The Relationship Between Restless Legs Syndrome and Cardiovascular Risk Factors
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Original Article
P: 29-36
June 2019

The Relationship Between Restless Legs Syndrome and Cardiovascular Risk Factors

J Turk Sleep Med 2019;6(2):29-36
1. Yedikule Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, Nöroloji Kliniği, İstanbul, Türkiye
2. edikule Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, Uyku Kliniği, İstanbul, Türkiye
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No information available
Received Date: 14.11.2018
Accepted Date: 26.02.2019
Publish Date: 31.05.2019
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ABSTRACT

Objective:

Restless Legs syndrome (RLS) is one of the common sleep disorders in the community. There are many studies on the relationship between sleep disorders and diabetes, hypertension, hyperlipidemia, obesity, and metabolic dysregulation. However, the results are contradicting in the studies conducted in cases with RLS. In this study, we retrospectively examined the possible relationship between cardiovascular risk factors and RLS.

Materials and Methods:

The study included 107 patients (group 1) diagnosed with RLS according to the diagnostic criteria recommended by the international RLS study group and 97 patients with the diagnosis of simple snoring (group 2) among the patients who were prescribed a diagnosis of sleep disorder in the sleep laboratory. Demographic, laboratory and polysomnographic data of all cases were retrospectively reviewed.

Results:

There was no significant difference between the groups in terms of age, gender, smoking, and alcohol use, however, weight, neck circumference, waist circumference, and body mass index were detected significantly higher (p=0.008, p=0.020, p=0.001, p=0.002, respectively). In addition, diastolic and systolic arterial blood pressure values and total cholesterol, low density lipoprotein-cholesterol, and triglyceride levels measured at the night of the examination were significantly different between the groups, and the presence of Metabolic syndrome was observed significantly higher in the RLS group (p=0.001, p=0.001, p=0.024, p=0.033, p=0.020, p=0.002, respectively).

Conclusion:

The incidence of hypertension, hyperlipidemia, obesity, and Metabolic syndrome increases in RLS patients. Further prospective studies are needed to elucidate the potential mechanisms underlying this correlation between the RLS and cardiovascular risk factors.

Keywords: Hyperlipidemia, hypertension, Restless Legs syndrome, cardiovascular risk factors, obesity

References

1
Yeh P,  Walters AS, Tsuang JW.  Restless legs syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath 2012;16:987-1007.
2
Innes KE, Selfe TK, Agarwal P. Prevalence of restless legs syndrome in North American and Western European populations: a systematic review. Sleep Med 2011;12:623-34.
3
Kim J, Choi C, Shin K, Yi H, Park M, Cho N. Kimm K, Shin C. Prevalence of restless legs syndrome and associated factors in the Korean adult population: the Korean Health and Genome Study. Psychiatry Clin Neurosci 2005;59:350-3.
4
Rangarajan S, Rangarajan S, D’Souza GA. Restless legs syndrome in an Indian urban population. Sleep Med 2007;9:88-93.
5
Sevim S, Dogu O, Camdeviren H, Bugdayci R, Sasmaz T, Kaleagasi H, Aral M, Helvaci I. Unexpectedly low prevalence and unusual characteristics of RLS in Mersin, Turkey. Neurology 2003;61:1562-9.
6
Özbek SE, Zarifoğlu M, Karlı N, Özçakır A, Yıldız D, Aslan D. A Population-Based Survey to Determine the Prevalence of Movement Disorders in Orhangazi District of Bursa, Turkey. Turk Norol Derg 2009;15:109-18.
7
Yilmaz NH, Akbostanci MC, Oto A, Aykac O. Prevalence of restless legs syndrome in Ankara, Turkey: an analysis of diagnostic criteria and awareness. Acta Neurol Belg 2013;113:247-51.
8
Ohayon MM, O’Hara R, Vitiello MV. Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 2012;16:283-95.
9
Cervenka S, Pålhagen SE, Comley RA, Panagiotidis G, Cselényi Z, Matthews JC, Lai RY, Halldin C, Farde L. Support for dopaminergic hypoactivity in restless legs syndrome: a PET study on D2-receptor binding. Brain 2006;129:2017-28.
10
Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J; Restless Legs Syndrome Diagnosis and Epidemiology workshop at the National Institutes of Health; International Restless Legs Syndrome Study Group. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003;4:101-19.
11
Allen R. Dopamine and iron in the pathophysiology of restless legs syndrome (RLS). Sleep Med 2004;5:385-91.
12
Earley CJ, B Barker P, Horská A, Allen RP. MRI-determined regional brain iron concentrations in early- and late-onset restless legs syndrome. Sleep Med 2006;7:458-61.
13
Rist PM, Elbaz A, Dufouil C, Tzourio C, Kurth T. Restless Legs Syndrome and Cognitive Function: A Population-based Cross-sectional Study. Am J Med 2015;128:1023.e33-9.
14
Li G, Tang H, Chen J, Qi X, Chen S, Ma J. Executive and Visuospatial Dysfunction in Patients With Primary Restless Legs Syndrome/Willis-Ekbom Disease: Study of a Chinese Population. J Clin Sleep Med 2018;14:785-90.
15
Winkelman JW, Shahar E, Sharief I, Gottlieb DJ. Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study. Neurology 2008;70:35-42.
16
Gao X, Schwarzschild MA, Wang H, Ascherio A. Obesity and restless legs syndrome in men and women. Neurology 2009;72:1255-61.
17
Walters AS, Rye DB. Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke. Sleep 2009;32:589-97.
18
Li Y, Li Y, Winkelman JW, Walters AS, Han J, Hu FB, Gao X. Prospective study of restless legs syndrome and total and cardiovascular mortality among women. Neurology 2018;90:135-41.
19
Walters AS, Moussouttas M, Siddiqui F, Silveira DC, Fuentes K, Wang L, Berger K. Prevalence of stroke in Restless Legs Syndrome: Initial Results Point to the Need for More Sophisticated Studies. Open Neurol J 2010;4:73-7.
20
Dredla BK, Del Brutto OH, Lee AS, Castillo PR. Willis-Ekbom disease is not associated with poor cardiovascular health in adults. J Negat Results Biomed 2015;14:17.
21
Schlesinger I, Erikh I, Avizohar O, Sprecher E, Yarnitsky D. Cardiovascular risk factors in restless legs syndrome. Mov Disord 2009;24:1587-92.
22
Ferri R, Zucconi M, Manconi M, Plazzi G, Bruni O, Ferini-Strambi L. New approaches to the study of periodic leg movements during sleep in restless legs syndrome. Sleep 2006;29:759-69.
23
Koo BB, Blackwell T, Ancoli-Israel S, Stone KL, Stefanick ML, Redline S; Osteoporotic Fractures in Men (MrOS) Study Group. Association of incident cardiovascular disease with periodic limb movements during sleep in older men: outcomes of sleep disorders in older men (MrOS) study. Circulation 2011;124:1223-31.
24
Yumino D, Wang H, Floras JS, Newton GE, Mak S, Ruttanaumpawan P, Parker JD, Bradley TD. Relation of periodic leg movements during sleep and mortality in patients with systolic heart failure. Am J Cardiol 2011;107:447-51.
25
Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, Zucconi M, Ferri R, Trenkwalder C, Lee HB; International Restless Legs Syndrome Study Group. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med 2014;15:860-73.
26
Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, Xiang AH, Watanabe RM. A better index of body adiposity. Obesity (Silver Spring) 2011;19:1083-9.
27
Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, Galluzzo A; AlkaMeSy Study Group. Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 2010;33:920-2.
28
Jablonowska-Lietz B, Wrzosek M, Wlodarczyk M, Nowicka G. New indexes of body fat distribution, visceral adiposity index, body adiposity index, waist-to-height ratio, and metabolic disturbances in the obese. Kardiol Pol 2017;75:1185-91.
29
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.
30
Van Den Eeden SK, Albers KB, Davidson JE, Kushida CA, Leimpeter AD, Nelson LM, Popat R, Tanner CM, Bibeau K, Quesenberry CP. Risk of Cardiovascular Disease Associated with a Restless Legs Syndrome Diagnosis in a Retrospective Cohort Study from Kaiser Permanente Northern California. Sleep 2015;38:1009-15.
31
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.
32
Katsanos AH, Kosmidou M, Konitsiotis S, Tsivgoulis G, Fiolaki A, Kyritsis AP, Giannopoulos S. Restless legs syndrome and cerebrovascular/cardiovascular events: Systematic review and meta-analysis. Acta Neurol Scand 2018;137:142-8.
33
Ondo WG, He Y, Rajasekaran S, Le WD. Clinical correlates of 6-hydroxydopamine injections into A11 dopaminergic neurons in rats: a possible model for restless legs syndrome. Mov Disord 2000;15:154-8.
34
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.
35
Ferini-Strambi L, Walters AS, Sica D. The relationship among restless legs syndrome (Willis-Ekbom Disease), hypertension, cardiovascular disease, and cerebrovascular disease. J Neurol 2014;261:1051-68.
36
Yıldız A, Yıldız C, Karakurt A. Assessment of cardiac autonomic functions by heart rate variability in patients with restless leg syndrome. Turk Kardiyol Dern Ars 2018;46:191-6.
37
Koh SY, Kim MS, Lee SM, Hong JM, Yoon JH. Impaired vascular endothelial function in patients with restless legs syndrome: a new aspect of the vascular pathophysiology. J Neurol Sci 2015;359:207-10.
38
Anderson KN, Di Maria C, Allen J. Novel assessment of microvascular changes in idiopathic restless legs syndrome (Willis-Ekbom disease). J Sleep Res 2013;22:315-21.
39
Wåhlin-Larsson B, Ulfberg J, Aulin KP, Kadi F. The expression of vascular endothelial growth factor in skeletal muscle of patients with sleep disorders. Muscle Nerve 2009;40:556-61.
40
Salminen AV, Rimpilä V, Polo O. Peripheral hypoxia in restless legs syndrome (Willis-Ekbom disease). Neurology 2014;82:1856-61.
41
Volders PG. Novel insights into the role of the sympathetic nervous system in cardiac arrhythmogenesis. Heart Rhythm 2010;7:1900-6.
42
Bertisch SM, Muresan C, Schoerning L, Winkelman JW, Taylor JA. Impact of Restless Legs Syndrome on Cardiovascular Autonomic Control. Sleep 2016;39:565-71.
43
De Vito K, Li Y, Batool-Anwar S, Ning Y, Han J, Gao X. Prospective study of obesity, hypertension, high cholesterol, and risk of restless legs syndrome. Mov Disord 2014;29:1044-52.
44
Liu Y, Liu G, Li L, Yang J, Ma S. Evaluation of Cardiovascular Risk Factors and Restless Legs Syndrome in Women and Men: A Preliminary Population-Based Study in China. J Clin Sleep Med 2018;14:445-50.
45
Salas RE, Gamaldo CE, Allen RP. Update in restless legs syndrome. Curr Opin Neurol 2010;23:401-6.
46
Schilling C, Schredl M, Strobl P, Deuschle M. Restless legs syndrome: evidence for nocturnal hypothalamic-pituitary-adrenal system activation. Mov Disord 2010;25:1047-52.
47
Lin S, Zhang H, Gao T, Zhong F, Sun Y, Cai J, Ma A.  The association between obesity and restless legs syndrome: A systemic review and meta-analysis of observational studies. J Affect Disord 2018;235:384-91.
48
Yildiz D, Buyukkoyuncu N, Kilic AK, Cander S, Yıldız A, Gunes A, Seferoglu M, Erer Ozbek S. Obesity: a possible risk factor for restless legs syndrome. Neurol Res 2017;39:1044-8.
49
Ohayon MM, Roth T. Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res 2002;53:547-54.
50
de Koning L, Merchant AT, Pogue J, Anand SS. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007;28:850-6.
51
Streng KW, Voors AA, Hillege HL, Anker SD, Cleland JG, Dickstein K, Filippatos G, Metra M, Ng LL, Ponikowski P, Samani NJ, van Veldhuisen DJ, Zwinderman AH, Zannad F, Damman K, van der Meer P, Lang CC. Waist-to-hip ratio and mortality in heart failure. Eur J Heart Fail 2018;20:1269-77.
52
Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, Ferini-Strambi L. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med 2005;165:1286-92.
53
Vgontzas AN, Liao D, Bixler EO, Chrousos GP, Vela-Bueno A. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 2009;32:491-7.
54
Sands-Lincoln M, Loucks EB, Lu B, Carskadon MA, Sharkey K, Stefanick ML, Ockene J, Shah N, Hairston KG, Robinson JG, Limacher M, Hale L, Eaton CB. Sleep duration, insomnia, and coronary heart disease among postmenopausal women in the Women’s Health Initiative. J Womens Health (Larchmt) 2013;22:477-86.
55
Li Y, Zhang X, Winkelman JW, Redline S, Hu FB, Stampfer M, Ma J, Gao X. Association between insomnia symptoms and mortality: a prospective study of U.S. men. Circulation 2014;129:737-46.
56
Gottlieb DJ, Somers VK, Punjabi NM, Winkelman JW. Restless legs syndrome and cardiovascular disease: a research roadmap. Sleep Med 2017;31:10-7.
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