Restless Leg Syndrome

Research shows that RLS should be taken seriously, even by heart doctors

restless
restless legs. PhotoAlto/Fredric Cirou/Getty Images

One common condition we usually fail to think about when assessing our risk of cardiovascular disease is restless leg syndrome. However, there is indeed an association between restless leg syndrome and heart disease.

What Is Restless Leg Syndrome?

Restless leg syndrome is a common condition characterized by symptoms in the legs that occur during rest, that compel sufferers to begin moving their legs around for relief.

These symptoms are usually limited to the evenings during periods of inactivity, and just before or during sleep.

People with restless leg syndrome typically describe feelings of burning, twitching, creeping, discomforting, restlessness, pulling or tension in their legs. Sometimes leg pain is involved. These sensations are perceived as coming from deep within the legs (and not on the surface), usually around the knees or in the lower legs. These symptoms almost always occur during quiet rest, and tend to be minimized while engaging in cognitive activities (such as crossword puzzles or poker), or during periods of emotional engagement.

The symptoms are generally relieved temporarily by getting up and moving around, or stretching, or massaging the legs.

Who Gets Restless Leg Syndrome?

Restless leg syndrome is quite common, and occurs to one degree or another in up to 15% of caucasian adults. It appears to be less common in other ethic groups.

While restless leg syndrome can be caused by iron deficiency, kidney failure, pregnancy, spinal disease and neurological disorders, in the large majority of sufferers there is no underlying cause.

Treatment of Restless Leg Syndrome

Most cases of restless leg syndrome are relatively mild, and can usually be treated by avoiding caffeine, getting regular exercise, engaging in cognitive activities during quiet periods in the evening, or getting up and taking a walk when symptoms occur.

Any underlying cause should be treated, especially iron deficiency.

If symptoms are severe and are not relieved by such measures, drug therapy is often effective. Drugs used successfully for restless leg syndrome have included dopamine agonists (the drugs used for Parkinson’s disease) such as pramipexole (Mirapex), certain drugs used for seizure disorders such as gabapentin (Neurontin), and benzodiazepines (drugs prescribed for anxiety disorders).

Restless Leg Syndrome and Cardiac Risk

Restless leg syndrome has been associated with an increased risk of cardiovascular disease, but no cause-and-effect relationship has been demonstrated.

However, many people with restless leg syndrome also have a movement disorder called “periodic limb movements of sleep (PLMS), in which repeated episodes of stereotypical leg movements occur while sleeping. Most people with PLMS are unaware of the condition (though their sleeping partners may well be). Research shows that patients with restless leg syndrome can have significant elevations in their blood pressure during episodes of leg movement while sleeping.

The degree of nocturnal hypertension that has been demonstrated is believed to be sufficient to significantly increase an individual's risk of developing cardiovascular disease - and may explain the association between RLS and cardiovascular disease.

Sources:

Yeh P, Walters AS, Tsuang JW. Restless legs syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath 2012; 16:987.

Ohayon MM, O'Hara R, Vitiello MV. Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 2012; 16:283.

Pennestri MH, Montplaisir J, Colombo R, Lavigne G, Lanfranchi PA. Nocturnal blood pressure changes in patients with restless legs syndrome. Neurology 2007; 68:1213-1218.

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