Abstract
Purpose
Results from studies on the relationship between restless legs syndrome (RLS) and coronary artery disease (CAD) are conflicting. Some studies associate RLS with CAD by heart rate variability, blood pressure variability, and other autonomic, neuronal reasons, while other studies do not support these observations. The aim of this study was to investigate the prevalence of RLS in patients undergoing coronary angiography for CAD and to assess RLS prevalence with severity of CAD.
Methods
After inclusion and exclusion criteria were applied, enrolled patients with less than 50% coronary artery stenosis by angiography (0–49%) were assigned to group 1, and patients with 50% or more coronary artery stenosis were assigned to group 2. Patients were diagnosed with RLS if they met all five essential criteria of the International RLS study group. RLS prevalence and other comorbidities were compared between the two groups.
Results
Of 126 patients, 74 men (59%), mean age 64.0 ± 8.7 years, mean BMI 29.6 kg/m2, 47 (37%) were assigned to group 1 (no or nonobstructive CAD) and 79 (63%) were assigned to group 2 (obstructive CAD). No significant differences were found between the groups in terms of mean age, BMI, gender, or prevalence of hypertension, hypercholesterolemia, and DM. The prevalence of RLS in group 2 (29%) was significantly higher than in group 1 (15%), p = 0.013.
Conclusion
These results suggest that prevalence of RLS is associated with CAD and with CAD severity. We conjecture that RLS may be related to vascular endothelial dysfunction in cardiovascular disease.
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References
Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J (2003) 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 leg syndrome diagnosis and epidemiology workshop at the national Institutes of Health. Sleep Med 4:101–119
Allen RP (2007) Controversies and challenges in defining the etiology and pathophysiology of restless legs syndrome. Am J Med 120(1 Suppl 1):S13–S21
Earley CJ, Silber MH (2010) Restless legs syndrome: understanding its consequences and the need for better treatment. Sleep Med 11(9):807–815
Innes KE, Selfe TK, Agarwal P (2011) Prevalence of restless legs syndrome in North American and Western European populations: a systematic review. Sleep Med 12(7):623–634
Ekbom K, Ulfberg J (2009) Restless legs syndrome. J Intern Med 266(5):419–431
Safak ED, Gocer S, Mucuk S, Ozturk A, Akin S, Arguvanli S, Mazicioglu MM (2016) The prevalence and related factors of restless leg syndrome in the community dwelling elderly; in Kayseri, Turkey: A cross-sectional study. Arch Gerontol Geriatr 65:29–35
Demir AU, Ardıç S, Fırat H, Karadeniz D, Aksu M, Uçar ZZ, for the TAPES Investigation Committee et al (2015) Prevalence of sleep disorders in the Turkish adult population epidemiology of sleep study. Sleep Biol Rhythms 13:298–308
Aboussouan LS, Lewis RA, Shy ME (1996) Restless legs syndrome in patients with neuropathy. Muscle Nerve 19:670–672
Högl B, Kiechl S, Willeit J, Saletu M, Frauscher B, Seppi K, Müller J, Rungger G, Gasperi A, Wenning G, Poewe W (2005) Restless legs syndrome: a community-based study of prevalence, severity and risk factors. Neurology 64:1920–1924
Winkelman JW, Blackwell T, Stone K, Ancoli-Israel S, Redline S (2017) Associations of incident cardiovascular events with restless legs syndrome and periodic leg movements of sleep in older men, for the outcomes of sleep disorders in older men study (MrOS sleep study). Sleep 1:40(4). https://doi.org/10.1093/sleep/zsx023
Gottlieb DJ, Somers VK, Punjabi NM, Winkelman JW (2017) Restless legs syndrome and cardiovascular disease: a research roadmap. Sleep Med 31:10–17. https://doi.org/10.1016/j.sleep.2016.08.008
Liu Y, Liu G, Li L, Yang J, Ma S (2018) Evaluation of cardiovascular risk factors and restless legs syndrome in women and men: a preliminary population-based study in China. J Clin Sleep Med 14(3):445–450
Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, International Restless Legs Syndrome Study Group et al (2014) 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 15:860–873
Lopes LA, Lins Cde M, Adeodato VG et al (2005) Restless legs syndrome and quality of sleep in type 2 diabetes. Diabetes Care 28(11):2633–2636
Walters AS, Moussouttas M, Siddiqui F, Silveira DC, Fuentes K, Wang L, Berger K (2010) Prevalence of stroke in restless legs syndrome: initial results point to the need for more sophisticated studies. Open Neurol J 4:73–77
Katsanos AH, Kosmidou M, Konitsiotis S, Tsivgoulis G, Fiolaki A, Kyritsis AP, Giannopoulos S (2018) Restless legs syndrome and cerebrovascular/cardiovascular events: systematic review and meta-analysis. Acta Neurol Scand 137(1):142–148
Szentkirályi A, Völzke H, Hoffmann W, Trenkwalder C, Berger K (2014) Multimorbidity and the risk of restless legs syndrome in 2 prospective cohort studies. Neurology 82(22):2026–2033
Winkelman JW, Shahar E, Sharief I, Gottlieb DJ (2008) Association of restless legs syndrome and cardiovascular disease in the sleep heart health study. Neurology 70(1):35–42
Yatsu S, Kasai T, Suda S, Matsumoto H, Ishiwata S, Shiroshita N, Kato M, Kawana F, Murata A, Shimizu M, Shitara J, Kato T, Hiki M, Sai E, Miyauchi K, Daida H (2019) Prevalence and significance of restless legs syndrome in patients with coronary artery disease. Am J Cardiol 30222(19):S0002–S9149
Young T, Peppard P (2000) Sleep-disordered breathing and cardiovascular disease: epidemiologic evidence for a relationship. Sleep 23:S122–S126
Walters AS, Rye DB (2009) Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke. Sleep 32(5):589–597
Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, JAG A (2019) Neurochemical features of idiopathic restless legs syndrome. Sleep Med Rev 45:70–87
Schilling C, Schredl M, Strobl P, Deuschle M (2010) Restless legs syndrome: evidence for nocturnal hypothalamic-pituitaryadrenal system activation. Mov Disord 25:1047–1052
Li Y, Walters AS, Chiuve SE, Rimm EB, Winkelman JW, Gao X (2012) Prospective study of restless legs syndrome and coronary heart disease among women. Circulation 126(14):1689–1694
ZA TA, Şengül Y (2018) Evaluation of inflammation with neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in restless legs syndrome. Turk J Neurol 24(3):259–263. https://doi.org/10.4274/tnd.98474
Koo DL, Nam H, Thomas RJ, Yun CH (2018) Sleep disturbances as a risk factor for stroke. J Stroke 20(1):12–32
Erdal Y, Akdogan O, Nalbantoglu M, Kavasoglu G, Emre U (2019) Autonomic dysfunction in restless legs syndrome. Sleep Breath. https://doi.org/10.1007/s11325-019-01939-8
Koh SY, Kim MS, Lee SM, Hong JM, Yoon JH (2015) Impaired vascular endothelial function in patients with restless legs syndrome: a new aspect of the vascular pathophysiology. J Neurol Sci 359(1-2):207–210
Erden İ, Çakcak Erden E, Durmuş H, Tıbıllı H, Tabakçı M, Kalkan ME, Türker Y, Akçakoyun M (2014) Anadolu Kardiyol Derg Nov;14(7): 612-6
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Aksoy, D., Çelik, A., Solmaz, V. et al. The prevalence of restless legs syndrome in patients undergoing coronary angiography and its relationship with the severity of coronary artery stenosis. Sleep Breath 25, 257–262 (2021). https://doi.org/10.1007/s11325-020-02085-2
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DOI: https://doi.org/10.1007/s11325-020-02085-2