Objectives: Patients with primary restless legs syndrome (pRLS) often have signs or symptoms of autonomic failure, including cardiovascular system. Gastrointestinal, sudomotor, thermoregulation, and bladder abnormalities are often reported in Restless Legs Syndrome but there is limited data concerning orthostatic hypotension (OH) in patients with pRLS. The aim of this study was to investigate the prevalence of OH in pRLS patients relative to controls.
Methods: Consecutive adult drug-naive pRLS patients and age- and sex-matched healthy controls were enrolled in the study. Blood pressure was measured first in a supine position and after rests of 3 minutes it was re-measured in seating and standing positions early in the morning. Orthostatic hypotension was considered as a sustained reduction of systolic blood pressure (SBP) of at least 20 mm Hg or diastolic blood pressure (DBP) of 10 mm Hg within these measurements. Diagnosis of pRLS was based on International Restless Legs Syndrome Study Group (IRLSSG) 2012 revised diagnostic criteria for RLS. To rule out secondary causes of RLS blood tests including full blood count, thyroid function tests, serum iron, ferritin, vitamin B12, folic acid, urea, creatinine, electrolytes, glucose and HbA1C levels were performed. Presence of anxiety (by Beck Anxiety Inventory), depression (by Beck Depression Inventory), severity of sleep disturbances (by Pittsburgh Sleep Quality Index) were determined by validated self-reported questionnaires.
Results: The mean age of 88 pRLS (70 women) and 110 control subjects (63 women) patients participated in the study was 50.3±9.3 and 50.1±9.2 respectively. Statistically, there was a significant difference between two groups for the presence of orthostatic hypotension (p<0.001), and also PSQI, Beck-A, Beck-D scores were higher in pRLS patients than the control group (p<0.001). Orthostatic hypotension, anxiety, depression and also sleep disturbance are significantly frequent in pRLS patients.
Conclusion: In recent studies orthostatic hypotension was found to be associated with increased risk of all causes of death including coronary heart disease, heart failure and stroke. Orthostatic hypotension is a serious finding accompanying to pRLS, needed attention.
Audience take away:
- These findings are remarkable for management of primary restless legs syndrome