The Relationship of Restless Legs Syndrome to History of Pregnancy-Induced Hypertension

Abstract

Background: Restless legs syndrome (RLS), a burdensome sleep disorder, has been associated with cardiovascular disease (CVD), hypertension, diabetes, and related disorders. However, the relationship of RLS to history of pregnancy-induced hypertension (PIH), a predictor of subsequent CVD, diabetes, and associated conditions, remains little explored. In this study, we investigated the relationship of RLS to history of PIH in a sample of primary care patients. Methods: Participants were women aged ‡40 years drawn from an anonymous survey study of West Virginia primary care patients. Data collected included detailed information on demographics, lifestyle factors, sleep patterns, and reproductive/medical history; the survey also included an RLS diagnostic questionnaire. Women who were pregnant or unsure about their pregnancy status were excluded from the analyses. Results: Of the 498 participants in the final analytic sample, 24.5% met diagnostic criteria for RLS (17.9% with symptoms ‡once/week, 11.9% with symptoms ‡3 times/week); 73 (16.5% of parous women) reported a history of PIH, defined as physician-diagnosed preeclampsia or gestational hypertension. After adjustment for demographics, lifestyle characteristics, obesity, reproductive history, health conditions, and other factors, those reporting a history of PIH were approximately twice as likely to meet criteria for RLS (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.1, 3.6). These associations increased in magnitude with increasing symptom frequency (adjusted OR for RLS with symptoms ‡3 times/week = 3.8; CI 1.9, 7.6; p for trend = 0.003). Conclusions: History of PIH was strongly and positively related to current RLS in this study of primary care patients; these findings further support a possible role for metabolic dysregulation in RLS etiology.

Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy

“…36 In a group of American women, a history of pregnancy-induced hypertension had a positive association with RLS (odds ratio [OR] 1.9, 95% CI 1.1-3.6) that increased with RLS frequency (OR 3.8, 95% CI 1.9-7.6). 37 However, these studies are association studies and none investigated the temporal link with hypertension or diabetes. Nonetheless, in nonpregnant adults, metabolic and autonomic factors have been suggested to play an important role in the development of RLS, [38][39][40] which supports a possible etiologic relationship.…”

Why Are Women Prone to Restless Legs Syndrome?

“…There is considerable comorbidity of RLS with diseases that are particularly common in women [40][41][42][43][44], notably migraine, sleep disorder, depression, and anxiety [3][4][5]44]. The drugs that treat these disorders may, in fact, be the culprits [45][46][47][48][49], as is shown by the fact that RLS symptoms start within days of initiating treatment.…”

Managing Sleep Disorders during Pregnancy

“…The odds increased with increasing symptom frequency (adj OR for RLS with symptoms ≥3 times/week: 3.8; 95% CI: 1.9–7.6; p for trend = 0.003). 43 The prevalence of gRLS increases in certain cohorts with PIH, 37 and gRLS remains a significant risk factor for PIH even after adjusting for smoking, obesity, gravidity, parity, age, and alcohol consumption ( OR : 1.35; 95% CI: 1.02–1.79). 44 Preeclampsia has been reported to be more prevalent in women with gRLS than age-, BMI-, and gestational age- matched controls (17.5% vs. 3%; p = 0.03).…”