Circulating levels of cytokines are increased in restless legs syndrome

Background

Restless legs syndrome [RLS] is known as a disease of iron and dopaminergic dysregulation but inflammatory processes might also have a role in the pathogenesis. In this study, we compared the circulating levels of hsCRP, IL-1β, IL-6, and TNF-α in patients with primary restless legs syndrome [RLS] and healthy control subjects.

Methods

We prospectively included 29 patients with primary RLS and 65 healthy controls [HC], all age-sex matched. The diagnosis of RLS was established using international guidelines. IRLSSG Severity Scale was used to evaluate the severity of RLS. Plasma levels of hsCRP, IL-1β, IL-6, and TNF-α were measured in all participants.

Results

The mean age of patients was 37.8?±?11.3 and 52% of RLS group were women. Serum IL-1β, IL-6, and TNF-α levels of the patient group were statistically significantly higher compared to HC [p?<?0.001 for all variables]. Plasma levels of hsCRP did not differ between groups. There were 8 patients with mild RLS [28%], 13 patients with moderate RLS [45%], and 8 patients with severe RLS [28%]. Only IL-6 values were significantly different between the groups. In the severe group, the value of IL-6 was significantly higher than in the other groups [p: 0.03].

Conclusion

These results showing higher circulating levels of inflammatory cytokines in patients with RLS support the notion that inflammation may be involved in the pathogenesis of primary RLS. However, it is necessary to perform further studies to determine if this finding is a cause or an effect.

     

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.     

Rhinitis is associated with increased systolic blood pressure in men: a population-based study

An association between impaired lower respiratory function and cardiovascular risk factors, such as hypertension, is often reported but it is unknown whether there is a relationship between upper airway disorders and cardiovascular risk factors, despite evidence that upper and lower respiratory tract disorders are closely linked. Our objective was to assess whether rhinitis is associated with arterial blood pressure and hypertension. In a population-based study of 330 adults aged 28-56 years, as part of the European Community Respiratory Health Survey, rhinitis was assessed by means of a questionnaire, and cardiovascular data were obtained using a questionnaire and by measuring blood pressure. Systolic blood pressure (SBP) was higher in men with rhinitis than in men without rhinitis (130.6 +/- 12.7 mm Hg versus 123.5 +/- 13.9 mm Hg; p = 0.002), and it was still the case after adjustment for cardiovascular and respiratory confounding factors. Hypertension was more frequent in men with rhinitis than in men without rhinitis, even after multivariate adjustment (odds ratio = 2.6, 95% confidence interval = [1.14-5.91]). The observation of SBP levels according to whether men have no rhinitis, seasonal rhinitis, or perennial rhinitis was compatible with a dose-response relationship (p for trend = 0.02). In conclusion, rhinitis is strongly associated with SBP and hypertension in men. Blood pressure should be regularly checked in men with rhinitis.     

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.     

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.     

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...     

Nocturnal blood pressure decrease is associated with increased regional cerebral blood flow in patients with a history of ischemic stroke

BACKGROUND: It remains controversial whether there is a J-shaped relationship between blood pressure and recurrent stroke among patients with a recent history of ischemic stroke. OBJECTIVE: To investigate the relationship between regional cerebral blood flow (rCBF) and the dipping of nocturnal blood pressure in patients receiving antihypertensive treatment after ischemic stroke. METHODS AND RESULTS: Forty-seven patients with a previous history of ischemic stroke and 37 patients with a history of non-ischemic stroke underwent 24-h ambulatory blood pressure monitoring and rCBF measurement with single photon emission computed tomography. Of the 47 patients with ischemic stroke, 30 were diagnosed as having suffered atheromatous or embolic stroke, and 37 had an ischemic lesion in the territory of the carotid artery. Systolic and diastolic blood pressures during daytime and night-time were controlled at less than 140/90 mmHg by a low-salt diet or long-acting antihypertensive agents, or both. In patients with ischemic stroke, there were significant negative correlations between the percentage change in nocturnal blood pressure and rCBFs in the thalamus (r = -0.33, P = 0.02), putamen (r = -0.34, P = 0.02) and cerebral cortex (r = -0.31, P = 0.03). Multivariate analysis revealed that only the percentage change in nocturnal blood pressure was related to rCBF. There was a significant positive correlation between rCBFs in the thalamus and the cerebral cortex (r = 0.74, P < 0.05). In patients with non-ischemic stroke, there was no significant correlation between the percentage change in nocturnal blood pressure and rCBFs. CONCLUSIONS: These findings indicate that the decrease in nocturnal blood pressure is associated with the increase in rCBF in patients with a history of ischemic stroke in the territory of the carotid artery.     

Removing confounders from the relationship between mortality risk and systolic blood pressure at low and moderately increased systolic blood pressure

OBJECTIVE: To assess the relationship between mortality risk and systolic blood pressure (SBP) at low and moderately increased SBP (less than the 70th percentile) before and after correcting for the regression-dilution bias and J-curve effects. DESIGN: Cohort study. SETTING: The First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study. PARTICIPANTS: The 6839 individuals who participated in the 1982-1984 survey for whom there were no missing data (age range 34-87 years). MAIN OUTCOME MEASURE: Cardiovascular disease mortality (n = 678) during a 9-year follow-up. METHODS: Corrections were made for the regression-dilution bias by using average SBP during the decade before baseline as the mortality predictor, and for J-curve effects by excluding individuals who exhibited high age-stratified mortality rates and a decrease in SBP. Cox's regression was used to analyse the follow-up relationship between mortality risk and SBP. RESULTS: The corrected relative cardiovascular disease mortality risk was 1.23 (95% confidence interval (CI), 1.16 to 1.31) for a 10 mmHg increase in SBP. The relationship was monotonically positive starting at the lowest SBP category in the analysis (< 115 mmHg), and robustly so above about the 32nd percentile (120 mmHg). The equivalent uncorrected result was 1.08 (95% CI, 1.05 to 1.13), and the relationship was J-shaped and became positive above about the 68th percentile (135 mmHg). Below the 70th percentile of SBP, individuals in the corrected analysis were 89% of all individuals. CONCLUSION: These two corrections transformed the relationship between mortality risk and SBP at low and moderately increased SBP from no association to a robustly positive association starting at 120 mmHg, for the majority of individuals.     

Nocturnal blood pressure fall and metabolic syndrome score in hypertensive patients

BACKGROUND: Data relating dipping status to metabolic syndrome (MS) scores are not available. The purpose of this study is to investigate any possible association of different dipping patterns to MS scores in untreated patients with essential hypertension. METHODS: The study included 6256 consecutive, treatment-naive patients with essential hypertension who attended our outpatient clinics. All underwent repeated office blood pressure measurements, 24-h ambulatory blood pressure monitoring, and full clinical and laboratory evaluation. The diagnosis of MS was made according to the Adult Treatment Panel III criteria and patients were classified into five groups: group I (hypertension), group II (hypertension+any one component), group III (hypertension+any two components), group IV (hypertension+any three components), and group V (all five components). Dipping pattern was defined as 'dippers' with nocturnal systolic blood pressure (NSBP) falling >or=10 but <20%, 'nondippers' with NSBP falling >or=0% but <10%, 'extreme dippers' with NSBP falling >or=20%, and 'reverse dippers' with NSBP increasing. RESULTS: Hypertensive patients with MS (n=2573) had higher clinical and ambulatory blood pressure values (P<0.001), whereas the dominant dipping pattern in the non-MS group was nondippers (47.6%), and in the MS group, extreme dippers (37.8%). Furthermore, a considerable decrease in the prevalence of dippers was noticed with the increasing number of MS components (21.1 vs. 19.2 vs. 14.5 vs. 8.4 vs. 7.2%, P<0.001). In contrast, a significant rise in the prevalence of reverse dippers was observed with the increasing number of MS components (7.4 vs. 10.1 vs. 14.9 vs. 20.4 vs. 31.2%, P<0.001). CONCLUSIONS: It seems that hypertensive patients have an increased prevalence of abnormal dipping patterns as the number of MS components rises.     

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。     

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.     

Excess mortality associated with increased pulse pressure among middle-aged men and women is explained by high systolic blood pressure

OBJECTIVE: To assess the risk of death from coronary heart disease, stroke, all cardiovascular diseases and all-cause mortality associated with pulse pressure among the middle-aged population. METHODS AND DESIGN: A prospective 15-year follow-up cohort study was conducted of two independent cross-sectional random samples of the population who participated in baseline surveys in 1972 or 1977. Each survey included a self-administered questionnaire with questions on smoking and antihypertensive drug treatment, measurements of height, weight and blood pressure and the determination of the serum cholesterol concentration. Multivariate analyses were performed by using Cox proportional hazard models. SETTING: The provinces of North Karelia and Kuopio in eastern Finland PARTICIPANTS: Men and women aged 45-64 years with no history of myocardial infarction or stroke at the time of the baseline survey were selected. In total 4333 men and 5270 women took part in this follow-up study. RESULTS: The relative risk of coronary heart disease, stroke, cardiovascular disease and all-cause mortality increased with the increasing pulse pressure in individuals aged 45-64 years independent of the diastolic blood pressure level. Only in women with diastolic blood pressure > or = 95 mmHg was the relative risk of fatal stroke not statistically significant. After adjustment for systolic blood pressure, the positive association between mortality and increasing pulse pressure disappeared. CONCLUSION: Increasing pulse pressure is a predictor of death from coronary heart disease, stroke, cardiovascular disease and all causes in men and women aged 45-64 years, but the increase in risk is entirely associated with the increase in systolic blood pressure.