Do Restless Legs Syndrome (RLS) and Periodic Limb Movements of Sleep (PLMS) Play a Role in Nocturnal Hypertension and Increased Cardiovascular Risk of Renally Impaired Patients?

Portaluppi, Francesco; Cortelli, Pietro; Calandra-Buonaura, Giovanna; Smolensky, Michael H.; Fabbian, Fabio

doi:10.1080/07420520903245276

Cited by 14 publications

(18 citation statements)

References 122 publications

(144 reference statements)

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“…The prevalence of RLS, which is high in dialysis patients and which has been associated with increased risk for cardiovascular disease in the general population, could also play a role in the pathogenesis of hypertension during sleep in renal patients. In renal failure, attention to sleep quality and related perturbations of the sleep/wake cycle may help prevent the occurrence and progression of cardiovascular disease [21]. The prevalence of both insomnia and RLS is reduced in kidney-transplanted patients compared to dialysis patients, and it is similar to the prevalence observed in the general population [22].…”

Section: Restless Legs Syndrome and Related Conditionsmentioning

confidence: 99%

Update in restless legs syndrome

Salas

Gamaldo²,

Allen³

2010

Current Opinion in Neurology

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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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Section: Restless Legs Syndrome and Related Conditionsmentioning

confidence: 99%

Update in restless legs syndrome

Salas

Gamaldo²,

Allen³

2010

Current Opinion in Neurology

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“…ABPM was introduced many decades ago as a comprehensive method to assess the 24-h variation in BP outside of the office setting, more thoroughly diagnose essential and secondary forms of hypertension, better appraise response to therapeutic interventions, and explore features of the 24-h BP profile potentially associated with elevated risk and triggering of acute cardiovascular accidents Bergheanu et al, 2009;Cabezas-Cerrato et al, 2009;Hermida et al, 2007aHermida et al, , 2007bHermida et al, , 2008Hermida et al, , 2009Jones et al, 2008Jones et al, , 2009Perez-Lloret et al, 2008;Portaluppi & Lemmer, 2007;Portaluppi et al, 2009;Shiotani et al, 2009;Smolensky et al, 2007).…”

Section: Abpm: Best Means Of Differentiating Hypertension From Normotmentioning

confidence: 99%

Perspectives on the Chronotherapy of Hypertension Based on the Results of the Mapec Study

Portaluppi

Smolensky

2010

Chronobiology International

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Appreciation of chronotherapy in hypertension continues to lag, despite clear demonstrations by many studies of (i) clinically relevant dosing-time differences of the beneficial and adverse effects of most blood pressure (BP) medications and (ii) significant association between reduced sleep-time BP decline of non-dippers and their heightened risk of cardiovascular disease (CVD). The Syst-Eur and HOPE outcome trials showed evening administration of nitrendipine and ramipril in these respective studies impacts sleep-time BP, converting the 24-h BP pattern to a more dipper one and in the HOPE study decreasing CVD risk. The CONVINCE study intended to compare BP control and CVD protection afforded by conventional β-blocker and diuretic medications versus a special drug-delivery verapamil formulation as a bedtime hypertension chronotherapy; however, the trial was terminated prematurely, not based on inadequate performance of the chronotherapy but on a corporate business decision. The just completed MAPEC study is the first trial specifically designed to prospectively test the hypothesis that bedtime administration of ≥1 conventional medications exerts better BP control and CVD risk reduction than the traditional approach of scheduling all medications in the morning. The results of this 5.6-yr median follow-up study establish that bedtime chronotherapy more effectively improves BP control, better decreases prevalence of non-dipping, and, most importantly, best reduces CVD morbidity and mortality. This chronotherapeutic approach to hypertension is justified by the fact that BP is usually lowest at night as is sodium excretion, but when sodium intake is excessive or its daytime excretion hampered, nocturnal BP is adjusted higher, to a level required for compensation overnight, via the pressure/natriuresis mechanism, resulting in non-dipping 24-h BP patterning. In diurnally active persons, the entire circadian BP pattern may be reset to a lower mean level and to a "more normal" day-night variation, simply by enhancing natriuresis during the night-the time-of-day when it can be most effective. A modification as simple and inexpensive as switching ≥1 hypertension medications from morning 1652 Address correspondence to Francesco Portaluppi, MD, Hypertension Center, Department of Medicine, University Hospital "S. Anna" of Ferrara, Corso Giovecca 203, I-44100 Ferrara, Italy. Tel: +39 0532 236631; Fax: +39 0532 236622; E-mail: prf@unife.it Submitted July 10, 2010, Returned for revision July 17, 2010, Accepted July 20, 2010 Chronobiology International, 27(8): 1652-1667 Copyright © 2010 Informa Healthcare USA, Inc. ISSN 0742-0528 print/1525-6073 online DOI: 10.3109/07420528.2010.510788 to evening may be all that is needed to normalize nighttime BP, exerting an effect exactly like sodium restriction. Current clinical concepts such as "normotensive nondipper" (with higher CVD risk than a hypertensive dipper), broad recommendation of pharmacotherapy with exclusively high "smoothness index" medications (without attention to ind...

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“…1 Briefl y, PLMS induces stereotypical repetitive leg movements during sleep, causing signifi cant sleep disturbances through its associated arousals and motor restlessness. Recent studies report that PLMS, as well as a related condition called restless legs syndrome (RLS), are associated with increased cardiovascular risk factors, both in uremic 2,3 and idiopathic RLS patients. [4][5][6] In addition, in the HD population, PLMS seems to be an independent predictor of all causes mortality.…”

mentioning

confidence: 99%

“…3,6 It is noteworthy that 80% of the patients suffering from RLS also co-experience PLMS (PLMS/h > 5). 29 The findings of the current study reveal that PLMS constitute a major contributor to the potential cardiovascular risk that the HD-RLS patients are exposed to.…”

mentioning

confidence: 99%

Periodic Limb Movements in Sleep Contribute to Further Cardiac Structure Abnormalities in Hemodialysis Patients with Restless Legs Syndrome

Giannaki

Zigoulis²,

Karatzaferi³

et al. 2013

Journal of Clinical Sleep Medicine

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Study Objectives: In hemodialysis (HD) patients, restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS) constitute common sleep disorders. Recent fi ndings 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 signifi cantly increased in the PLMS group (4.96 ± 0.61 vs 4.19 ± 0.48 cm, p = 0.007), leading to a signifi cantly 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 fi rst data to associate severe PLMS with further LV structure abnormalities in HD patients with RLS.

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Do Restless Legs Syndrome (RLS) and Periodic Limb Movements of Sleep (PLMS) Play a Role in Nocturnal Hypertension and Increased Cardiovascular Risk of Renally Impaired Patients?

Cited by 14 publications

References 122 publications

Update in restless legs syndrome

Update in restless legs syndrome

Perspectives on the Chronotherapy of Hypertension Based on the Results of the Mapec Study

Periodic Limb Movements in Sleep Contribute to Further Cardiac Structure Abnormalities in Hemodialysis Patients with Restless Legs Syndrome

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