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

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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.

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Acknowledgements

This work is based on information from the Emory Predictive Health Institute and Center for Health Discovery and Well Being (CHDWB) supported by Emory University and the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378. CHDWB leadership approved the addition of RLS questions to the database and the collection of PLMS and OSA data in a subset of CHDWB participants, provided us access to RLS and CVD measures for the cohort, and approved the submission of this article for publication. Additional support for this work was provided by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2 RR025009 (LMT) and the National Institute for Neurologic Disorders and Stroke under Award Number R01 NS111280 (LMT). We are grateful to Jane Clark for arranging access to the CHDWB database.

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Authors and Affiliations

  1. Department of Neurology, Emory Sleep Center, Emory University School of Medicine, 12 Executive Park Dr NE, Atlanta, GA, 30329, USA

    Kevin J. Hochstrasser, David B. Rye & Lynn Marie Trotti

  2. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA

    Dayna Johnson & Amit J. Shah

  3. Emory Nell Hodgson Woodruff School of Nursing, Atlanta, USA

    Victoria Pak

  4. Division of Cardiology, Department of Internal Medicine, Emory University School of Medicine, Atlanta, USA

    Steven C. Rogers, Arshed Quyyumi & Amit J. Shah

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Correspondence to Lynn Marie Trotti.

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The authors declare they have no financial conflicts of interest. Dr. Trotti is a member of the Board of Directors of the American Academy of Sleep Medicine (AASM); views expressed are those of the authors and do not necessarily reflect those of the AASM or the funding source (National Institutes of Health).

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Hochstrasser, K.J., Rogers, S.C., Quyyumi, A. et al. Restless legs syndrome, periodic limb movements of sleep, and subclinical cardiovascular disease. Sleep Biol. Rhythms 22, 259–267 (2024). https://doi.org/10.1007/s41105-023-00497-7

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