Review of the Relationship of Restless Legs Syndrome and Periodic Limb Movements in Sleep to Hypertension, Heart Disease, and Stroke

Abstract

Evidence is reviewed documenting an intimate relationship among restless legs syndrome (RLS) / periodic limb movements in sleep (PLMS) and hypertension and cardiovascular and cerebrovascular disease. Sympathetic overactivity is associated with RLS/PLMS, as manifested by increased pulse rate and blood pressure coincident with PLMS. Causality is far from definitive. Mechanisms are explored as to how RLS/PLMS may lead to high blood pressure, heart disease, and stroke: (a) the sympathetic hyperactivity associated with RLS/PLMS may lead to daytime hypertension that in turn leads to heart disease and stroke; (b) in the absence of daytime hypertension, this sympathetic hyperactivity may predispose to heart disease and stroke either directly or indirectly via atherosclerotic plaque formation and rupture; and (c) comorbidities associated with RLS/PLMS, such as renal failure, diabetes, iron deficiency, and insomnia, may predispose to heart disease and stroke. One theoretical cause for sympathetic hyperactivity is insufficient All diencephalospinal dopaminergic neuron inhibition of sympathetic preganglionic neurons residing in the intermediolateral cell columns of the spinal cord. We cannot exclude the possibility that peripheral vascular, cardiovascular, and cerebrovascular disease may also contribute to RLS/PLMS, and mechanisms for these possibilities are also discussed.

Restless Legs Syndrome in an Appalachian Primary Care Population: Prevalence, Demographic and Lifestyle Correlates, and Burden

“…15 RLS has also been linked to increased risk for cardiovascular disease (CVD) and stroke, and has been associated with diabetes and other related chronic conditions. 2 However, the etiology of RLS remains poorly understood, [16][17][18] and there is still no cure for RLS. Prevalence estimates of RLS have varied widely (from 4% to 29%) depending on the study population characteristics, study location, and RLS definition and ascertainment 1 ; even among the five studies in US primary care populations, prevalence estimates have ranged from 13.3% 12 to 29.3%.…”

Is autonomic nervous system involved in restless legs syndrome during wakefulness?

“…In the last decade, many authors focused on the potential consequences of RLS on cardio-and cerebrovascular diseases [6,7], sometimes by investigating the autonomic nervous system (ANS), mainly during sleep [8][9][10][11].…”

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

“…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. 7 The pathway through which PLMS may confer greater cardiovascular risk in HD patients is not clear but one potential process, via an impact of cardiac structure and function, has not been assessed before.…”

“…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.…”