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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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2
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Herberts M, Kolla B, Paul T, Mekala P, Mansukhani MP. Sleep apnea and autonomic dysfunction in patients with dementia. Front Neurosci 2022; 16:951147. [PMID: 36408398 PMCID: PMC9669746 DOI: 10.3389/fnins.2022.951147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Sleep apnea is common sleep disorder that is associated with an is an increase in risk of many health conditions, including systemic hypertension, stroke, atrial fibrillation, and heart failure. The predominant underlying pathophysiological mechanism for elevated risk of these conditions in patients with sleep apnea is thought to involve autonomic dysfunction in the form of sympathetic overactivity. Autonomic dysfunction is also associated with several neurodegenerative disorders and sleep apnea, in turn, has been shown to be associated with an increased risk of development of mild cognitive impairment and various types of dementia. Rapid eye movement sleep behavior disorder, which is also associated with an increased risk of alpha synucleiopathy-related dementia, is also linked with autonomic dysfunction. In this article we explore the relationship between sleep apnea, autonomic dysfunction, rapid eye movement sleep behavior disorder and dementia. This article describes the various autonomic dysfunction that are thought to occur in the context of sleep apnea. And illustrate the mechanisms by which sleep apnea, through its impact on autonomic dysfunction could potentially result in dementia. We also review the evidence examining the impact of treatment of sleep apnea on autonomic dysfunction and cognitive outcomes.
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Affiliation(s)
- Michelle Herberts
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Travis Paul
- Mayo Clinic Health System, Southwest Minnesota, Mankato, MN, United States
| | - Praveen Mekala
- Mayo Clinic Health System, Southwest Minnesota, Mankato, MN, United States
| | - Meghna P. Mansukhani
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Meghna P. Mansukhani,
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3
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Toba A, Ishikawa J, Harada K. Increased blood pressure variability is associated with probable rapid eye movement sleep behaviour disorder in elderly hypertensive patients. Blood Press 2022; 31:40-46. [DOI: 10.1080/08037051.2022.2055531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Ayumi Toba
- Division of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Joji Ishikawa
- Division of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Kazumasa Harada
- Division of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
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4
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Alizadeh K, Esmaeili R, Shorofi SA, Mousavinasab N, Espahbodi F, Esmaeili M. Effect of Urtica dioica (nettle) on quality of sleep in hemodialysis patients: A randomized clinical trial. J Herb Med 2021. [DOI: 10.1016/j.hermed.2020.100356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Ainge-Allen HW, Yee BJ, Ip MSM. Contemporary Concise Review 2020: Sleep. Respirology 2021; 26:700-706. [PMID: 34018277 DOI: 10.1111/resp.14084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022]
Abstract
Obstructive sleep apnoea (OSA) now affects one-seventh of the world's population. Treatment of even mild OSA can improve daytime sleepiness and quality of life. Recent modifications to uvulopalatopharyngoplasty may make it a more widely applicable treatment option in selected patients with OSA. Diet and exercise have effects on sleep apnoea severity independent of weight loss. Insomnia has become increasingly common during the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Henry W Ainge-Allen
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory Medicine, Dubbo Health Service, Dubbo, New South Wales, Australia
| | - Brendon J Yee
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mary S M Ip
- Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Hong Kong, Hong Kong.,Respiratory Division, University of Hong Kong Shenzhen Hospital, Shenzhen, China
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6
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Baek SJ, Ban HJ, Park SM, Lee B, Choi Y, Baek Y, Lee S, Cha S. Circulating microRNAs as Potential Diagnostic Biomarkers for Poor Sleep Quality. Nat Sci Sleep 2021; 13:1001-1012. [PMID: 34234603 PMCID: PMC8254567 DOI: 10.2147/nss.s311541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/21/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Persistent poor sleep quality leads to impaired cognitive performance and an inability to perform daily activities. Biomarker-assisted diagnosis is important for the early treatment of poor sleep quality; however, diagnostic biomarkers for poor sleep quality remain unidentified. Circulating microRNAs (miRNAs) have been reported to be linked to the pathogenesis of poor sleep quality, indicating their possible role in sleep problem diagnosis. The present study aimed to identify potential miRNA biomarkers for poor sleep quality. PATIENTS AND METHODS Differentially expressed serum miRNAs in patients with poor sleep quality and healthy controls (n=20) were analyzed via small RNA sequencing. Two-step quantitative RT-PCR in the two independent populations and receiver operating characteristic (ROC) analyses were used to validate the identified miRNAs. In silico analysis was then used to identify the target genes. RESULTS Of the 59 circulating miRNAs identified via differential analysis, six were validated for differential expression by quantitative RT-PCR (n=60). Two of these six miRNAs, miR-4433b-3p and miR-619-5p, were reconfirmed in the second validation with an independent validation cohort (n=59). ROC analyses (n=40) revealed the probability of the two miRNAs as potential biomarkers with areas under the ROC curve (AUCs) of 0.81 and 0.70, respectively. The combined AUC was 0.86, which was much higher than that of each miRNA. Using in silico target gene analysis, the target genes of the two miRNAs were identified to be associated with the regulation of the circadian rhythm and inflammatory pathways. CONCLUSION Our results revealed that miR-619-5p and miR-4433b-3p could be developed as potential diagnostic biomarkers for poor sleep quality. The combination of both miRNAs may be more effective than the use of the individual miRNA for sleep problem diagnosis.
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Affiliation(s)
- Su-Jin Baek
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hyo-Jeong Ban
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sang-Min Park
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Boyoung Lee
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Yoorae Choi
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Younghwa Baek
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Siwoo Lee
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Seongwon Cha
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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7
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Krakoff LR. Nocturnal Blood Pressure and Cardiovascular Risk. Hypertension 2020; 76:316-317. [PMID: 32639886 DOI: 10.1161/hypertensionaha.120.14409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Guyenet PG, Stornetta RL, Souza GMPR, Abbott SBG, Brooks VL. Neuronal Networks in Hypertension: Recent Advances. Hypertension 2020; 76:300-311. [PMID: 32594802 DOI: 10.1161/hypertensionaha.120.14521] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neurogenic hypertension is associated with excessive sympathetic nerve activity to the kidneys and portions of the cardiovascular system. Here we examine the brain regions that cause heightened sympathetic nerve activity in animal models of neurogenic hypertension, and we discuss the triggers responsible for the changes in neuronal activity within these regions. We highlight the limitations of the evidence and, whenever possible, we briefly address the pertinence of the findings to human hypertension. The arterial baroreflex reduces arterial blood pressure variability and contributes to the arterial blood pressure set point. This set point can also be elevated by a newly described cerebral blood flow-dependent and astrocyte-mediated sympathetic reflex. Both reflexes converge on the presympathetic neurons of the rostral medulla oblongata, and both are plausible causes of neurogenic hypertension. Sensory afferent dysfunction (reduced baroreceptor activity, increased renal, or carotid body afferent) contributes to many forms of neurogenic hypertension. Neurogenic hypertension can also result from activation of brain nuclei or sensory afferents by excess circulating hormones (leptin, insulin, Ang II [angiotensin II]) or sodium. Leptin raises blood vessel sympathetic nerve activity by activating the carotid bodies and subsets of arcuate neurons. Ang II works in the lamina terminalis and probably throughout the brain stem and hypothalamus. Sodium is sensed primarily in the lamina terminalis. Regardless of its cause, the excess sympathetic nerve activity is mediated to some extent by activation of presympathetic neurons located in the rostral ventrolateral medulla or the paraventricular nucleus of the hypothalamus. Increased activity of the orexinergic neurons also contributes to hypertension in selected models.
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Affiliation(s)
- Patrice G Guyenet
- From the Department of Pharmacology, University of Virginia, Charlottesville (P.G.G., R.L.S., G.M.P.R.S., S.B.G.A.)
| | - Ruth L Stornetta
- From the Department of Pharmacology, University of Virginia, Charlottesville (P.G.G., R.L.S., G.M.P.R.S., S.B.G.A.)
| | - George M P R Souza
- From the Department of Pharmacology, University of Virginia, Charlottesville (P.G.G., R.L.S., G.M.P.R.S., S.B.G.A.)
| | - Stephen B G Abbott
- From the Department of Pharmacology, University of Virginia, Charlottesville (P.G.G., R.L.S., G.M.P.R.S., S.B.G.A.)
| | - Virginia L Brooks
- Department of Chemical Physiology and Biochemistry, Oregon Health & Sciences University, Portland (V.L.B.)
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9
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Howard ME, O'Donoghue FJ. Periodic leg movements: A marker of cardiovascular risk? Respirology 2020; 25:793-794. [PMID: 32147897 DOI: 10.1111/resp.13795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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