Blood pressure monitoring in restless legs syndrome (Willis–Ekbom disease) patients

Abstract

Restless Legs Syndrome (RLS) patients frequently report symptoms like insomnia, fragmentation of sleep and also complain of paresthesia and pain in lower limbs that could be associated with changes in blood pressure (BP). The aim of this study was to determine possible changes in nocturnal blood pressure and risk of developing Hypertension in patients with RLS. Thirty patients were divided in three groups: Ten patients (age range 40–75 y, median age 65 y; 6 women) with clinical diagnostic of RLS that have full criteria for RLS by International Restless Legs Syndrome Study Group (IRLSSG) without Hypertension (G1); ten patients (age range 29–71 y, median age 58.5 y; 3 women) with Hypertension without RLS (G2) and ten healthy controls (age range 28–58 y, median age 47.5 y; 6 women) (G3). All patients were submitted to a clinical interview and neurological examination. Each subject completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Restless Legs Syndrome Rating Scale (RLSRS). All patients were investigated by 24 h Ambulatory Blood Pressure Monitoring (ABPM). RLS patients underwent overnight Polysomnography. Informed consent of all study members was obtained after a full explanation of the survey. The study was approved by ethical committee. The mean age was statistically different by the groups ( p = 0.03). RLS patients were approximately 14.3 years age older than controls ( p = 0.027). The correlation of sleep scales and BP shows statistical differences in PSQI scale between the groups ( p < 0.001). RLS patients demonstrated higher values than G2 ( p < 0.005) and G3 ( p < 0.001). The blood pressure values for each group and comparative tests were nocturnal systolic blood pressure (109 ± 11.2 vs. 127 ± 29.5 vs. 108 ± 11.3 mmhg; p = 0.06) and nocturnal diastolic blood pressure (65 ± 4.9 vs. 74 ± 16.5 vs. 65 ± 9.1 mmhg; p = 0.11). The blood pressure values were statistically similar among the variables studied for age, gender, BMI and quality of sleep ( p > 0.05). Possible relationship between RLSRS and BP were also investigated. There is no statistical significance between RLSRS and BP during sleep time ( p > 0.05). The mean of PLMS index was 33.8/h. Although many studies have shown the relationship of RLS/PLMS and cardiovascular disease, no significant changes on blood pressures were evidenced in RLS patients in one night measure of 24 h blood pressure monitoring. The work was performed at Interclinica Ribeiro do Valle – Poços de Caldas, Brazil. The authors would like to thank all members of Sleep Medicine Advanced Research Group.