can be overlooked in clinical practice in the context of a prominent primary neurological disorder. Objectives To review neurological conditions that combine movement disorders and primary cardiac involvement. Methods A comprehensive and structured literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria was conducted to identify disorders combining movement disorders and cardiac disease. Results Some movement disorders are commonly or prominently associated with cardiac disease. Neurological and cardiac symptoms may share underlying physiopathological mechanisms in diseases, such as Friedreich's ataxia and Wilson's disease, and in certain metabolic disorders, including Refsum disease, Gaucher disease, a congenital disorder of glycosylation, or cerebrotendinous xanthomatosis. In certain conditions, such as Sydenham's chorea or dilated cardiomyopathy with ataxia syndrome (ATX-DNAJC19), heart involvement can present early in the course of disease, whereas in others such as Friedreich's ataxia or Refsum disease, cardiac symptoms tend to present in later stages. In another 68 acquired or inherited conditions, cardiac involvement or movement disorders are seldom reported. Conclusions As cardiac disease is part of the phenotypic spectrum of several movement disorders, heart involvement should be carefully investigated and increased awareness of this association encouraged as it may represent a leading cause of morbidity and mortality.
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Affiliation(s)
- Malco Rossi
- Sección Movimientos Anormales, Departamento de Neurociencias Instituto de Investigaciones Neurológicas Raúl Carrea, Fleni Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council Buenos Aires Argentina
| | - Nestor Wainsztein
- Departamento de Medicina Interna Unidad de Cuidados Críticos, Fleni Buenos Aires Argentina
| | - Marcelo Merello
- Sección Movimientos Anormales, Departamento de Neurociencias Instituto de Investigaciones Neurológicas Raúl Carrea, Fleni Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council Buenos Aires Argentina.,Pontificia Universidad Católica Argentina Buenos Aires Argentina
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16
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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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17
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Lin CY, Tsai SJ, Peng CK, Yang AC. Sleep state instabilities in patients with periodic limb movements in sleep - Detection and quantification with heart rate variability. Psychiatry Res 2020; 293:113454. [PMID: 32977051 DOI: 10.1016/j.psychres.2020.113454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) has been thought to increase the risk of hypertension, cardiovascular events, and all-cause mortality. Periodic limb movements in sleep (PLMS) can be observed in most patients with RLS. Using non-invasive physiologic measurement and analysis, including heart rate variability (HRV) analysis, we aimed to investigate sleep quality and sleep state stability. METHOD A total of 53 healthy controls and 15 patients with RLS and PLMS were recruited. Patients with other sleep-related disorders such as obstructive sleep apnea (OSA) and major depressive disorder (MDD) were excluded. Each subject was evaluated using sleep and mood questionnaires and had to undergo polysomnography (PSG). HRV analysis was applied to assess autonomic function and analyze correlations with the severity of periodic leg movements (PLM). The power of different brainwaves was analyzed using electroencephalogram (EEG). Electromyogram (EMG) was also used to explore the temporal correlation between changes in HRV and leg movement events. RESULTS Compared with healthy controls, PLMS group had not only poorer perceived sleep and mood questionnaires scales but also reductions in parasympathetic-related HRV indices and increases in sympathetic-related HRV parameters. The changes were in proportion to the severity of PLM. Brainwaves and sleep stage which indicate "deep sleep" decreased in the PLMS group. There were no significant temporal correlations between changes in HRV and leg movement events. CONCLUSIONS Our findings suggest that patients with RLS and PLMS have poorer subjective sleep and mood scales. Besides, objective sleep quality including HRV analysis and brainwaves analysis revealed reduced parasympathetic tone, increased sympathetic tone, and sleep disturbance, which reveal the possibility of a higher risk for secondary disease.
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Affiliation(s)
- Chen-Yu Lin
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Jen Tsai
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science/Digital Medicine Center, National Yang-Ming University, No 155, Sec. 2, Li-Nung St. Beitou Dist., Taipei, Taiwan
| | - Chung-Kang Peng
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, United States
| | - Albert C Yang
- Institute of Brain Science/Digital Medicine Center, National Yang-Ming University, No 155, Sec. 2, Li-Nung St. Beitou Dist., Taipei, Taiwan.
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18
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Abstract
Hypertension is a highly common condition with well-established adverse consequences. Ambulatory blood pressure monitoring has repeatedly been shown to better predict cardiovascular outcomes and mortality, compared to single office visit blood pressure. Non-dipping of sleep-time blood pressure is an independent marker for increased cardiovascular risk. We review blood pressure variability and the challenges of blood pressure monitoring during sleep. Although pathological sleep such as obstructive sleep apnea has been associated with non-dipping of sleep-time blood pressure, blood pressure is not routinely measured during sleep due to lack of unobtrusive blood pressure monitoring technology. Second, we review existing noninvasive continuous blood pressure monitoring technologies. Lastly, we propose including sleep-time blood pressure monitoring during sleep studies and including sleep studies in patients undergoing ambulatory blood pressure monitoring.
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19
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Chenini S, Rassu AL, Barateau L, Lopez R, Carlander B, Guiraud L, Jaussent I, Dauvilliers Y. Increased Blood Pressure Dipping in Restless Legs Syndrome With Rotigotine: A Randomized Trial. Mov Disord 2020; 35:2164-2173. [PMID: 32875658 DOI: 10.1002/mds.28224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/06/2020] [Accepted: 07/06/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The objective of this study was to assess the rotigotine effect on the nocturnal blood pressure (BP) dip by 24-hour ambulatory BP monitoring and on endothelial function in patients with restless legs syndrome (RLS) compared with placebo. METHODS In this double-blind, placebo-controlled trial, 76 adult patients with moderate to severe RLS and periodic legs movements in sleep index ≥10/hour were randomized to rotigotine at optimal dose of 3 mg per day or placebo for 6 weeks. A total of 6 patients had a major protocol deviation. Polysomnography, ambulatory BP monitoring, and endothelial function were assessed at baseline and end point. The primary outcome was the between-group difference in the percentage of BP nondipper profiles at end point. The main secondary outcomes were the mean BP dip, periodic legs movements in sleep index, and endothelial function. RESULTS Of the 70 patients (age, 59.4 ± 11.40; 43 women) randomized to rotigotine (n = 34) and placebo (n = 36), 66 (33 rotigotine, 33 placebo) completed the study. The percentage of BP nondippers at end point was higher in the placebo than in the rotigotine group (systolic BP, 72.22% vs 47.06%; diastolic BP, 47.22% vs 20.59%; P < 0.05). Mean BP dip at end point was higher in the rotigotine than in the placebo group (systolic BP, 11.24 ± 6.15 vs 6.12 ± 7.98; diastolic BP, 15.12 ± 7.09 vs 9.36 ± 10.23; P < 0.05). Endothelial function was comparable between the groups. No significant safety concerns were reported with similar incidences of adverse events between groups. CONCLUSION Rotigotine increased the percentage of BP dipper profiles and the BP dip in patients with RLS. Future studies should assess whether this change is associated with a reduction in the long-term cardiovascular risk in RLS. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sofiene Chenini
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France
| | - Anna Laura Rassu
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France
| | - Lucie Barateau
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France.,University of Montpellier, INSERM U1061, Montpellier, France
| | - Regis Lopez
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France.,University of Montpellier, INSERM U1061, Montpellier, France
| | - Bertrand Carlander
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France
| | - Lily Guiraud
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France
| | | | - Yves Dauvilliers
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France.,University of Montpellier, INSERM U1061, Montpellier, France
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20
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André S, Andreozzi F, Van Overstraeten C, Ben Youssef S, Bold I, Carlier S, Gruwez A, Bruyneel AV, Bruyneel M. Cardiometabolic comorbidities in obstructive sleep apnea patients are related to disease severity, nocturnal hypoxemia, and decreased sleep quality. Respir Res 2020; 21:35. [PMID: 31996224 PMCID: PMC6990595 DOI: 10.1186/s12931-020-1284-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSA) is currently recognized as an independent risk factor for hypertension, arrhythmia, coronary heart disease, stroke, and metabolic disorders (e.g. diabetes, dyslipidemia). In clinical practice, apnea-hypopnea index (AHI) is the marker used to classify disease severity and guide treatment. However, AHI alone does not sufficiently identify OSA patients at risk for cardiometabolic comorbidities. With this in mind, the aim of this retrospective study was to determine whether some polysomnographic parameters (e.g. apnea-hypopnea duration, sleep structure, nocturnal hypoxemia) are specifically associated with cardiometabolic comorbidities in OSA. METHODS In this retrospective study, 1717 patients suffering from moderate/severe OSA were included between 2013 and 2017. Data on demographics, comorbidities, and polysomnographic characteristics were collected and analyzed to identify factors associated with cardiometabolic complications. RESULTS The medical files of 1717 patients (68% male) were reviewed. The mean AHI was 43.1 +/- 27.7 with 57.3% of patients suffering from severe OSA, and 52% from at least one cardiovascular comorbidity (CVCo). Diabetes affected 22% of the patients and 27% exhibited dyslipidemia. Patients affected by CVCos were older, and more often women and non-smokers. These patients also had worse sleep quality, and a more marked intermittent/global nocturnal hypoxemia. With regard to diabetes, diabetics were older, more often non-smoker, non-drinker women, and were more obese. These patients also exhibited more severe OSA, especially in non-REM (NREM) sleep, worse sleep quality, and a more marked intermittent/global nocturnal hypoxemia. Dyslipidemia was more frequent in the absence of alcohol consumption, and was associated with OSA severity, decreased sleep quality, and longer AH in REM sleep. CONCLUSIONS This study identifies demographic and polysomnographic factors associated with cardiometabolic comorbidities. Patients (especially women) suffering from more severe OSA, longer sleep apneas and hypopneas, worse sleep quality, and marked intermittent/global nocturnal hypoxemia are more likely to develop cardiometabolic comorbidities. This should stimulate clinicians to obtain adequate treatment in this population.
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Affiliation(s)
- Stephanie André
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium
| | - Fabio Andreozzi
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Chloé Van Overstraeten
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Sidali Ben Youssef
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Ionela Bold
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah Carlier
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium
| | - Alexia Gruwez
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium
| | | | - Marie Bruyneel
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium.
- Université Libre de Bruxelles, Brussels, Belgium.
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium.
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21
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Budhiraja R, Javaheri S, Pavlova MK, Epstein LJ, Omobomi O, Quan SF. Prevalence and correlates of periodic limb movements in OSA and the effect of CPAP therapy. Neurology 2019; 94:e1820-e1827. [PMID: 31882530 DOI: 10.1212/wnl.0000000000008844] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/11/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE We sought to assess the prevalence, correlates, and consequences of periodic limb movements of sleep (PLMS) in persons with obstructive sleep apnea (OSA) and the effect (worsening or improvement) of continuous positive airway pressure (CPAP) therapy on PLMS in a large prospective multicenter randomized controlled trial. METHODS We performed retrospective analyses of data from the Apnea Positive Pressure Long-term Efficacy Study, a prospective multicenter randomized controlled trial. A total of 1,105 persons with OSA enrolled in this study underwent a polysomnographic investigation at baseline, another one for CPAP titration, and another study 6 months after randomization to either active CPAP or sham CPAP. RESULTS Of all participants, 19.7% had PLM index (PLMI) ≥10/hour, 14.8% had PLMI ≥15/hour, 12.1% had PLMI ≥20/hour, 9.3% had PLMI ≥25/hour, and 7.5% had PLMI ≥30/hour. The odds of having a PLMI ≥10 were higher in older participants (odds ratio [OR] 1.03, p < 0.001), men (OR 1.63. p = 0.007), those using antidepressants (OR 1.48. p = 0.048), and those with higher caffeine use (OR 1.01, p = 0.04). After controlling for OSA and depression, PLMS were associated with increased sleep latency, reduced sleep efficiency, and reduced total sleep time. No significant relationships were noted between PLMS frequency and subjective sleepiness (Epworth Sleepiness Scale score) or objective sleepiness (Maintenance of Wakefulness Test). There was no differential effect of CPAP in comparison to sham CPAP on PLMS after 6 months of therapy. CONCLUSIONS PLMS are common in patients with OSA and are associated with a significant reduction in sleep quality over and above that conferred by OSA. Treatment with CPAP does not affect the severity of PLMS.
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Affiliation(s)
- Rohit Budhiraja
- From the Divisions of Sleep and Circadian Disorders (R.B., S.J., L.J.E., O.O., S.F.Q.) and Pulmonary and Critical Care Medicine (R.B.), Department of Medicine, and Division of Sleep and Circadian Disorders (M.K.P.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Arizona Respiratory Center (S.F.Q.), University of Arizona, Tucson.
| | - Sogol Javaheri
- From the Divisions of Sleep and Circadian Disorders (R.B., S.J., L.J.E., O.O., S.F.Q.) and Pulmonary and Critical Care Medicine (R.B.), Department of Medicine, and Division of Sleep and Circadian Disorders (M.K.P.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Arizona Respiratory Center (S.F.Q.), University of Arizona, Tucson
| | - Milena K Pavlova
- From the Divisions of Sleep and Circadian Disorders (R.B., S.J., L.J.E., O.O., S.F.Q.) and Pulmonary and Critical Care Medicine (R.B.), Department of Medicine, and Division of Sleep and Circadian Disorders (M.K.P.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Arizona Respiratory Center (S.F.Q.), University of Arizona, Tucson
| | - Lawrence J Epstein
- From the Divisions of Sleep and Circadian Disorders (R.B., S.J., L.J.E., O.O., S.F.Q.) and Pulmonary and Critical Care Medicine (R.B.), Department of Medicine, and Division of Sleep and Circadian Disorders (M.K.P.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Arizona Respiratory Center (S.F.Q.), University of Arizona, Tucson
| | - Olabimpe Omobomi
- From the Divisions of Sleep and Circadian Disorders (R.B., S.J., L.J.E., O.O., S.F.Q.) and Pulmonary and Critical Care Medicine (R.B.), Department of Medicine, and Division of Sleep and Circadian Disorders (M.K.P.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Arizona Respiratory Center (S.F.Q.), University of Arizona, Tucson
| | - Stuart F Quan
- From the Divisions of Sleep and Circadian Disorders (R.B., S.J., L.J.E., O.O., S.F.Q.) and Pulmonary and Critical Care Medicine (R.B.), Department of Medicine, and Division of Sleep and Circadian Disorders (M.K.P.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Arizona Respiratory Center (S.F.Q.), University of Arizona, Tucson
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22
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Lombardi C, Parati G, Soranna D, Zambon A, Sliwinski P, Roisman G, Pepin J, Schiza S, Riha R, Joppa P, Fietze I, Hedner J, Grote L, U A, F B, MR B, OK B, P B, Z D, Z D, P E, I F, L G, J H, H H, P J, JA K, P L, C L, O M, JF M, WT M, JM M, G P, A P, T P, E P, JL P, R P, M P, RL R, G R, S R, T S, S S, R S, P S, JL P, MS T, R T, R S, P S, G V, J V. Periodic limb movements during sleep and blood pressure changes in sleep apnoea: Data from the European Sleep Apnoea Database. Respirology 2019; 25:872-879. [DOI: 10.1111/resp.13760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/25/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Carolina Lombardi
- Sleep Disorders Center, Department of Cardiovascular, Neural and Metabolic SciencesSan Luca Hospital, Instituto Auxologico Italiano, IRCCS Milan Italy
- Department of Medicine and SurgeryUniversity of Milano‐Bicocca Milan Italy
| | - Gianfranco Parati
- Sleep Disorders Center, Department of Cardiovascular, Neural and Metabolic SciencesSan Luca Hospital, Instituto Auxologico Italiano, IRCCS Milan Italy
- Department of Medicine and SurgeryUniversity of Milano‐Bicocca Milan Italy
| | - Davide Soranna
- Sleep Disorders Center, Department of Cardiovascular, Neural and Metabolic SciencesSan Luca Hospital, Instituto Auxologico Italiano, IRCCS Milan Italy
| | - Antonella Zambon
- Sleep Disorders Center, Department of Cardiovascular, Neural and Metabolic SciencesSan Luca Hospital, Instituto Auxologico Italiano, IRCCS Milan Italy
- Department of Statistics and Quantitative MethodsUniversity of Milano‐Bicocca Milan Italy
| | - Paweł Sliwinski
- Second Department of Respiratory MedicineInstitute of Tuberculosis and Lung Diseases Warsaw Poland
| | - Gabriel Roisman
- Sleep Medicine Unit at Hôpital BéclèreHôpitaux Universitaires Paris‐Sud Paris France
| | - Jean‐Louis Pepin
- HP2 Laboratory, INSERM U1042University Grenoble Alpes Grenoble France
- EFCR Laboratory, Pole Thorax et VaisseauxGrenoble Alpes University Hospital Grenoble France
| | - Sophia Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical SchoolUniversity of Crete Heraklion Greece
| | - Renata Riha
- Centre for Clinical Brain Sciences, Sleep Research Unit, Department of Sleep MedicineRoyal Infirmary of Edinburgh Edinburgh UK
| | - Pavol Joppa
- University Hospital L. Pasteur Košice – Univerzitnej nemocnice L. Pasteura Košice Košice Slovakia
| | - Ingo Fietze
- Department of Cardiology and Angiology, Center of Sleep MedicineCCM, Charité – Universitätsmedizin Berlin Berlin Germany
| | - Jan Hedner
- Sleep Disorders Center, Sahlgrenska University HospitalGothenburg University Gothenburg Sweden
- Center for Sleep and Wake Disorders, Sahlgrenska AcademyGothenburg University Gothenburg Sweden
| | - Ludger Grote
- Sleep Disorders Center, Sahlgrenska University HospitalGothenburg University Gothenburg Sweden
- Center for Sleep and Wake Disorders, Sahlgrenska AcademyGothenburg University Gothenburg Sweden
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Blood pressure profile and endothelial function in restless legs syndrome. Sci Rep 2019; 9:15933. [PMID: 31685922 PMCID: PMC6828664 DOI: 10.1038/s41598-019-52401-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/14/2019] [Indexed: 12/21/2022] Open
Abstract
Restless legs syndrome (RLS) is frequently comorbid with hypertension and cardiovascular diseases; however this relationship and underlying mechanisms remain controversial. After clinical evaluation, 84 drug-free patients with primary RLS (53 women; mean age 55.1 ± 12.3 years) and 76 controls (47 women; mean age 52.2 ± 15.3 years) underwent 24-hour ambulatory blood pressure (BP) and polysomnographic monitoring, and peripheral arterial tonometry to assess endothelial function for 61 patients and 69 controls. Hypertension was diagnosed in 11.9% of patients with RLS based on office measurement, and in 46.4% on the 24 h recording, with nighttime hypertension, two times more frequent than daytime hypertension. Periodic limb movement during sleep (PLMS), markers of sleep fragmentation, and systolic and mean BP non-dipping profile were more frequent among patients. BP non-dipping status was associated with older age, later RLS onset and diagnosis, RLS severity and higher sleep fragmentation. The mean 24-hour, daytime and nighttime BP values, the frequency of hypertension and the endothelial function were comparable between groups. However, both systolic and diastolic BP trajectories over a 24-hour period differed between groups. In conclusion, patients with RLS exhibit a 24-hour BP deregulation with increased frequency of systolic non-dipping profiles that could worsen the risk for CVD morbidity and mortality.
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Rassu AL, Chenini S, Barateau L, Lopez R, Evangelista E, Guiraud L, Jaussent I, Dauvilliers Y. Increased blood pressure during the suggested immobilization test in Restless Legs Syndrome. Sleep 2019; 43:5602988. [DOI: 10.1093/sleep/zsz263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/13/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To investigate the relationship between sensory discomfort/motor component and cardiovascular autonomic response by continuous beat-to-beat blood pressure monitoring (CBPM) during the suggested immobilization test (SIT) in patients with restless legs syndrome (RLS).
Methods
Thirty-two drug-free patients with primary RLS (10 men; mean age 60.29 ± 10.81 years) and 17 healthy controls (2 men; mean age 58.82 ± 11.86 years) underwent a 1-hour SIT starting at 8 pm with concomitant CBPM to measure the heart rate (HR) and systolic/diastolic blood pressure (SBP, DBP). In all subjects, the presence of sensory discomfort and motor component during the SIT (S-SIT+ and M-SIT+, respectively) was quantified. Mixed regression models were used to compare the SBP, DBP, and HR profiles during the SIT by taking into account the repeated measures (6 time periods of 10 minutes).
Results
In patients with S-SIT+ (n = 17), SBP (p < 0.0001), DBP (p = 0.0007), and HR (p = 0.03) increased during the SIT compared with other patients and controls. Seventeen patients had M-SIT+ (none among healthy controls). Classifying patients in 4 groups in function of the presence/absence of the SIT sensory and motor components revealed that SDB and DBP increased throughout the SIT in patients with S-SIT+, independently of the motor component (p < 0.0001 and p = 0.0008 for SBD; p < 0.0001 and p = 0.01 for DBP in the S-SIT+/M-SIT− and S-SIT+/M-SIT+ groups, respectively).
Conclusion
During the SIT, BP concomitantly increased only in patients with RLS and sensory discomfort, with or without motor component. This highlights the link between evening sensory RLS symptoms, autonomic activation, and potential long-term cardiovascular consequences.
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Affiliation(s)
- Anna Laura Rassu
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Sofiène Chenini
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Lucie Barateau
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Regis Lopez
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Elisa Evangelista
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Lily Guiraud
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Isabelle Jaussent
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Yves Dauvilliers
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
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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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Sleep disorders, nocturnal blood pressure, and cardiovascular risk: A translational perspective. Auton Neurosci 2019; 218:31-42. [DOI: 10.1016/j.autneu.2019.02.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/16/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
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Szentkirályi A, Stefani A, Hackner H, Czira M, Teismann IK, Völzke H, Stubbe B, Gläser S, Ewert R, Penzel T, Fietze I, Young P, Högl B, Berger K. Prevalence and associated risk factors of periodic limb movement in sleep in two German population-based studies. Sleep 2018; 42:5248299. [DOI: 10.1093/sleep/zsy237] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/30/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- András Szentkirályi
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Heinz Hackner
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Maria Czira
- Institute for Sleep Medicine and Neuromuscular Disorders, Münster University Hospital, Münster, Germany
| | - Inga K Teismann
- Institute for Sleep Medicine and Neuromuscular Disorders, Münster University Hospital, Münster, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Beate Stubbe
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany
| | - Sven Gläser
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany
- Vivantes Klinikum Berlin Spandau, Department of Internal Medicine and Pulmonary Diseases, Berlin, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany
| | - Thomas Penzel
- Sleep Centre, University Hospital Charité Berlin, Berlin, Germany
| | - Ingo Fietze
- Sleep Centre, University Hospital Charité Berlin, Berlin, Germany
| | - Peter Young
- Institute for Sleep Medicine and Neuromuscular Disorders, Münster University Hospital, Münster, Germany
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany
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28
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Mollenhauer B, Zimmermann J, Sixel‐Döring F, Focke NK, Wicke T, Ebentheuer J, Schaumburg M, Lang E, Friede T, Trenkwalder C. Baseline predictors for progression 4 years after Parkinson's disease diagnosis in the De Novo Parkinson Cohort (DeNoPa). Mov Disord 2018; 34:67-77. [DOI: 10.1002/mds.27492] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Brit Mollenhauer
- Paracelsus‐Elena‐Klinik Kassel Germany
- Department of Neurology University Medical Centre Goettingen Goettingen Germany
| | | | | | - Niels K. Focke
- Department of Clinical Neurophysiology University Medical Centre Goettingen Goettingen Germany
| | | | | | | | | | - Tim Friede
- Department of Medical Statistics University Medical Centre Goettingen Goettingen Germany
| | - Claudia Trenkwalder
- Paracelsus‐Elena‐Klinik Kassel Germany
- Department of Neurosurgery University Medical Centre GoettingenGoettingen Germany
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Abstract
INTRODUCTION Stroke is a major cause of disability and death in the United States and across the world, and the incidence and prevalence of stroke are expected to rise significantly due to an aging population. Obstructive sleep apnea, an established independent risk factor for stroke, is a highly prevalent disease that is estimated to double the risk of stroke. It remains uncertain whether non-apnea sleep disorders increase the risk of stroke. Areas covered: This paper reviews the literature describing the association between incident stroke and sleep apnea, rapid eye movement sleep behavior disorder, restless legs syndrome, periodic limb movements of sleep, insomnia, and shift work. Expert commentary: Trials of continuous positive airway pressure for stroke prevention in sleep apnea patients have been largely disappointing, but additional trials that target populations not yet optimally studied are needed. Self-reported short and long sleep duration may be associated with incident stroke. However, abnormal sleep duration may be a marker of chronic disease, which may itself be associated with incident stroke. The relationship between non-apnea sleep disorders and incident stroke deserves further attention. Identification of specific non-apnea sleep disorders or sleep problems that convey an increased risk for stroke may provide novel targets for stroke prevention.
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Affiliation(s)
- Mollie McDermott
- Michigan Medicine Stroke Program, Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Devin L. Brown
- Michigan Medicine Stroke Program, Cardiovascular Center, Ann Arbor, Michigan, USA
- Michigan Medicine Michael S. Aldrich Sleep Disorders Laboratory, Ann Arbor, Michigan, USA
| | - Ronald D. Chervin
- Michigan Medicine Stroke Program, Cardiovascular Center, Ann Arbor, Michigan, USA
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31
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Guo S, Huang J, Jiang H, Han C, Li J, Xu X, Zhang G, Lin Z, Xiong N, Wang T. Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management. Front Aging Neurosci 2017. [PMID: 28626420 PMCID: PMC5454050 DOI: 10.3389/fnagi.2017.00171] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Restless legs syndrome (RLS), a common neurological sensorimotor disorder in western countries, has gained more and more attention in Asian countries. The prevalence of RLS is higher in older people and females. RLS is most commonly related to iron deficiency, pregnancy and uremia. The RLS symptoms show a significant circadian rhythm and a close relationship to periodic limb movements (PLMs) in clinical observations, while the pathophysiological pathways are still unknown. The diagnostic criteria have been revised in 2012 to improve the validity of RLS diagnosis. Recent studies have suggested an important role of iron decrease of brain in RLS pathophysiology. Dopaminergic (DA) system dysfunction in A11 cell groups has been recognized long ago from clinical treatment and autopsy. Nowadays, it is believed that iron dysfunction can affect DA system from different pathways and opioids have a protective effect on DA system. Several susceptible single nucleotide polymorphisms such as BTBD9 and MEIS1, which are thought to be involved in embryonic neuronal development, have been reported to be associated with RLS. Several pharmacological and non-pharmacological treatment are discussed in this review. First-line treatments of RLS include DA agents and α2δ agonists. Augmentation is very common in long-term treatment of RLS which makes prevention and management of augmentation very important for RLS patients. A combination of different types of medication is effective in preventing and treating augmentation. The knowledge on RLS is still limited, the pathophysiology and better management of RLS remain to be discovered.
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Affiliation(s)
- Shiyi Guo
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Jinsha Huang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Haiyang Jiang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Chao Han
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Jie Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Xiaoyun Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Guoxin Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Zhicheng Lin
- Department of Psychiatry, Harvard Medical School, BelmontMA, United States.,Division of Alcohol and Drug Abuse, Mailman Neuroscience Research Center, McLean Hospital, BelmontMA, United States
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
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Manconi M, Bassetti CL, Ferri R. Periodic Limb Movements During Sleep and White Matter MRI Hyperintensity in Minor Stroke or TIA. Sleep 2017; 40:3827931. [DOI: 10.1093/sleep/zsx031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- 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
| | - Claudio L. Bassetti
- Neurology Department Inselspital, Bern University Hospital, Bern, Switzerland
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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Högl B, Stefani A. Restless legs syndrome and periodic leg movements in patients with movement disorders: Specific considerations. Mov Disord 2017; 32:669-681. [DOI: 10.1002/mds.26929] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Birgit Högl
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - Ambra Stefani
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
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34
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Jahangir A, Murthy V. Effect of restless legs syndrome on blood pressure: is it sleep disturbance? Sleep Med 2017; 32:234-235. [PMID: 28057493 DOI: 10.1016/j.sleep.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Arshad Jahangir
- Aurora Cardiovascular Services and Center for Integrative Research on Cardiovascular Aging, Aurora Health Care, Milwaukee, WI, United States.
| | - Vishnubhakta Murthy
- Aurora Cardiovascular Services and Center for Integrative Research on Cardiovascular Aging, Aurora Health Care, Milwaukee, WI, United States
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Ferri R, Cosentino FII, Moussouttas M, Lanuzza B, Aricò D, Bagai K, Wang L, McLaughlin B, Walters AS. Silent Cerebral Small Vessel Disease in Restless Legs Syndrome. Sleep 2016; 39:1371-7. [PMID: 27091527 DOI: 10.5665/sleep.5966] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/22/2016] [Indexed: 01/09/2023] Open
Abstract
STUDY OBJECTIVES Growing literature suggests that patients with restless legs syndrome (RLS) may be at increased risk for hypertension, heart disease, and stroke. Cerebral small vessel disease (SVD) is a known risk factor for clinical stroke. This study evaluated silent cerebral SVD by MRI in patients with RLS, in the absence of a history of previous clinical stroke or known stroke risk factors and taking into account disease duration. METHODS Fifty-three patients with RLS < 10 y were prospectively recruited along with 44 with RLS > 10 y and 74 normal controls. A magnetic resonance imaging study was obtained from all subjects and scans were analyzed for area and volume of SVD. RESULTS There was a significant increase in SVD area in the entire group of RLS patients compared to controls (P = 0.036); this was almost entirely driven by the group with RLS > 10 y. SVD area and volume were significantly increased in patients with RLS > 10 y with respect to both controls (P < 0.0001 and P < 0.0014, respectively) and RLS < 10 y (P < 0.00022 and P < 0.003, respectively). Age, duration of RLS, and the interaction of age and duration of RLS were independent predictors of SVD disease. Duration of RLS was an independent predictor of the burden of cerebral SVD (area P < 0.00012 and volume P < 0.0025), whereas sex and insomnia were not. CONCLUSION RLS duration should be taken into account when analyzing the association between RLS and cerebrovascular disease; our data support the hypothesis that a long-lasting RLS and its accompanying periodic limb movements in sleep are a risk factor for silent SVD and perhaps for the development of clinical stroke.
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Affiliation(s)
- Raffaele Ferri
- Department of Neurology I.C., Oasi Research Institute, Troina (EN), Italy
| | | | | | - Bartolo Lanuzza
- Department of Neurology I.C., Oasi Research Institute, Troina (EN), Italy
| | - Debora Aricò
- Department of Neurology I.C., Oasi Research Institute, Troina (EN), Italy
| | - Kanika Bagai
- Vanderbilt University School of Medicine, Nashville, TN
| | - Lily Wang
- Vanderbilt University School of Medicine, Nashville, TN
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Ferini-Strambi L, Marelli S, Galbiati A. Clinical pharmacology and efficacy of rotigotine (Neupro® patch) in the treatment of restless leg syndrome. Expert Opin Drug Metab Toxicol 2016; 12:967-75. [DOI: 10.1080/17425255.2016.1194393] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Luigi Ferini-Strambi
- Division of Neuroscience, Sleep Disorders Center, Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Sara Marelli
- Division of Neuroscience, Sleep Disorders Center, Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Galbiati
- Division of Neuroscience, Sleep Disorders Center, Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
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37
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Bauer A, Cassel W, Benes H, Kesper K, Rye D, Sica D, Winkelman JW, Bauer L, Grieger F, Joeres L, Moran K, Schollmayer E, Whitesides J, Carney HC, Walters AS, Oertel W, Trenkwalder C. Rotigotine's effect on PLM-associated blood pressure elevations in restless legs syndrome: An RCT. Neurology 2016; 86:1785-93. [PMID: 27164714 PMCID: PMC4862252 DOI: 10.1212/wnl.0000000000002649] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 01/28/2016] [Indexed: 11/15/2022] Open
Abstract
Objective: This double-blind, placebo-controlled, interventional trial was conducted to investigate the effects of rotigotine patch on periodic limb movement (PLM)–associated nocturnal systolic blood pressure (SBP) elevations. Methods: Patients with moderate to severe restless legs syndrome (RLS) were randomized to rotigotine (optimal dose [1–3 mg/24 h]) or placebo. Continuous beat-to-beat blood pressure (BP) assessments were performed during polysomnography at baseline and at the end of 4-week maintenance. Primary outcome was change in number of PLM-associated SBP elevations (defined as slope of linear regression ≥2.5 mm Hg/beat-to-beat interval over 5 consecutive heartbeats [≥10 mm Hg]). Additional outcomes were total SBP elevations, PLM-associated and total diastolic BP (DBP) elevations, periodic limb movements index (PLMI), and PLM in sleep arousal index (PLMSAI). Results: Of 81 randomized patients, 66 (37 rotigotine, 29 placebo) were included in efficacy assessments. PLM-associated SBP elevations were significantly reduced with rotigotine vs placebo (least squares mean treatment difference [95% confidence interval (CI)] −160.34 [−213.23 to −107.45]; p < 0.0001). Rotigotine-treated patients also had greater reduction vs placebo in total SBP elevations (−161.13 [−264.47 to −57.79]; p = 0.0028), PLM-associated elevations (−88.45 [−126.12 to −50.78]; p < 0.0001), and total DBP elevations (−93.81 [−168.45 to −19.16]; p = 0.0146), PLMI (−32.77 [−44.73 to −20.80]; p < 0.0001), and PLMSAI (−7.10 [−11.93 to −2.26]; p = 0.0047). Adverse events included nausea (rotigotine 23%; placebo 8%), headache (18% each), nasopharyngitis (18%; 8%), and fatigue (13%; 15%). Conclusions: Further investigation is required to determine whether reductions in nocturnal BP elevations observed with rotigotine might modify cardiovascular risk. Classification of evidence: This study provides Class I evidence that for patients with moderate to severe RLS, rotigotine at optimal dose (1–3 mg/24 h) reduced PLM-associated nocturnal SBP elevations.
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Affiliation(s)
- Axel Bauer
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany.
| | - Werner Cassel
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Heike Benes
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Karl Kesper
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - David Rye
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Domenic Sica
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - John W Winkelman
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Lars Bauer
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Frank Grieger
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Lars Joeres
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Kimberly Moran
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Erwin Schollmayer
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - John Whitesides
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Hannah C Carney
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Arthur S Walters
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
| | - Wolfgang Oertel
- From the Munich University Clinic and DZHK (German Centre for Cardiovascular Research) (A.B.); Philipps Universität Marburg (W.C., K.K., W.O.); Somni Bene Institut für Medizinische Forschung und Schlafmedizin (H.B.), Schwerin; Medical Center (H.B.), Rostock University, Germany; Emory University (D.R.), Atlanta, GA; Virginia Commonwealth University (D.S.), Richmond; Massachusetts General Hospital (J.W.W.), Boston; UCB Pharma (L.B., F.G., L.J., E.S.), Monheim am Rhein, Germany; UCB Pharma (K.M.), Smyrna, GA; UCB Pharma (J.W.), Raleigh, NC; Evidence Scientific Solutions (H.C.C.), Horsham, UK; Vanderbilt University School of Medicine (A.S.W.), Nashville, TN; Hertie Foundation (W.O.), Frankfurt am Main; and Department of Neurosurgery (C.T.), University Medical Center, Göttingen and Paracelsus-Elena-Klinik, Kassel, Germany
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Fulda S. The Role of Periodic Limb Movements During Sleep in Restless Legs Syndrome: A Selective Update. Sleep Med Clin 2015; 10:241-8, xii. [PMID: 26329434 DOI: 10.1016/j.jsmc.2015.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Periodic leg movements during sleep (PLMS) are a highly active research topic and accumulating recent evidence has led to reevaluation of key aspects on the role of PLMS in restless legs syndrome (RLS). This article summarizes the recent developments in 3 areas: the relationship of PLMS to cortical arousals in patients with RLS, the differential effect of dopaminergic and non-dopaminergic treatment on PLMS, and the possible emergence of PLMS as a sleep-related cardiovascular risk factor.
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Affiliation(s)
- Stephany Fulda
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, Lugano 6903, Switzerland.
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