Restless legs syndrome, periodic limb movements of sleep, and subclinical cardiovascular disease

Kevin J Hochstrasser; Steven C Rogers; Arshed Quyyumi; Dayna Johnson; Victoria Pak; Amit J Shah; David B Rye; Lynn Marie Trotti

doi:10.1007/s41105-023-00497-7

Restless legs syndrome, periodic limb movements of sleep, and subclinical cardiovascular disease

Sleep Biol Rhythms. 2023 Nov 2;22(2):259-267. doi: 10.1007/s41105-023-00497-7. eCollection 2024 Apr.

Authors

Kevin J Hochstrasser¹, Steven C Rogers², Arshed Quyyumi², Dayna Johnson³, Victoria Pak⁴, Amit J Shah^{3

2}, David B Rye¹, Lynn Marie Trotti¹

Affiliations

¹ Department of Neurology, Emory Sleep Center, Emory University School of Medicine, 12 Executive Park Dr NE, Atlanta, GA 30329 USA.
² Division of Cardiology, Department of Internal Medicine, Emory University School of Medicine, Atlanta, USA.
³ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA.
⁴ Emory Nell Hodgson Woodruff School of Nursing, Atlanta, USA.

Abstract

Restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) have been variably implicated in risk for cardiovascular disease (CVD), but there is lack of consensus on these relationships. We sought to assess subclinical CVD measures and RLS/PLMS in a large cohort to further evaluate these associations. The Emory Center for Health Discovery and Well Being cohort is composed of employed adults, with subclinical CVD measures including endothelial function (flow-mediated vasodilation), microvascular function (reactive hyperemia index, RHI), arterial stiffness (pulse wave velocity and augmentation index), and carotid intima-media thickness (cIMT). Participants were grouped based on presence (N = 50) or absence (N = 376) of RLS and subclinical CVD measures compared between groups. A subset of participants (n = 40) underwent ambulatory monitoring for PLMS and obstructive sleep apnea. PLMS association with subclinical CVD measures was assessed. RLS status was significantly associated with flow-mediated dilation in univariate analyses but not after controlling for potential confounders; RLS was not associated with other subclinical CVD measures. PLMS were significantly correlated with the RHI, augmentation index, and cIMT in univariate analyses; only the association between PLMS and cIMT remained significant (p = 0.04) after controlling for RLS status, age, apnea-hypopnea index, hyperlipidemia, and hypertension. The observed association between higher PLMS and greater cIMT suggests that PLMS may be a marker of subclinical CVD. Further work is needed to determine the relationship between PLMS and CVD risk.

Supplementary information: The online version contains supplementary material available at 10.1007/s41105-023-00497-7.

Keywords: Cardiovascular disease; Carotid artery; Intima-media thickness; Periodic limb movements of sleep; Restless legs syndrome.

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Abstract

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