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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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Katunina EA, Titova NV, Katunin DA, Bagmanyan SD, Pogorova AR. [Restless legs syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:106-113. [PMID: 33728859 DOI: 10.17116/jnevro2021121021106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Restless legs syndrome (RLS) is seen widely in clinical practice. RLS commonly occurs at night time and presents with unpleasant or uncomfortable sensations in the legs that causes an urge to move them. This article describes the epidemiology, risk factors and pathophysiology of RLS. There is a detailed description of clinical presentations, diagnostic criteria and also management of RLS.
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Affiliation(s)
- E A Katunina
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - N V Titova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - D A Katunin
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - S D Bagmanyan
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A R Pogorova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Chiaro G, Manconi M. Restless legs syndrome, periodic limb movements during sleep and cardiovascular risk. Auton Neurosci 2019; 220:102554. [PMID: 31331694 DOI: 10.1016/j.autneu.2019.102554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/16/2022]
Abstract
Multiple mechanisms may modulate an association between restless legs syndrome/Willis-Ekbom disease (RLS/WED) and cardiovascular disease (CVD), including chronic sleep deprivation, intermittent, periodic limb movements in sleep (PLMS)-related autonomic fluctuations and possible autonomic dysfunction intrinsically associated with RLS per se. The purpose of this paper is to review the existing RLS/WED literature focusing on the pathophysiologic evidence for possible associations between RLS/WED and PLMS with CVD and events (CVE). Specific intrinsic dysautonomic aspects of the disease, which may contribute to generating CVD, are separately discussed. The association between RLS/WED and both CV risk factors and CVD still remains elusive. Although several shared pathophysiological causes could explain these possible relationships, the emerging body of literature focusing on these disorders remains controversial. Not only longitudinal population-based studies and meta-analyses, but also more animal models and therapeutic interventions are needed in order to build a sufficiently robust body of evidence on this topic.
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Affiliation(s)
- Giacomo Chiaro
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland; Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland; Department of Neurology, Bern University Hospital, Bern, Switzerland.
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Kendzerska T, Kamra M, Murray BJ, Boulos MI. Incident Cardiovascular Events and Death in Individuals With Restless Legs Syndrome or Periodic Limb Movements in Sleep: A Systematic Review. Sleep 2017; 40:2979287. [DOI: 10.1093/sleep/zsx013] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Giner-Galvañ V, Sanz-García FJ, Canet-Sanz T. Síndrome de piernas inquietas como causa de hipertensión arterial reversible. Med Clin (Barc) 2016; 147:e15-6. [DOI: 10.1016/j.medcli.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 11/16/2022]
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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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Plasma apelin level in patients with restless legs syndrome and its association with periodic leg movements. Sleep Breath 2016; 21:19-24. [DOI: 10.1007/s11325-016-1355-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 05/01/2016] [Accepted: 05/09/2016] [Indexed: 12/26/2022]
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Katsi V, Katsimichas T, Kallistratos MS, Tsekoura D, Makris T, Manolis AJ, Tousoulis D, Stefanadis C, Kallikazaros I. The association of Restless Legs Syndrome with hypertension and cardiovascular disease. Med Sci Monit 2014; 20:654-9. [PMID: 24747872 PMCID: PMC3999161 DOI: 10.12659/msm.890252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Restless Legs Syndrome (RLS), is a sensory-motor neurological disorder that appears to be surprisingly common in the community. Periodic limb movements in sleep are typically encountered in more than 80% of RLS patients and comprise involuntary muscular jerks in the lower limbs, such as flexion of the knees or ankles. Iron deficiency and dopaminergic neuronal dysfunction in the central nervous system are currently thought to be the likely pathophysiological culprits. There is evidence linking RLS to hypertension and cardiovascular disease. This short review will first present a synopsis of epidemiological, clinical and pathophysiological data concerning the syndrome, and then information on the possible links between RLS and cardiovascular disorders.
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Affiliation(s)
- Vasiliki Katsi
- Department of Cardiology, Hippokration Hospital, Athens, Greece
| | | | | | - Dora Tsekoura
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Thomas Makris
- Department of Cardiology, Elena Venizelou Hospital, Athens, Greece
| | | | - Dimitris Tousoulis
- First University Department of Cardiology, Hippokration Hospital, Athens, Greece
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Ferini-Strambi L, Marelli S. Pharmacotherapy for restless legs syndrome. Expert Opin Pharmacother 2014; 15:1127-38. [DOI: 10.1517/14656566.2014.908850] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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The relationship among restless legs syndrome (Willis-Ekbom Disease), hypertension, cardiovascular disease, and cerebrovascular disease. J Neurol 2013; 261:1051-68. [PMID: 23963470 PMCID: PMC4057632 DOI: 10.1007/s00415-013-7065-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 08/02/2013] [Accepted: 08/03/2013] [Indexed: 01/12/2023]
Abstract
Untreated sleep disorders may contribute to secondary causes of uncontrolled hypertension, cardiovascular disease (CVD), and stroke. Restless legs syndrome, or Willis–Ekbom Disease (RLS/WED), is a common sensorimotor disorder with a circadian rhythmicity defined by an uncontrollable urge to move the legs that worsens during periods of inactivity or at rest in the evening, often resulting in sleep disruptions. Sleep disorders such as insomnia and obstructive sleep apnea (OSA) are established risk factors for increased risk of hypertension and vascular diseases. This literature review outlines the lessons learned from studies demonstrating insomnia and OSA as risk factors for hypertension and vascular diseases to support the epidemiologic and physiologic evidence suggesting a similar increase in hypertension and vascular disease risk due to RLS. Understanding the relationships between RLS and hypertension, CVD, and stroke has important implications for reducing the risks associated with these diseases.
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Giannini G, Zanigni S, Melotti R, Gögele M, Provini F, Facheris MF, Cortelli P, Pramstaller PP. Association between restless legs syndrome and hypertension: a preliminary population-based study in South Tyrol, Italy. Eur J Neurol 2013; 21:72-8. [DOI: 10.1111/ene.12244] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/01/2013] [Indexed: 12/01/2022]
Affiliation(s)
- G. Giannini
- Center for Biomedicine; European Academy Bozen/Bolzano (EURAC) (affiliated institute of the University of Lübeck); Bolzano Italy
| | - S. Zanigni
- Center for Biomedicine; European Academy Bozen/Bolzano (EURAC) (affiliated institute of the University of Lübeck); Bolzano Italy
| | - R. Melotti
- Center for Biomedicine; European Academy Bozen/Bolzano (EURAC) (affiliated institute of the University of Lübeck); Bolzano Italy
| | - M. Gögele
- Center for Biomedicine; European Academy Bozen/Bolzano (EURAC) (affiliated institute of the University of Lübeck); Bolzano Italy
| | - F. Provini
- IRCCS Istituto di Scienze Neurologiche di Bologna; Bologna Italy
- Department of Biomedical and NeuroMotor Sciences (DIBINEM) Alma Mater Studiorum - Università di Bologna; Bologna Italy
| | - M. F. Facheris
- Center for Biomedicine; European Academy Bozen/Bolzano (EURAC) (affiliated institute of the University of Lübeck); Bolzano Italy
| | - P. Cortelli
- IRCCS Istituto di Scienze Neurologiche di Bologna; Bologna Italy
- Department of Biomedical and NeuroMotor Sciences (DIBINEM) Alma Mater Studiorum - Università di Bologna; Bologna Italy
| | - P. P. Pramstaller
- Center for Biomedicine; European Academy Bozen/Bolzano (EURAC) (affiliated institute of the University of Lübeck); Bolzano Italy
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Szentkirályi A, Völzke H, Hoffmann W, Happe S, Berger K. A time sequence analysis of the relationship between cardiovascular risk factors, vascular diseases and restless legs syndrome in the general population. J Sleep Res 2013; 22:434-42. [PMID: 23374090 DOI: 10.1111/jsr.12040] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 01/02/2013] [Accepted: 01/09/2013] [Indexed: 01/09/2023]
Abstract
Previous cross-sectional studies regarding the association of restless legs syndrome (RLS) with cardiovascular morbidity are controversial. Our aim was to evaluate prospectively the relationship of cardiovascular risk factors and vascular diseases with incident RLS in the general population. The results are from two prospective population-based cohort studies: the Dortmund Health Study (n = 1312, median follow-up of 2.1 years) and the Study of Health in Pomerania (n = 4308, median follow-up of 5.0 years). RLS status was assessed twice according to the minimal criteria. Diabetes, hypertension, myocardial infarction and stroke, as well as currently taken medications, were assessed as self-reports. Body mass index and serum total cholesterol were also measured. The independent risks associated with each outcome were estimated by multivariable logistic regression models adjusted for comorbidities and behavioural factors. Obesity was an independent risk factor of incident RLS in the Dortmund Health Study, and higher body mass index was an independent risk factor in both studies. Diabetes, hypertension and hypercholesterolaemia were independent predictors of incident RLS in the Study of Health in Pomerania. The vascular comorbidity index, defined by the number of concurrent cardiovascular risk factors and vascular diseases, showed a positive association with incident RLS in both studies. RLS at baseline was not a significant predictor of any subsequent cardiovascular risk factors and/or vascular diseases in any of the studies. Cardiovascular risk factors and diseases predict the subsequent development of RLS in the general population. The presence of RLS is not a significant risk factor of cardiovascular morbidity.
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Affiliation(s)
- András Szentkirályi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany; Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary.
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Trotti LM, Rye DB, De Staercke C, Hooper WC, Quyyumi A, Bliwise DL. Elevated C-reactive protein is associated with severe periodic leg movements of sleep in patients with restless legs syndrome. Brain Behav Immun 2012; 26:1239-43. [PMID: 22750520 PMCID: PMC3468666 DOI: 10.1016/j.bbi.2012.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/09/2012] [Accepted: 06/11/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Restless legs syndrome (RLS) is a common sleep disorder in which urges to move the legs are felt during rest, are felt at night, and are improved by leg movement. RLS has been implicated in the development of cardiovascular disease. Periodic leg movements (PLMs) may be a mediator of this relationship. We evaluated systemic inflammation and PLMs in RLS patients to further assess cardiovascular risk. METHODS 137 RLS patients had PLM measurements taken while unmedicated for RLS. Banked plasma was assayed for high sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha). RESULTS Mean (SD) PLM index was 19.3 (22.0). PLMs were unrelated to TNF-a and IL-6, but were modestly correlated with logCRP (r(129)=0.19, p=0.03). Those patients with at least 45PLMs/h had an odds ratio of 3.56 (95% CI 1.26-10.03, p=0.02, df=1) for having elevated CRP compared to those with fewer than 45PLMs/h. After adjustment for age, race, gender, diabetes, hypertension, hyperlipidemia, inflammatory disorders, CRP-lowering medications, and body mass index, the OR for those with ≥ 45PLMs/h was 8.60 (95% CI 1.23 to 60.17, p=0.03, df=10). CONCLUSIONS PLMs are associated with increased inflammation, such that those RLS patients with at least 45PLMs/h had more than triple the odds of elevated CRP than those with fewer PLMs. Further investigation into PLMs and inflammation is warranted.
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Affiliation(s)
- Lynn Marie Trotti
- Emory Program in Sleep, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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