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Kambampati S, Wasim S, Kukkar V, Awad VM, Malik BH. Restless Leg Syndrome in the Setting of Patients With End-Stage Renal Disease on Hemodialysis: A Literature Review. Cureus 2020; 12:e9965. [PMID: 32983669 PMCID: PMC7510539 DOI: 10.7759/cureus.9965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Restless Leg Syndrome (RLS), or Willis-Ekbom disease (WED), is an irresistible urge to move the legs, predominantly while resting, sitting, or sleeping, which disrupts sleep and impairs quality of life. RLS can occur secondary to uremia in chronic kidney disease (CKD) patients due to inadequate hemodialysis. Early diagnosis is essential to prevent muscular atrophy and to improve the quality of life of RLS patients, especially those with end-stage renal disease (ESRD). Cardiac mortality high in uremic RLS patients due to associated discomfort and lowering the duration of hemodialysis treatment. This review focuses on and discusses the diagnosis, treatment, and associated comorbid conditions of uremic RLS. Though the exact pathophysiology is unknown, altered transferrin expression in the choroid plexus, increased glutamate levels in the thalamus, decreased opioid receptors, dopamine system dysfunction, calcium/phosphate imbalance, and single nucleotide polymorphisms in the BTBD9 and MEIS1 genes are a few nonconfirmatory pathophysiological concepts for uremic RLS. Nonpharmacological options include lowering the temperature of dialysate by 1 degree C and home-based therapies like massages, warm/cold baths, and aerobic exercises. Pharmacological therapy like dopamine agonists ropinirole and pramipexole reduces the symptoms effectively. However, surgical options like parathyroidectomy and renal transplantation are stated as the best treatment options in patients suffering from uremic RLS.
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Affiliation(s)
- Srikala Kambampati
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shehnaz Wasim
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vishal Kukkar
- Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vanessa M Awad
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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2
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Tsai LH, See LC, Chien CC, Chen CM, Chang SH. Risk factors for restless legs syndrome in hemodialysis patients in Taiwan: A case-control study. Medicine (Baltimore) 2019; 98:e18450. [PMID: 31861018 PMCID: PMC6940127 DOI: 10.1097/md.0000000000018450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 01/12/2023] Open
Abstract
Restless legs syndrome (RLS) increases the risks of cardiovascular disease and death in hemodialysis (HD) patients. Previous studies of risk factors for RLS in HD patients have yielded varying results. We attempted to identify risk factors for RLS in HD patients in Taiwan.This case-control study recruited 59 HD patients with RLS and 353 HD patients without RLS from the largest HD center in Taiwan during the period from April 1, 2015 through August 31, 2015. Demographic and disease characteristics, information from the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic questionnaire, and IRLSSG Severity Scale scores were collected by interview. Clinical laboratory data were abstracted from medical records and then analyzed with logistic regression and Pearson correlation analysis. A P value of less than .05 was considered to indicate statistical significance.A dialysis duration of longer than 5 years (odds ratio [OR] = 2.32; 95% CI = 1.23-4.39; P = .002) and a low high-density lipoprotein cholesterol level (<40 mg/dL in men; <50 mg/dL in women) (OR = 2.73; 95% CI = 1.44-5.15; P = .009) were associated with increased risk of RLS. Among the 59 patients with RLS, 48 (81.3%) had moderate or severe symptoms (IRLSSG Severity Scale >10), and RLS severity was significantly correlated with dialysis duration (r = .26; P = .043).Among HD patients, RLS was more common among those receiving dialysis for longer than 5 years and those with a low serum high-density lipoprotein cholesterol (HDL-C) level.
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Affiliation(s)
- Li-Hung Tsai
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan
- Department of Nephrology, Chang Gung Memorial Hospital at Linkou
| | - Lai-Chu See
- Department of Public Health, College of Medicine
- Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou
| | - Chu-Chun Chien
- Department of Nephrology, Chang Gung Memorial Hospital at Linkou
| | - Chuan-Mei Chen
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
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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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Huang CW, Lee MJ, Wang LJ, Lee PT, Tu YK, Hsu CW, Lin PY. Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis. Nephrol Dial Transplant 2019; 35:1609-1618. [DOI: 10.1093/ndt/gfz097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Restless legs syndrome (RLS) is common in end-stage renal disease (ESRD) patients and impairs health and quality of life significantly. However, the optimal treatment of RLS in ESRD patients is uncertain and less studied compared with idiopathic RLS patients.
Methods
We conducted a systematic review and network meta-analysis to compare the efficacy and acceptability of treatments for RLS in ESRD patients. Randomized controlled trials (RCTs) by February 2019 in the PubMed, Cochrane Library, Embase and ClinicalTrials.gov were reviewed. RLS severity reduction was treated as treatment efficacy, and adverse events were treated as acceptable. Both outcomes were appraised using a random effects model expressed as standardized mean differences and odds ratios with 95% confidence intervals (CIs), respectively, and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to obtain a hierarchy of interventions.
Results
A total of 12 RCTs were included, comprising 9 interventions and 498 participants. All the interventions significantly improved RLS severity without critical side effects compared with placebo. Gabapentin achieved the greatest decrease of RLS severity [standardized mean difference (SMD) = 1.95, 95% CI 0.81–3.09 (SUCRA: 79.3%)], despite its frequent adverse events [SMD = 0.18, 95% CI 0.02–1.50 (19.9%)]. The combination therapy of exercise plus dopamine agonist had better efficacy [SMD = 1.60, 95% CI 0.08–3.12 (59.8%)] and acceptability [SMD = 1.41, 95% CI 0.01–142.53 (63.9%)] compared with that of vitamin C plus vitamin E [SMD = 1.50, 95% CI 0.47–2.54 (56.6%); SMD = 0.32, 95% CI 0.04–2.86 (32.5%)].
Conclusions
This network meta-analysis supports that gabapentin is the most effective treatment for RLS in ESRD patients. Exercise plus dopamine agonist is a favorable combination therapy concerning side effects. Future large RCTs with long-term treatment outcomes are necessary.
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Affiliation(s)
- Chien-Wei Huang
- Department of Medicine, Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Min-Jing Lee
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Tsang Lee
- Department of Medicine, Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Restless Legs Syndrome in Dialysis Patients: Does the Dialysis Modality Influence Its Occurrence and Severity? Int J Nephrol 2018; 2018:1414568. [PMID: 29682346 PMCID: PMC5845496 DOI: 10.1155/2018/1414568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
Background Restless legs syndrome (RLS) is more prevalent in chronic kidney patients than in the general population, but it is often diagnosed late and its predictors are unknown. Purpose To diagnose RLS in a group of chronic kidney patients on dialysis, determine its frequency and severity, compare the prevalence and severity of the condition among dialytic modalities, and identify possible predictive factors in this population. Methods An observational and cross-sectional study with 326 patients who had been on dialysis for more than 3 months, 241 on hemodialysis (HD) and 85 on automatic peritoneal dialysis (APD), using the criteria established by the International Study Group on RLS for the diagnosis and the RLS Rating Scale to determine its severity. Results RLS was diagnosed in 19.3% of the patients, 52.4% with severe or very severe forms. Patients with and without RLS did not differ in clinical and demographic characteristics and dialytic modality; however, patients on APD presented higher RLS severity compared to the HD group. Conclusions RLS is frequent in dialysis patients and occurs predominantly in its most severe forms; the dialytic modality seems to have no influence on its occurrence; however, it is more severe in patients on APD.
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Baiardi S, Mondini S, Baldi Antognini A, Santoro A, Cirignotta F. Survival of Dialysis Patients with Restless Legs Syndrome: A 15-Year Follow-Up Study. Am J Nephrol 2017; 46:224-230. [PMID: 28869939 DOI: 10.1159/000479938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Restless legs syndrome, also known as Willis/Ekbom disease (RLS/WED), is a sleep-related, sensorimotor disorder with a high prevalence among end-stage renal disease (ESRD) patients undergoing haemodialysis (HD) (about 15-40%). Whether RLS/WED in uremic patients influences cardiovascular morbidity and mortality remains a matter of controversy. The aim of this study was to evaluate the relationship of RLS/WED and mortality in a population of chronically dialyzed patients. METHOD In 1996, we studied 128 patients with ESRD undergoing HD; 47 subjects (36.7%) complained RLS/WED symptoms. Fifteen years later we evaluated the mortality of this population. No clinical follow-up examination of the uremic population was made. The Kaplan-Maier curves in dialysis patients with or without RLS/WED (control group matched for age) were constructed for all-cause mortality and compared using log-rank test. RESULTS The Kaplan-Maier curves disclosed a lower mortality rate in the uremic patients with RLS/WED than in those without RLS/WED (p = 0.04). In our analysis, the mortality rate was not influenced by RLS/WED severity (p = 0.11) or gender (p = 0.15). No difference among the causes of death was found in the 2 groups. CONCLUSIONS Our study suggests that mortality in ESRD patients is not influenced by concomitant RLS/WED. After a 15-year follow-up, survival rates in our cohort were significantly longer in uremic subjects with RLS/WED than in those without RLS/WED. Finally, we found no relationship between RLS/WED severity and mortality.
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Affiliation(s)
- Simone Baiardi
- Neurology Unit, S. Orsola-Malpighi Hospital, AOU Bologna, Bologna, Italy
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Hermida RC, Ayala DE, Smolensky MH, Fernández JR, Mojón A, Portaluppi F. Sleep-time blood pressure: Unique sensitive prognostic marker of vascular risk and therapeutic target for prevention. Sleep Med Rev 2017; 33:17-27. [DOI: 10.1016/j.smrv.2016.04.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/03/2016] [Accepted: 04/06/2016] [Indexed: 01/04/2023]
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Torabi-Nami M, Mehrabi S, Derman S. Repetitive Arm Movements During Sleep: A Polysomnographic Assessment. Basic Clin Neurosci 2016; 7:269-75. [PMID: 27563420 PMCID: PMC4981839 DOI: 10.15412/j.bcn.03070312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Sleep-related movement disorders should be differentiated from parasomnias, sleep-associated behavioral disorders, and epilepsy. Polysomnography (PSG) is the gold standard in evaluating such disorders. Periodic leg movement disorder during sleep (PLMS), hypnic jerks, bruxism, rhythmic movement disorder, restless legs syndrome, and nocturnal leg cramps have broadly been discussed in the literature. However, periodic arm movement disorder in sleep (PAMS) is a less-appreciated entity perhaps because arm surface electromyography is not an integral part of the standard polysomnography. Results from our PSG study in a case suspected for PAMS prompted us to herewith discuss this problem.
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Affiliation(s)
- Mohammad Torabi-Nami
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.; Sleep Disorders Laboratory, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.; Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samrad Mehrabi
- Sleep Disorders Laboratory, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.; Division of Pulmonology, Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sabri Derman
- Sleep Disorders Unit, American Hospital, Koç Foundation, Istanbul, Turkey
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Fröhlich AC, Eckeli AL, Bacelar A, Poyares D, Pachito DV, Stelzer FG, Coelho FMS, Rizzo GNV, Prado GFD, Sander HH, Goulart LI, Lucchesi LM, Gitai LLG, Prado LBFD, Ataíde-Junior L, Bezerra MLDS, Lopes MC, Trentin MM, Rodrigues RND, Hasan R, Alves RSC, Schönwald SV, Moraes WADS. Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:260-280. [PMID: 25807136 DOI: 10.1590/0004-282x20140239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.
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Affiliation(s)
| | - Alan Luiz Eckeli
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirao Preto, SP, Brazil
| | | | - Dalva Poyares
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | | | | | | | | | | | - Heidi Haueisen Sander
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirao Preto, SP, Brazil
| | | | | | | | | | | | | | - Maria Cecília Lopes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Ma S, Shang X, Guo Y, Liu G, Yang J, Xue R. Restless legs syndrome and hypertension in Chinese pregnant women. Neurol Sci 2015; 36:877-81. [PMID: 25647293 DOI: 10.1007/s10072-015-2094-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
Abstract
Hypertension is a common complication of pregnancy, and studies show that pregnant women are more likely to suffer from restless legs syndrome (RLS). Pregnant women with hypertension and RLS often experience disrupted sleep patterns because of activation of the nervous system. The present study aimed to clarify the relationship between hypertension and RLS in pregnant women, and their impact on sleep. We enrolled 3,781 pregnant women who were admitted at our hospital for delivery between May 2011 and May 2014. The face-to-face questionnaire used to gather data included the International RLS Study Group criteria for diagnosis, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and hypertension diagnosis. Depending on the time of occurrence of hypertension, it was divided into two different types: pregnancy-induced hypertension and chronic hypertension in pregnancy. Out of 3,781 patients, 453 fulfilled the diagnostic criteria for RLS and 486 met the diagnostic criteria for hypertension. Among patients with RLS, prophylactic iron supplementation was less frequently taken during pregnancy. Pregnancy-induced hypertension, rather than chronic hypertension in pregnancy, was found to be more frequent in patients with RLS; pregnant women with RLS had higher PSQI and ESS scores than pregnant controls. In our study, RLS was frequent in pregnant women, especially in those without prophylactic iron supplementation. Patients with RLS described more serious sleep disruption and excessive daytime sleepiness (EDS). In addition, pregnancy-induced hypertension was more common in patients with RLS.
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Affiliation(s)
- Shengli Ma
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, No.1 Jian She Dong Avenue, Zhengzhou, 450002, People's Republic of China
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Manconi M, Zavalko I, Fanfulla F, Winkelman JW, Fulda S. An evidence-based recommendation for a new definition of respiratory-related leg movements. Sleep 2015; 38:295-304. [PMID: 25325500 DOI: 10.5665/sleep.4418] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 09/30/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Current sleep scoring rules exclude leg movements that occur near respiratory events from being scored as periodic leg movements during sleep (PLMS) but differ in whether they exclude leg movements occurring at the end (WASM/ IRLSSG) or during a respiratory event (AASM). The aim of the present study was to describe the distribution of leg movements in relation to respiratory events and to contribute to an evidence-based rule for the identification and scoring of respiratory-related leg movements (RRLMs). DESIGN Retrospective chart review and analysis of polysomnographic recordings. SETTING Clinical sleep laboratory. PARTICIPANTS 64 patients with polysomnographic recordings between January 2010 and July 2011, aged 18 to 75 years, with AHI >20, ODI >10, more than 50% of apneas being obstructive, >15 leg movements of any type per hour of sleep, no more than 20% of total sleep time with artifacts and no medical condition or medication that could influence leg movements or respiratory disturbances. INTERVENTIONS None. MEASUREMENTS AND RESULTS Back-averaging of leg movement activity (LMA) with respect to respiratory events revealed that LMA was present shortly before the end of the respiratory events, but occurred mostly following respiratory events with peak onset of LMA 2.5 s after respiratory event termination. Increased LMA before the beginning of the respiratory event consisted mainly of the tail of LMA after the end of the previous respiratory event. Change-point analysis indicated that LMA was increased over an interval of -2.0 s to +10.25 s around the end of respiratory events. Changing the definition of RRLMs had a significant influence on PLMS counts. The number of patients with obstructive sleep apnea (OSA) with PLMS index >15 was 80% when considering the WASM/ IRLSSG definition, 67% for the AASM criteria, and 41% when based on the interval identified by change-point analysis (-2.0 to 10.25 s). CONCLUSIONS Leg movements are not augmented at the beginning or middle of respiratory events but are increased around the end of respiratory events over a period significantly longer than specified in the AASM and the WASM/ IRLSSG rules. Both rules underestimate the number of RRLMs and thus overestimate the number of PLMS in patients with OSA.
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Affiliation(s)
- Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Irina Zavalko
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland.,Institute for Bio-Medical Problems, Russian Academy of Science, Moscow, Russia
| | - Francesco Fanfulla
- Sleep Center, Scientific Institute of Pavia, Salvatore Maugeri Foundation IRCCS, Pavia, Italy
| | - John W Winkelman
- Department of Psychiatry, Sleep Disorders Clinical Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Stephany Fulda
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
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Current trends in the management of uremic restless legs syndrome: a systematic review on aspects related to quality of life, cardiovascular mortality and survival. Sleep Med Rev 2014; 21:39-49. [PMID: 25261116 DOI: 10.1016/j.smrv.2014.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 07/26/2014] [Accepted: 07/28/2014] [Indexed: 12/22/2022]
Abstract
Restless legs syndrome (RLS) affects almost one out of three end-stage renal disease patients. This review assesses the current treatment options for uremic RLS and the potential benefits of those treatments on quality of life parameters, cardiovascular mortality and survival. A systematic review was conducted searching PubMed and Scopus by using the Cochrane and PRISMA guidelines. Fourteen studies met the inclusion criteria in which the international RLS study group criteria were used as the primary diagnostic tool. Both pharmacological and non-pharmacological approaches were found to reduce the severity of uremic RLS symptoms. Only four studies reported changes on aspects related to quality of life while those changes were also associated with health benefits that resulted in reduced cardiovascular risk. The severity of uremic RLS symptoms can be ameliorated by using dopamine agonists and gabapentin, intravenous iron, exercise or supplementation with vitamins C and E, although some of those treatment benefits may be transient. There is a lack of strong evidence regarding the effects of the pharmacological approaches on quality of life and cardiovascular survival and mortality. In contrast exercise has been proven beneficial in both reducing the RLS symptoms' severity score and improving the quality of life.
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Epidemiology, impact, and treatment options of restless legs syndrome in end-stage renal disease patients: an evidence-based review. Kidney Int 2013; 85:1275-82. [PMID: 24107848 DOI: 10.1038/ki.2013.394] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/30/2013] [Accepted: 08/15/2013] [Indexed: 12/17/2022]
Abstract
Restless legs syndrome (RLS) (or Willis-Ekbom disease) is a neurological disorder with high prevalence among the end-stage renal disease population. This is one of the most predominant types of secondary RLS, and it is called uremic RLS. Despite the fact that uremic RLS has been less studied compared to idiopathic RLS, recent studies now shed light in many aspects of the syndrome including clinical characteristics, impact, epidemiology, and treatment options. The current review discusses the above topics with special emphasis given on the management of uremic RLS, including the management of symptoms that often appear during a hemodialysis session. Uremic RLS symptoms may be ameliorated by using pharmacological and nonpharmacological treatments. Evidence so far shows that both approaches may be effective in terms of reducing the RLS symptom's severity; nevertheless, more research is needed on the efficiency of treatments for uremic RLS.
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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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Hermida RC, Smolensky MH, Ayala DE, Portaluppi F, Crespo JJ, Fabbian F, Haus E, Manfredini R, Mojón A, Moyá A, Piñeiro L, Ríos MT, Otero A, Balan H, Fernández JR. 2013 Ambulatory Blood Pressure Monitoring Recommendations for the Diagnosis of Adult Hypertension, Assessment of Cardiovascular and other Hypertension-associated Risk, and Attainment of Therapeutic Goals. Chronobiol Int 2013; 30:355-410. [DOI: 10.3109/07420528.2013.750490] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Giannaki CD, Zigoulis P, Karatzaferi C, Hadjigeorgiou GM, George KP, Gourgoulianis K, Koutedakis Y, Stefanidis I, Sakkas GK. Periodic limb movements in sleep contribute to further cardiac structure abnormalities in hemodialysis patients with restless legs syndrome. J Clin Sleep Med 2013; 9:147-53. [PMID: 23372468 DOI: 10.5664/jcsm.2412] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVES In hemodialysis (HD) patients, restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS) constitute common sleep disorders. Recent findings indicate a role for PLMS as a risk factor in the development of new or the aggravation of existing cardiovascular disease. The aim of the current study was to investigate the association of PLMS with indices of cardiac morphology and function in HD patients with RLS as a potential pathway by which PLMS could alter cardiovascular risk. METHODS Based on PLMS diagnosis by an overnight polysomnographic evaluation, 19 stable HD-RLS patients were divided into the PLMS group (n = 10) and the non-PLMS group (n = 9). During the overnight assessment, nocturnal blood pressure (BP) indices were also assessed. Left ventricular (LV) dimensions were examined by M-mode echocardiography, whereas LV diastolic function was evaluated by conventional Doppler and tissue Doppler imaging the following day. RESULTS LV internal diameter in diastole was significantly increased in the PLMS group (4.96 ± 0.61 vs 4.19 ± 0.48 cm, p = 0.007), leading to a significantly increase in LV mass (202 ± 52 vs 150 ± 37 g, p = 0.026). In contrast, no between group differences were observed in diastolic function indices (p > 0.05). CONCLUSIONS These are the first data to associate severe PLMS with further LV structure abnormalities in HD patients with RLS.
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Portaluppi F, Smolensky MH, Haus E, Fabbian F. Relevance of Chronobiology to the Research and Clinical Practice of Neurorehabilitation. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2012.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ríos MT, Domínguez-Sardiña M, Ayala DE, Gomara S, Sineiro E, Pousa L, Callejas PA, Fontao MJ, Fernández JR, Hermida RC. Prevalence and Clinical Characteristics of Isolated-Office and True Resistant Hypertension Determined by Ambulatory Blood Pressure Monitoring. Chronobiol Int 2012; 30:207-20. [DOI: 10.3109/07420528.2012.701135] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Grimaldi D, Provini F, Calandra-Buonaura G, Barletta G, Cecere A, Pierangeli G, Cortelli P. Cardiovascular-sleep interaction in drug-naïve patients with essential grade I hypertension. Chronobiol Int 2012; 30:31-42. [PMID: 23072288 DOI: 10.3109/07420528.2012.701139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Lack of nighttime blood pressure (BP) reduction by 10-20% from the mean daytime values (dipping) has been described as a distinguishing feature of essential hypertension and associated, also in normotensive subjects, with increased cardiovascular (CV) risk. Mechanisms involved in the loss of the nocturnal dip are still unclear, but involvement of autonomic nervous system (ANS) activity probably plays a crucial role. Sleep is fundamental in modulating ANS activity to maintain the physiological BP circadian rhythm, and for this reason its integrity has been widely investigated in hypertension. We investigated, under controlled conditions, the autonomic control of the CV system through an autonomic reflex screen in the awake condition and by assessment of circadian rhythm-, day-night-, time-, and state-dependent changes of BP and heart rate (HR) and associated sleep parameters in patients with a recent (≤1 yr) diagnosis of essential grade I hypertension naïve of therapy. Fourteen hypertensive patients (6 males, age: 43 ± 11 yrs; body mass index [BMI]: 24 ± 3 kg/m(2)) were compared with 28 healthy controls matched for sex, age, BMI (2 controls/patient) for cardiovascular reflex and to 8 different subjects from previous controls (6 males), comparable for age and BMI, for the day-night and nighttime CV profiles during two consecutive nights. The cardiovascular reflex screen data showed increased sympathetic effect in hypertensive patients, represented by higher overshoot of BP after Valsalva maneuver. Nighttime sleep architecture during the dark period in terms of duration, representation of sleep stages, sleep fragmentation, and incidence of arousals-periodic limb movements in sleep (PLMS) and PLMS arousals-was similar in patients and controls. Hypertensive patients displayed higher 24-h BP and HR values, but their sleep-related BP decrease was significantly reduced compared with controls. The circadian rhythms of BP and HR were intact and similar in patients and controls, coupling with the expected physiological peak time. BP and HR showed normal state-dependent modulation in hypertensive patients that, however, was higher in all sleep stages compared with controls. The lowering of systolic blood pressure (SBP) during non-rapid eye movement (NREM) sleep stages 1 and 2 and REM sleep, relative to daytime wake values, was significantly attenuated in the hypertensive group, whereas it was comparable to controls during slow-wave sleep. In hypertensive patients, analysis of sleep and CV parameters in the 90 min following sleep onset and preceding morning awakening showed normal depressor effect during the first part of the night after sleep onset and significantly higher BP rise in the hours preceding morning awakening. These findings were associated with comparable sleep architecture, sleep fragmentation, incidence of arousals, and PLMS and PLMS arousals in patients and controls. Our data suggest that drug-naïve essential grade I hypertension is associated with signs of increased vascular sympathetic response to standardized stress of the Valsalva maneuver during the awake condition, and during sleep with a non-dipping BP profile plus higher BP surge preceding morning awakening, assessable only by around-the-clock ambulatory BP monitoring, both representing additional CV risk already in early-stage hypertension and, therefore, requiring proper selection of pharmacological treatment.
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Affiliation(s)
- Daniela Grimaldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Dipartimento di Scienze Neurologiche, Alma Mater Studiorum, Università di Bologna, Bologna, Italy
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Fabbian F, Smolensky MH, Tiseo R, Pala M, Manfredini R, Portaluppi F. Dipper and non-dipper blood pressure 24-hour patterns: circadian rhythm-dependent physiologic and pathophysiologic mechanisms. Chronobiol Int 2012; 30:17-30. [PMID: 23002916 DOI: 10.3109/07420528.2012.715872] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuroendocrine mechanisms are major determinants of the normal 24-h blood pressure (BP) pattern. At the central level, integration of the major driving factors of this temporal variability is mediated by circadian rhythms of monoaminergic systems in conjunction with those of the hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, opioid, renin-angiotensin-aldosterone, plus endothelial systems and specific vasoactive peptides. Humoral secretions are typically episodic, coupled either to sleep and/or the circadian endogenous (suprachiasmatic nucleus) central pacemaker clock, but exhibiting also weekly, monthly, seasonal, and annual periodicities. Sleep induction and arousal are influenced also by many hormones and chemical substances that exhibit 24-h variation, e.g., arginine vasopressin, vasoactive intestinal peptide, melatonin, somatotropin, insulin, steroids, serotonin, corticotropin-releasing factor, adrenocorticotropic hormone, thyrotropin-releasing hormone, endogenous opioids, and prostaglandin E2, all with established effects on the cardiovascular system. As a consequence, physical, mental, and pathologic stimuli that activate or inhibit neuroendocrine effectors of biological rhythmicity may also interfere with, or modify, the temporal BP structure. Moreover, immediate adjustment to exogenous components/environment demands by BP rhythms is modulated by the circadian-time-dependent responsiveness of biological oscillators and their neuroendocrine effectors. This knowledge contributes to a better understanding of the pathophysiology of abnormalities of the 24-h BP pattern and level and their correction through circadian rhythm-based chronotherapeutic strategies.
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Affiliation(s)
- Fabio Fabbian
- Section of Clinica Medica, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, Ferrara, Italy
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Batool-Anwar S, Malhotra A, Forman J, Winkelman J, Li Y, Gao X. Restless legs syndrome and hypertension in middle-aged women. Hypertension 2011; 58:791-6. [PMID: 21986505 DOI: 10.1161/hypertensionaha.111.174037] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Limited research suggests a relationship between restless legs syndrome and hypertension. We, therefore, assessed the relationship between restless legs syndrome and hypertension among middle-aged women. This is a cross-sectional study including 65 544 women (aged 41-58 years) participating in Nurses' Health Study II. The participants with diabetes mellitus and arthritis were excluded, because these conditions can mimic restless legs syndrome. Restless legs syndrome was assessed by a self-administered questionnaire based on the International Restless Legs Study Group criteria. Information on diagnosis of hypertension and blood pressure values were collected via questionnaires. Multivariable logistic regression models were used to analyze the relation between restless legs syndrome and hypertension, with adjustment for age, race, body mass index, physical activity, menopausal status, smoking, use of analgesics, and intake of alcohol, caffeine, folate, and iron. Compared with women with no restless legs symptoms, the multiple adjusted odds of having hypertension were 1.20 times (95% CI: 1.10-1.30; P<0.0001) higher among women with restless legs symptoms. The adjusted odds ratios for women who reported restless legs symptoms 5 to 14 times per month and ≥15 times per month were 1.06 (95% CI: 0.94-1.18) and 1.41 (95% CI: 1.24-1.61) respectively, compared with those without the symptoms (P trend: <0.0001). Greater frequency of restless legs symptoms was associated with higher concurrent systolic and diastolic blood pressures (P trend: <0.0001 for both). Women with restless legs syndrome have a higher prevalence of hypertension, and this prevalence increases with more frequent restless legs symptoms.
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Affiliation(s)
- Salma Batool-Anwar
- Harvard Medical School, Brigham and Women's Hospital, Division of Sleep Medicine, 221 Longwood Ave, BL1044, Boston, MA 02115, USA.
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Smolensky MH, Di Milia L, Ohayon MM, Philip P. Sleep disorders, medical conditions, and road accident risk. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:533-48. [PMID: 21130215 DOI: 10.1016/j.aap.2009.12.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 12/07/2009] [Indexed: 05/08/2023]
Abstract
Sleep disorders and various common acute and chronic medical conditions directly or indirectly affect the quality and quantity of one's sleep or otherwise cause excessive daytime fatigue. This article reviews the potential contribution of several prevalent medical conditions - allergic rhinitis, asthma, chronic obstructive pulmonary disease, rheumatoid arthritis/osteoarthritis - and chronic fatigue syndrome and clinical sleep disorders - insomnia, obstructive sleep apnea, narcolepsy, periodic limb movement of sleep, and restless legs syndrome - to the risk for drowsy-driving road crashes. It also explores the literature on the cost-benefit of preventive interventions, using obstructive sleep apnea as an example. Although numerous investigations have addressed the impact of sleep and medical disorders on quality of life, few have specifically addressed their potential deleterious effect on driving performance and road incidents. Moreover, since past studies have focused on the survivors of driver crashes, they may be biased. Representative population-based prospective multidisciplinary studies are urgently required to clarify the role of the fatigue associated with common ailments and medications on traffic crash risk of both commercial and non-commercial drivers and to comprehensively assess the cost-effectiveness of intervention strategies.
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Abstract
PURPOSE OF REVIEW Although restless legs syndrome (RLS) is a disorder recognized in the medical literature since the 17th century, there have only recently been significant clinical and scientific advances in diagnosis, epidemiology and understanding the disorder, mainly due to the advent of dopaminergic treatment. RECENT FINDINGS Recent discoveries have uncovered the iron-dopamine connection in RLS and the basic dopaminergic pathology related to the RLS symptoms. These have led to new understanding of the morbidity of RLS and the many conditions associated with RLS, which have also supported new approaches to treatment. These developments are each briefly described here. SUMMARY Although there has been progress in understanding, diagnosing and treating RLS, it remains an underdiagnosed and undertreated condition severely impairing functioning of patients with moderate-to-severe disease. Much work is needed to improve on current, as well as other novel therapies.
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La Manna G, Pizza F, Persici E, Baraldi O, Comai G, Cappuccilli ML, Centofanti F, Carretta E, Plazzi G, Coli L, Montagna P, Stefoni S. Restless legs syndrome enhances cardiovascular risk and mortality in patients with end-stage kidney disease undergoing long-term haemodialysis treatment. Nephrol Dial Transplant 2010; 26:1976-83. [DOI: 10.1093/ndt/gfq681] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Cuellar NG, Hanlon A, Ratcliffe SJ. The relationship with iron and health outcomes in persons with restless legs syndrome. Clin Nurs Res 2010; 20:144-61. [PMID: 21041807 DOI: 10.1177/1054773810388557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Restless Legs Syndrome (RLS) is a sleep disorder cause by inadequate iron metabolism. However, no studies have identified the impact of iron in RLS patients on sleep, depression, fatigue, or quality of life (QoL). OBJECTIVE The aims of this secondary data analysis was to determine relationships (a) between serum iron with RLS symptom severity, sleep quality, daytime sleepiness, depression, fatigue, and quality of life (QoL); and (b) based on demographics, specifically age and ethnicity. METHOD Data were collected on iron and ferritin concentrations in 48 persons with RLS. RESULTS Low serum iron levels were measured in 32% of the participants with only 1 person (4%) treated with iron supplementation. General linear models identified age and race as covariants: (a) being White (p = .047) and higher iron levels (p = .019) were independent predictors of higher social functioning; (b) being White (p = .047) and higher iron levels (p = .004) were independent predictors of less sleepiness; (c) younger age (p = .001) and lower iron levels (p = .025) were independent predictors of depression; and (d) younger age (p = .006) and lower iron levels (p = .005) were independent predictors of fatigue. DISCUSSION Findings from this study show that iron supplementation for persons with RLS not only improves motor and sensory symptoms but might also improve sleep, sleepiness, depression, fatigue, and QoL and should be considered by health care providers for treatment of RLS.
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Portaluppi F, Smolensky MH, Touitou Y. ETHICS AND METHODS FOR BIOLOGICAL RHYTHM RESEARCH ON ANIMALS AND HUMAN BEINGS. Chronobiol Int 2010; 27:1911-29. [DOI: 10.3109/07420528.2010.516381] [Citation(s) in RCA: 973] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Portaluppi F, Smolensky MH. PERSPECTIVES ON THE CHRONOTHERAPY OF HYPERTENSION BASED ON THE RESULTS OF THE MAPEC STUDY. Chronobiol Int 2010; 27:1652-67. [DOI: 10.3109/07420528.2010.510788] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Francesco Portaluppi
- Hypertension Center, Department of Medicine, University Hospital “S. Anna” of Ferrara, Ferrara, Italy
| | - Michael H. Smolensky
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
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Hermida RC, Ayala DE, Fontao MJ, Mojón A, Alonso I, Fernández JR. Administration-time-dependent effects of spirapril on ambulatory blood pressure in uncomplicated essential hypertension. Chronobiol Int 2010; 27:560-74. [PMID: 20524801 DOI: 10.3109/07420528.2010.485411] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The administration of most angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) at bedtime results in a greater reduction of nighttime blood pressure (BP) than dosing upon awakening. It has been proposed that this effect may be a consequence of a short half-life and duration of action. However, those findings were also documented for long-acting medications, such as the ARB telmisartan. Accordingly, we investigated the administration-time-dependent effects on ambulatory BP of spirapril, an ACEI with an elimination half-life of about 40 h. We studied 165 previously untreated hypertensive subjects, 42.5 +/- 13.9 yrs of age, treated with spirapril (6 mg/day) as monotherapy for 12 weeks either upon awakening or at bedtime. BP was measured by ambulatory monitoring for 48 h before and after treatment. The BP reduction during diurnal activity was similar for both treatment times. Bedtime spirapril administration, however, was significantly more efficient than morning administration in reducing asleep BP. The awake/asleep BP ratio was decreased with the upon-awakening spirapril treatment schedule but significantly increased toward a more dipping pattern with the bedtime treatment schedule. The proportion of patients with controlled ambulatory BP increased from 23 to 59% (p < 0.001) with bedtime treatment. Sleep-time BP regulation is significantly better achieved with bedtime spirapril administration. This might be clinically important, as the sleep-time BP mean has been shown to be a more relevant marker of cardiovascular risk than the awake mean values. These administration-time-dependent effects of spirapril seem to be a class-related feature, and may be associated with the nocturnal activation of the renin-angiotensin-aldosterone system.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering Laboratory, University of Vigo, Campus Universitario, Vigo, Spain.
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Salas RE, Rasquinha R, Gamaldo CE. All the wrong moves: a clinical review of restless legs syndrome, periodic limb movements of sleep and wake, and periodic limb movement disorder. Clin Chest Med 2010; 31:383-95. [PMID: 20488295 DOI: 10.1016/j.ccm.2010.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Restless legs syndrome, periodic limb movements in sleep, and periodic limb movement disorder are a group of conditions that merit awareness from the medical community. These disorders are commonly encountered yet are often confused and misdiagnosed by health care professionals. It is imperative that health care providers are able to recognize these conditions to accurately diagnose, manage, and appropriately refer patients.
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Affiliation(s)
- Rachel E Salas
- Department of Neurology, Division of Pulmonary and Critical Care, Johns Hopkins Sleep Disorders Center at Johns Hopkins Hospital, 600 North Wolfe Street, Suite 1261, Baltimore, MD 21287, USA.
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Chen JD, Lin YC, Hsiao ST. Obesity and high blood pressure of 12-hour night shift female clean-room workers. Chronobiol Int 2010; 27:334-44. [PMID: 20370473 DOI: 10.3109/07420520903502242] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The 12 h shift schedule is widely used in clean rooms for electronic semiconductor production in Taiwan. This study investigated the associations of obesity and metabolic syndrome (MetS) components among women working in a semiconductor manufacturing factory in North Taiwan. Workers were divided into four groups according to their work schedules and duties (i.e., office workers, day workers, fixed 12 h day shift, and fixed 12 h night shiftworkers). The subjects comprised 1838 women who voluntarily attended a health examination between August 2006 and November 2006. Their mean (+/-SD) age was 33.6 (+/-7.1) yrs and their mean duration of work was 7.4 (+/-5.2) yrs. Each subject's health-related behaviors, body mass index, and MetS components were measured and analyzed using multivariate logistic regression. Obesity and MetS were defined according to World Health Organization criteria for Asian populations and the National Cholesterol Educational Program and Adult Treatment Panel III Guidelines, respectively. The results showed that women working in the clean room on fixed 12 h night shifts had significantly elevated odds ratios for obesity (OR, 2.7; 95% CI, 1.6-4.5), central obesity (OR, 2.9; 95% CI, 1.7-5.1), and high blood pressure (OR, 2.3; 95% CI, 1.2-4.4) compared to female office workers; these results persisted after adjusting for age, smoking, drinking, education, and duration of work. We did not find any significant differences in triglyceride and high-density lipoprotein cholesterol among women working different schedules. We conclude that working fixed 12 h night shifts was associated with an increased odds ratio for obesity, central obesity, and high blood pressure among clean-room women workers. Weight reduction and blood pressure control programs should be implemented in the workplace for women working fixed 12 h night shifts.
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Affiliation(s)
- Jong-Dar Chen
- Center for Occupational and Environmental Medicine, Department of Family Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Shih Lin, Taipei, 110 Taiwan.
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Current world literature. Curr Opin Cardiol 2010; 25:411-21. [PMID: 20535070 DOI: 10.1097/hco.0b013e32833bf995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roumelioti ME, Ranpuria R, Hall M, Hotchkiss JR, Chan CT, Unruh ML, Argyropoulos C. Abnormal nocturnal heart rate variability response among chronic kidney disease and dialysis patients during wakefulness and sleep. Nephrol Dial Transplant 2010; 25:3733-41. [PMID: 20466675 DOI: 10.1093/ndt/gfq234] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dialysis patients and patients with chronic kidney disease (CKD) experience a substantial risk for abnormal autonomic function and abnormal heart rate variability (HRV). It remains unknown whether HRV changes across sleep stages in patients with different severity of CKD or dialysis dependency. We hypothesized that high-frequency (HF) HRV (vagal tone) will be attenuated from wakefulness to non-rapid eye movement (NREM) and then to rapid eye movement (REM) sleep in dialysis patients as compared to patients with CKD. METHODS In-home polysomnography was performed in 95 patients with stages 4-5 CKD or end-stage renal disease (ESRD) on haemodialysis (HD) or peritoneal dialysis (PD). HRV was measured using fast Fourier transform of interbeat intervals during wakefulness and sleep. Low-frequency (LF) and HF intervals were generated. Natural logarithm HF (LNHF) and the logarithm LF/HF ratio (sympathovagal tone) were analysed by multivariable quantile regression and generalized estimating equations. RESULTS Of the 95 patients, 63.2% (n = 60) was male, 35.8% (n = 34) was African American and 20.4% (n = 19) was diabetic. Average age was 51.6 ± 15.1 (range 19-82). HRV variables were significantly associated with diabetic status, higher periodic limb movement indices and lower bicarbonate levels. Patients with advanced CKD did not differ from dialysis patients in their inability to increase vagal tone during sleep. During wakefulness, female gender (P = 0.05) was associated with the increases in the vagal tone. CONCLUSIONS Patients with CKD/ESRD exhibit dysregulation of the autonomic nervous system tone manifesting as a failure to increase HRV during wakefulness and sleep. Different patient characteristics are associated with changes in HRV at different sleep stages.
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Affiliation(s)
- Maria-Eleni Roumelioti
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, A909 Scaife Hall, Pittsburgh, PA 15261, USA.
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