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Szklarek M, Kostka T, Kostka J. Correlates of Restless Legs Syndrome in Older People. J Clin Med 2024; 13:1364. [PMID: 38592261 PMCID: PMC10932329 DOI: 10.3390/jcm13051364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
Background: We examined the association between restless legs syndrome (RLS) and comprehensive geriatric assessment (CGA) data in two older European populations. The second goal was to evaluate correlates of their quality of life (QoL). Methods: Diagnostic criteria of the International RLS Study Group (IRLSSG) and elements of CGA were used in this study. Results: Among the examined 246 participants, 77 (31.3%) suffered from RLS, more often in the UK (39.4%) than in Poland (25.4%) (p = 0.019). In the multivariate logistic regression model, female sex [OR (CI) = 3.29 (1.51-7.21); p = 0.0014], the number of medications per day [OR (CI) = 1.11 (1.02-1.20); p = 0.011] and alcohol consumption [OR (CI) = 5.41 (2.67-10.95); p < 0.001] increased the probability of RLS. Residing in Poland [OR (CI) = 3.06 (1.36-6.88); p = 0.005], the presence of RLS [OR (CI) = 2.90 (1.36-6.17); p = 0.004], chronic heart failure, [OR (CI) = 3.60 (1.75-7.41); p < 0.001], osteoarthritis [OR (CI) = 2.85 (1.47-5.49); p = 0.0016], and urinary incontinence [OR (CI) = 4.74 (1.87-11.9); p < 0.001] were associated with a higher probability of mobility dimension problems in the QoL. Higher physical activity was related to a lower probability of mobility problems [OR (CI) = 0.85 (0.78-0.92); p < 0.001]. Conclusions: female sex, the number of medications and alcohol consumption are independent correlates of RLS in older adults. RLS together with several chronic medical conditions and a low physical activity level were independent correlates of the mobility dimension of the QoL.
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Affiliation(s)
- Magdalena Szklarek
- Department of Geriatrics, Medical University of Lodz, 90-647 Lodz, Poland; (M.S.); (T.K.)
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, 90-647 Lodz, Poland; (M.S.); (T.K.)
| | - Joanna Kostka
- Department of Gerontology, Medical University of Lodz, 93-113 Lodz, Poland
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Walters AS, Li Y, Koo BB, Ondo WG, Weinstock LB, Champion D, Afrin LB, Karroum EG, Bagai K, Spruyt K. Review of the role of the endogenous opioid and melanocortin systems in the restless legs syndrome. Brain 2024; 147:26-38. [PMID: 37633259 PMCID: PMC10796165 DOI: 10.1093/brain/awad283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023] Open
Abstract
Restless legs syndrome (RLS) is responsive to opioid, dopaminergic and iron-based treatments. Receptor blocker studies in RLS patients suggest that the therapeutic efficacy of opioids is specific to the opioid receptor and mediated indirectly through the dopaminergic system. An RLS autopsy study reveals decreases in endogenous opioids, β-endorphin and perhaps Met-enkephalin in the thalamus of RLS patients. A total opioid receptor knock-out (mu, delta and kappa) and a mu-opioid receptor knock-out mouse model of RLS show circadian motor changes akin to RLS and, although both models show sensory changes, the mu-opioid receptor knock mouse shows circadian sensory changes closest to those seen in idiopathic RLS. Both models show changes in striatal dopamine, anaemia and low serum iron. However, only in the total receptor knock-out mouse do we see the decreases in serum ferritin that are normally found in RLS. There are also decreases in serum iron when wild-type mice are administered a mu-opioid receptor blocker. In addition, the mu-opioid receptor knock-out mouse also shows increases in striatal zinc paralleling similar changes in RLS. Adrenocorticotropic hormone and α-melanocyte stimulating hormone are derived from pro-opiomelanocortin as is β-endorphin. However, they cause RLS-like symptoms and periodic limb movements when injected intraventricularly into rats. These results collectively suggest that an endogenous opioid deficiency is pathogenetic to RLS and that an altered melanocortin system may be causal to RLS as well.
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Affiliation(s)
- Arthur S Walters
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Yuqing Li
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Brian B Koo
- Sleep Medicine Laboratory, VA Connecticut Health Care System, West Haven, CT 06516, USA
- Yale Center for Restless Legs Syndrome, Yale School of Medicine, New Haven, CT 06520, USA
| | - William G Ondo
- Department of Neurology, Methodist Hospital, Weill Cornell Medical School, Houston, TX 77030, USA
| | - Leonard B Weinstock
- Department of Internal Medicine, Washington University School of Medicine, St.Louis, MO 63130, USA
| | - David Champion
- Sydney Children's Hospital, Department of Pain Medicine, Randwick, NSW 2031, Australia
| | - Lawrence B Afrin
- Hematology/Oncology, AIM Center for Personalized Medicine, Purchase, NY 10577, USA
| | - Elias G Karroum
- Department of Neurology and Rehabilitation Medicine, The George Washington University School of Medicine and Health Sciences, George Washington University, Washington, D.C. 20052, USA
| | - Kanika Bagai
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot Inserm, Paris 75019, France
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Deng MG, Liu F, Liang Y, Chen Y, Nie JQ, Chai C, Wang K. Associations of serum zinc, copper, and selenium with sleep disorders in the American adults: Data from NHANES 2011-2016. J Affect Disord 2023; 323:378-385. [PMID: 36464094 DOI: 10.1016/j.jad.2022.11.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Even though various studies have been conducted to investigate the relationship between trace metals and sleep, few epidemiological studies have evaluated the relationship between trace metals and sleep disorders in American adults. OBJECTIVE This study intended to evaluate the associations of serum zinc (Zn), copper (Cu), selenium (Se), Zn/Cu, Zn/Se, and Cu/Se ratios with sleep disorders in American adults. METHODS We conducted a cross-sectional analysis of 3660 adults aged ≥18 years old who participated in the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Binary logistic regression was employed to calculate the odds ratio (OR) and 95 % confidence interval (CI) of either serum trace metals or serum trace metals ratios with risks among sleep disorder phenotypes. The restricted cubic spline (RCS) model was additionally utilized to check the dose-response relationships between serum trace metals, serum trace metals ratios, and sleep disorders. RESULTS Logistic regression demonstrated that higher serum Zn (OR: 0.70, 95 % CI: 0.51-0.97, p = 0.035), Zn/Cu (OR: 0.62, 95 % CI: 0.45-0.87, p = 0.007), and Zn/Se (OR: 0.68, 95 % CI: 0.49-0.95, p = 0.025) were related to a decreased likelihood of self-reported sleep disorders, and dose-response relationships were detected by the RCS models, after adjustment for sociodemographic, behavioral, and health characteristics. No associations between serum Cu, Se, Cu/Se, and sleep disorders were observed. The findings in the sensitivity analyses were consistent with these results. CONCLUSION Our study revealed that serum Zn, Zn/Cu, and Zn/Se were inversely associated with the risk of self-reported sleep disorders in US adults.
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Affiliation(s)
- Ming-Gang Deng
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Fang Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Yuehui Liang
- Department of Nutrition and Food Hygiene, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Yanling Chen
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jia-Qi Nie
- Department of Nutrition and Food Hygiene, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Chen Chai
- China Emergency Center, Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Kai Wang
- Department of Public Health, Wuhan Fourth Hospital, Wuhan 430033, China.
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Liampas I, Siokas V, Kyrozis A, Sakoutis G, Yannakoulia M, Kosmidis MH, Sakka P, Sakkas GK, Giannaki CD, Stefanidis I, Scarmeas N, Dardiotis E, Hadjigeorgiou GM. Prevalence and Determinants of Restless Legs Syndrome (Willis-Ekbom Disease) in an Older Greek Population. Behav Sleep Med 2022:1-13. [PMID: 35994615 DOI: 10.1080/15402002.2022.2112194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES The present study aimed to explore the descriptive and analytic epidemiology of restless legs syndrome (RLS) in the older Greek population, with a specific focus on lifestyle indicators. METHODS Baseline data from the randomly selected non-demented older participants of the population-based HELIAD cohort were analyzed. Multivariable binary logistic regression with RLS diagnosis as the dichotomous dependent outcome was performed. Demographic, socioeconomic, anthropometric, dietary, sleep-related and psychological parameters, physical activity, use of psychoactive substances and personal medical history were investigated for potential associations. RESULTS A total of 133 from the eligible sample of 1,838 participants were diagnosed with RLS. The mean age-sex standardized prevalence of RLS among the elderly was estimated at 6.1% (95%CI = 5.0-7.2), with a female (8.0%, 95%CI = 6.4-9.6) to male (3.7%, 95%CI = 2.4-5.1) ratio of 2.1. The prevalence of RLS peaked during the 8th decade of life and diminished thereafter. The positive associations of RLS with female sex [OR = 2.06, 95%CI = (1.19-3.57)], anxiety levels [assessed by the 22-point HADS scale, OR = 1.08, 95%CI = (1.03-1.13)] and traumatic brain injury [OR = 2.22, 95%CI = (1.37-3.62)] were reproduced. Good sleep quality was related to 55% [95%CI~(24-83%)] lower odds of having RLS in comparison with both poor and moderate quality. Adherence to the Mediterranean dietary pattern [assessed by a 55-point scale, OR = 1.06, 95%CI = (1.01-1.11)], and low daily energy intake [low-moderate vs. low: OR = 0.45, 95%CI = (0.26-0.79)]; [moderate-high vs. low: OR = 0.69, 95%CI = (0.40-1.22)]; [high vs. low: OR = 0.31, 95%CI = (0.13-0.69)] were related to RLS for the first time. CONCLUSIONS More emphasis should be placed on the dietary-nutritional aspects of RLS.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Andreas Kyrozis
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - George Sakoutis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Marousi, Greece
| | - Giorgos K Sakkas
- School of Physical Education and Sport Science, University of Thessaly, Trikala, Greece.,School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Ioannis Stefanidis
- Department of Nephology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece.,Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Georgios M Hadjigeorgiou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
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5
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Affiliation(s)
- Wei-Sheng Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Jiménez-Jiménez FJ, Ayuso P, Alonso-Navarro H, Calleja M, Díez-Fairén M, Álvarez I, Pastor P, Plaza-Nieto JF, Navarro-Muñoz S, Turpín-Fenoll L, Millán-Pascual J, Recio-Bermejo M, García-Ruiz R, García-Albea E, Agúndez JAG, García-Martín E. Serum Trace Elements Concentrations in Patients with Restless Legs Syndrome. Antioxidants (Basel) 2022; 11:antiox11020272. [PMID: 35204155 PMCID: PMC8868060 DOI: 10.3390/antiox11020272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
Increased brain and serum zinc levels in patients with idiopathic restless legs syndrome (idiopathic RLS or iRLS) were described when compared with controls, suggesting a possible role of zinc in the pathogenesis of this disease. However, serum magnesium, calcium, manganese, iron, and copper levels of RLS patients were similar to controls, suggesting a specific impairment of zinc-dependent metabolism in RLS. The aim of this study is to assess the serum concentrations of trace elements involved in oxidative stress or causing peripheral nerve toxicity in a large series of patients with iRLS and controls. We determined serum levels of iron, copper, manganese, zinc, magnesium, selenium, calcium, aluminium, lead, cadmium, arsenic and mercury in 100 patients diagnosed with iRLS and in 110 age- and sex-matched controls using Inductively Coupled Plasma Mass Spectrometry. Serum copper, magnesium, selenium, and calcium concentrations were significantly higher in RLS patients than in controls. These differences were observed both in men and women. There were no major correlations between serum trace metal concentrations and age at onset of RLS or RLS severity, nor was there any association with a family history of RLS or drug response. This study shows an association between increased serum concentrations of copper, magnesium, selenium, and calcium with RLS in a Spanish Caucasian population and does not confirm the previously reported increase in serum zinc concentrations in patients suffering from this disease, suggesting that the different accuracy of the analytical methods used could have influenced the inconsistent results found in the literature.
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Affiliation(s)
- Félix Javier Jiménez-Jiménez
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
- Correspondence: (F.J.J.-J.); (J.A.G.A.)
| | - Pedro Ayuso
- University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, Universidad de Extremadura, 10071 Cáceres, Spain; (P.A.); (E.G.-M.)
| | - Hortensia Alonso-Navarro
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
| | - Marisol Calleja
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
| | - Mónica Díez-Fairén
- Fundació per la Recerca Biomèdica i Social Mútua de Terrassa, 08221 Terrassa, Spain; (M.D.-F.); (I.Á.); (P.P.)
- Movement Disorders Unit, Department of Neurology, Univeristy Hospital Mutua de Terrassa, 08221 Terrassa, Spain
| | - Ignacio Álvarez
- Fundació per la Recerca Biomèdica i Social Mútua de Terrassa, 08221 Terrassa, Spain; (M.D.-F.); (I.Á.); (P.P.)
- Movement Disorders Unit, Department of Neurology, Univeristy Hospital Mutua de Terrassa, 08221 Terrassa, Spain
| | - Pau Pastor
- Fundació per la Recerca Biomèdica i Social Mútua de Terrassa, 08221 Terrassa, Spain; (M.D.-F.); (I.Á.); (P.P.)
- Movement Disorders Unit, Department of Neurology, Univeristy Hospital Mutua de Terrassa, 08221 Terrassa, Spain
| | - José Francisco Plaza-Nieto
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
| | - Santiago Navarro-Muñoz
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Laura Turpín-Fenoll
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Jorge Millán-Pascual
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Marta Recio-Bermejo
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Rafael García-Ruiz
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Esteban García-Albea
- Department of Medicine-Neurology, Hospital “Príncipe de Asturias”, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain;
| | - José A. G. Agúndez
- University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, Universidad de Extremadura, 10071 Cáceres, Spain; (P.A.); (E.G.-M.)
- Correspondence: (F.J.J.-J.); (J.A.G.A.)
| | - Elena García-Martín
- University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, Universidad de Extremadura, 10071 Cáceres, Spain; (P.A.); (E.G.-M.)
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