Nocturnal systolic blood pressure is increased in restless legs syndrome

Purpose

Restless legs syndrome (RLS) is a frequent sensorimotor disorder characterized by an urge to move the legs, with symptoms appearing during the night and disturbing nocturnal sleep. There is a growing body of evidence that RLS correlates with an increased risk of cardiovascular diseases and hypertension. The aim of this study was to test the hypothesis that patients with RLS have higher blood pressure (BP) during the night than people without RLS.

Methods

We have analyzed polysomnographic (PSG) recordings of 30 patients with RLS and 27 subjects without the sleep disorder. During PSG, beat-to-beat BP measurement was performed.

Results

Patients with RLS have higher nocturnal and sleep-time systolic blood pressure compared to controls (124.4 vs. 116.5 mmHg, p < 0.05; 123.5 vs. 116.1 mmHg, p < 0.05). There was no noticeable dip in the values of nocturnal systolic pressure of patients with RLS.

Conclusions

Our results support the hypothesis that RLS and hypertension are linked. Thus, we believe patients with RLS require close observation with regard to cardiovascular risk factors.

     

不宁腿综合征研究进展

不宁腿综合征(RLS)是一种常见的神经系统感觉运动障碍性疾病,其发病率约为3%～15%.主要临床表现为:经常出现下肢不适感而伴发腿部急促运动,静息时开始或加重;运动后缓解;夜间睡眠时加重,常导致患者睡眠障碍,生活质量下降.本文就RLS近几年来流行病学、病理生理机制、诊断以及治疗的研究进展作一综述.     

Relation of serum hepcidin levels and restless legs syndrome in chronic hemodialysis patients

Background

Iron deficiency anemia, pregnancy, and end-stage renal disease (ESRD) are common causes of secondary restless legs syndrome (RLS). Serum ferritin is considered the most specific test associated with the total amount of body iron stores. However, due to the increase of serum ferritin secondary to inflammation in chronic hemodialysis (HD) patients, serum ferritin test results do not fully reflect decreased iron stores in these patients. The present study evaluates the serum hepcidin levels, as the main regulator of iron metabolism, and its relationship with RLS in chronic HD patients.

Methods

The present cross-sectional study involved 72 patients (36 with and 36 without RLS) who received chronic HD treatment between April 2014 and April 2015. Demographic and biochemical data were evaluated in all patients, and statistical analyses were performed.

Results

The mean age and mean dialysis vintage of all patients (56% women) included in the study were 65.3?±?11.6 years and 41.5?±?36.5 months, respectively. Serum hepcidin, hemoglobin A1C (HbA1C), and ferritin levels were significantly higher in patients with RLS (p =?0.001, p?= 0.032, p?= 0.042, respectively). In addition, a positive correlation was found between International Restless Legs Syndrome Study Group severity scale score and serum hepcidin levels, HbA1C, and ferritin (r?= 0.387, p?= 0.001; r?= 0.426, p?= 0.034; r?= 0.240, p?= 0.046, respectively). A multivariate linear regression analysis revealed hepcidin and HbA1C to be independently associated with the presence of RLS.

Conclusion

A significant relationship was detected between RLS and increased serum hepcidin levels in chronic HD patients, and uncontrolled diabetes was noted to contribute to this association.

     

More evidence of cannabis efficacy in restless legs syndrome

Restless legs syndrome (RLS) is one of the most disabling and sometimes painful sensorimotor ailment of the nervous system that has only in recent years become more widely accepted as a clinical disorder with its own distinct features. Usually, symptoms respond well to dopamine agonists, anticonvulsants, or opiates, but still a subset of patients remains refractory to medical therapy and/or reports serious side effects. Recently, patients’ statement of a remarkable and total remission of RLS symptoms following cannabis use has been reported. Here, we confirm and extend these findings to more patients with RLS. The antinociceptive effect of marijuana has been documented in many painful neurological conditions, and the potential benefit of cannabis use in patients with refractory RLS should therefore be questioned by robust clinical trials.

     

Secondary causes of restless legs syndrome in older people

BACKGROUND: Secondary causes of restless legs syndrome (RLS) have been reported to be more common in those with late-onset RLS. However, 'late-onset' in previous studies was defined as onset after 45 years. OBJECTIVE: To determine the prevalence of secondary causes of RLS and the relationship between aetiological factors and age of symptom onset in an older population. DESIGN: Prospective study conducted over a 5-year period. PARTICIPANTS: 80 consecutive non-related patients diagnosed with RLS. MEASUREMENTS: Patients were assessed according to a standard protocol. Age at symptom onset, severity of symptoms, neurological findings and laboratory tests were examined. RESULTS: Iron deficiency (serum ferritin <50 ng/ml) was present in 22% of patients with onset before 50 years, 39% of those with onset at 50 to 64 years and 58% in those with onset after 64 years (P = 0.009). Clinical neuropathy was also more common in older-onset patients (P = 0.08). Family history was positive in 39%, 23% and 8% of these groups, respectively (P = 0.008). CONCLUSION: Secondary causes of RLS become more common and a positive family history less common with increased age of symptom onset.     

Psychosomatic symptom profiles in patients with restless legs syndrome

Purpose

It has been reported that restless legs syndrome (RLS) might be associated with multiple psychosomatic symptoms. We aimed to identify which psychosomatic symptom is the most related in RLS patients compared to healthy controls. We also attempted to determine the relation between psychosomatic comorbidity and RLS severity regardless of sleep-related symptoms.

Methods

One hundred two newly diagnosed patients with RLS and 37 healthy control subjects participated in the present study. The RLS patients were categorized as mild and severe based on the International RLS Study Group rating scale. Data on demographics were collected. All participants completed the Pittsburgh Sleep Quality Index, Athens Insomnia Scale, and Epworth Sleepiness Scale as sleep-related questionnaires. All participants completed the Symptom Checklist-90-Revision (SCL-90-R).

Results

RLS patients were found to have pervasive comorbid psychosomatic symptoms. Somatization was found to be the most significant contributing factor (OR 1.145, 95 % CI 1.061–1.234, p?<?0.001) for psychosomatic comorbidity in RLS. Severe RLS patients were found to have poorer sleep quality than mild RLS patients. Furthermore, severe RLS patients had higher scores for most psychosomatic symptom domains in SCL-90-R. Anxiety was found to be the most independent contributing factor for psychosomatic comorbidity according to RLS severity (OR 1.145, 95 % CI 1.043–1.257, p?=?0.005).

Conclusions

Our study demonstrates that comorbid psychosomatic distress is considerable in patients with RLS. Furthermore, most psychosomatic comorbidity is increased with the RLS severity in association with poorer sleep quality.     

Prevalence of restless legs syndrome in patients with irritable bowel syndrome

AIM:To determine the prevalence of restless legs syndrome(RLS)in patients with irritable bowel syndrome(IBS).METHODS:Patients with diarrhea-predominant IBS(n=30),constipation-predominant IBS(n=30),or mixed-symptom IBS(n=30)were recruited from the community between March 2008 and February 2009.Rifaximin 200 mg three times daily was administered empirically to alleviate small intestinal bowel over-growth in all patients.The presence of RLS was assessed via an RLS questionnaire and polysomnography.RESULTS:Twen...     

老年人不宁腿综合征15例临床分析

目的探讨老年人不宁腿综合征的临床表现、诊断与治疗。方法回顾老年人不宁腿综合征15例的临床表现和治疗效果,结合文献进行讨论。结果不宁腿综合征以单侧或双侧下肢感觉异常为突出表现,静息时出现或加重,活动及被动运动症状缓解或消失,夜间症状明显,均伴有睡眠障碍。结论不宁腿综合征的诊断主要依据临床特征、左旋多巴制剂、多巴胺受体激动剂、抗惊厥药有一定疗效。     

Sequential compression devices for treatment of restless legs syndrome

Restless legs syndrome (RLS) is a common disorder that presents with irresistible urges to move the legs and motor restlessness, worsening in the evening. RLS commonly causes insomnia and associated daytime symptoms. Treatment of first choice for RLS is usually medication, but medications are often ineffective or poorly tolerated. An effective nonpharmacologic therapy would be highly desirable. Here we review RLS and its treatment and present data from a pilot study on the effect of a novel treatment for this condition. The objective of this study was to determine the therapeutic effect of pneumatic sequential compression devices (SCDs) on RLS symptoms.We performed an uncontrolled, prospective interventional study using SCDs on a convenience sample of adults reliably diagnosed with RLS. Patients were asked to wear the SCD for an hour each evening before the usual time of onset of restless legs symptoms. Before and after 1-3 months of SCD therapy, patients completed validated questionnaires to assess RLS severity, daytime sleepiness, and impact of RLS on quality of life in the domains of social function, daily task function, sleep quality, and emotional well-being. Compliance with SCD therapy was measured using patient-recorded logs.Of 10 patients (7 women; age range, 37-80 yr; mean age, 56 yr), symptomatic for a mean of 68 months (range, 12-360 mo), 1 could not tolerate wearing the SCD and withdrew from the protocol after 3 days. The remaining 9 patients complied with therapy 58%-100% of nights (mean, 82%). Three patients experienced complete resolution of RLS and 6 patients had improvement of symptoms. Group severity score improved from 24/40 to 8/40 (p = 0.001). Epworth Sleepiness Scale score improved from 12/24 to 8/24 (p = 0.05). Every quality of life score improved: social function from 74% to 96% (p = 0.04), daily task function 63% to 80% (p = 0.05), sleep quality 27% to 63% (p = 0.003), and emotional well-being from 49% to 83% (p = 0.02). In this group of patients, wearing the SCD in the evening for an hour improved symptoms of RLS and improved quality of life, with complete resolution of symptoms in 3 of 10 patients.     

老年人不宁腿综合征的临床分析

目的 探讨老年人不宁腿综合征的诊断与治疗。方法 对2年内收治的不宁腿综合征老年患者10例临床特征和治疗结果进行回顾性分析。结果 10例均有活动肢体的迫切愿望，以减轻肢体的不舒服感觉，单纯累及双下肢4例，累及四肢5例，仅累及左侧肢体1例。10例均在夜间症状加重，其中3例白天也有严重症状。3例有家族史。5例经神经电生理检查，结果正常。实验室检查：1例有缺铁性贫血。1例口服息宁治疗3年的患者出现了症状加重和反跳等副作用。10例协良行治疗有效。结论 诊断不宁腿综合征主要根据临床表现，老年患者临床表现具有特征性，反跳和症状加重是长期左旋多巴制剂治疗的主要副作用，多巴胺受体激动剂是治疗的首选药物。     

Circulating IGF-I levels are associated with increased biventricular contractility in top-level rowers

Background The intensive physical activity is often associated with cardiac changes. Objectives (i) To evaluate the IGF‐I system and myocardial structure and function by standard Doppler echocardiography and Tissue Doppler in athletes and sedentary controls; and (ii) to determine any relationship between IGF‐I system and echocardiographic parameters. Methods Nineteen male top‐level rowers and 19 age‐matched healthy sedentary male controls underwent blood determination of fasting serum IGF‐I, IGFBP‐3 and acid‐labile subunit levels and standard Doppler echocardiography combined with pulsed Tissue Doppler of posterior septal wall, left ventricular (LV) lateral mitral annulus and right ventricular (RV) tricuspid annulus. Myocardial presystolic (PS_m), systolic (S_m), the ratio of early diastolic (E_m) to atrial (A_m) velocities as well as myocardial time intervals were calculated. Results Rowers had higher serum IGF‐I levels (P = 0·04), higher biventricular cavity dimensions and wall thicknesses compared to controls. They also had better LV and RV myocardial function than controls. In the rowers, IGF‐I was associated with LV ejection fraction (r = 0·50, P = 0·03), RV PS_m velocity (r = 0·55, P = 0·01) and with RV myocardial precontraction time (r = ?0·57, P = 0·01). These associations remained significant after adjusting for age and heart rate. Conclusions Top‐level athletes showed higher IGF‐I levels and a better myocardial performance than controls, particularly for the RV systolic activity. The independent correlations between IGF‐I and systolic parameters of the left (ejection fraction) and right (PS_m velocity and precontraction time) ventricles may possibly indicate a role of IGF‐I system in the modulation of myocardial inotropism in athletes. Further studies are needed to confirm this hypothesis.     

Risk of restless legs syndrome in low socioeconomic rheumatoid arthritis patients

Abstract

Objectives Our aim was to determine the frequency of restless leg syndrome (RLS) in rheumatoid arthritis (RA) patients from a low socioeconomic area of Pakistan and compare results with a control group to evaluate the effect of variables on RLS patients.

Methods A clinical observational study was carried out on 240 RA patients form low socioeconomic group. Controls (n = 210) were frequency-matched by age group to the RA patients. We evaluated the presence of RLS and collected information on characteristics believed to be correlated with RLS in the general population. Multiple logistic regression models were used to study the association between RLS and other risk factors such as age, smoking status, and obesity.

Results Among all rheumatic patients seen at our rheumatology clinic, 70.8 % were women. Our study shows that 20 % of RA patients were suffering from RLS compared with 10 % of the control group with other rheumatic diseases. Multivariate logistic regression adjusted for age, obesity, and smoking also showed that women with RA were more likely to have RLS than control patients. RLS was also significantly associated with increasing age, high body mass index, and smoking status.

Conclusions Approximately 20 % of RA patients were suffering from RLS. Hence, there is need of increase awareness of RLS among rheumatologists to enhance early RLS diagnosis and appropriate management of this treatable condition.     

维持性血液透析患者不宁腿综合征的横断面研究

目的 了解维持性血液透析患者中不宁腿综合征(restless legs syndrome,RLS)的发病率及其影响因素.方法 入选2012年9月1-30日在广东省人民医院血液净化中心行维持性血液透析的375例患者,收集相关实验室和透析指标数据,应用多元logistic回归分析对相关危险因素进行统计分析.结果 RLS的发病率为13.3％,严重程度评分为(18.69±0.95)分,多元logistic回归分析显示无尿(OR0.292,95％ CI 0.114～0.750)和β2微球蛋白升高(OR 1.023,95％ CI 1.003～1.044)是维持性血液透析患者发生RLS的危险因素,而体重指数、血红蛋白、血清铁、甲状旁腺素等与RLS无相关性.结论 维持性血液透析患者RLS发病率高,其发生危险因素为无尿和β2微球蛋白升高,故保存残余肾功能,提高透析充分性,特别是清除中分子毒素,可降低不宁腿的发生率进而改善透析患者的生活质量.     

Evaluation of affective temperament profile and levels of depressive symptoms and anxiety in patients with restless legs syndrome

Sleep and Breathing - Restless legs syndrome (RLS) is a sleep-related sensorimotor disorder associated with mood and anxiety disorders. Although affective temperaments are considered subclinical...