Moderate to severe but not mild RLS is associated with greater sleep-related sympathetic autonomic activation than healthy adults without RLS.
Moderate to severe but not mild RLS is associated with greater sleep-related sympathetic autonomic activation than healthy adults without RLS.
复制标题
与没有 RLS 的健康成年人相比，中度至重度但不轻度的 RLS 与睡眠相关的交感神经自主激活程度更高有关。
DOI：
10.1016/j.sleep.2019.09.005
复制
发表时间：
2020
期刊：
影响因子：
4.8
通讯作者：
Allen,Richard
中科院分区：
文献类型：
--
作者：
Jin,Byungjoo;Wang,Allan;Earley,Christopher;Allen,Richard
不宁腿综合征（RLS）患者的交感自主神经系统的活性随着心率和血压的增加而短暂增加。通过评估心率或血压变化来确定这些变化，而不依赖于任何腿部运动分析。有一个隐含的假设，这种高比率的交感神经激活是异常的，但一直没有直接比较类似的措施与健康人群的RLS。因此，不知道在睡眠期间，RLS的交感神经系统激活率是否高于健康人群。本研究的目的是确定：（1）与健康对照组相比，RLS患者的交感神经系统激活频率更高（2）交感神经激活频率及其与腿部运动的关系与RLS患者的RLS严重程度显著相关;和（3）有一些最低阈值的RLS严重程度定义的RLS人口，其中大多数（如85%）有异常高率的交感神经activation.MethodsSleep数据32例RLS患者和21匹配的健康对照组获得了从以前的研究。根据新的WASM标准，确定了睡眠期间的所有腿部运动（LMS）和睡眠中的周期性腿部运动（PLMS）;不属于PLMS的LMS被认为是睡眠中的孤立腿部运动（ILMS）。根据Cassel等人建立的程序确定所有具有显著心率增加的发作，(2016参见后面的引文），即在五次连续心跳中线性回归的斜率≥2.5次/分钟。RLS的严重程度进行了评估，使用国际不宁腿研究组量表（IRLS）。ResultsRLS患者有显着更多的心率增加比对照组（67.88/小时与9.87/小时）。RLS患者发生LMS和PLMS的百分比显著高于对照组（分别为44%和30%; 48%和18%）。这些措施与IRLS和PLMS/hr.85%的RLS患者IRLS分数>22或PLMS >50/hr的交感神经激活率为> 90 th百分位数的健康controls.ConclusionThis是第一篇文件记录，RLS患者表现出明显增加交感神经激活时，确定独立的PLMS。然而，这发生在更严重的RLS中，而不是更温和的RLS。已经提出RLS患者的异常高的交感神经激活率与在一些研究中观察到的不良心血管健康后果的发展有关。因此，这些数据可以提供一个基本的标准，可能用于流行病学研究，以确定更可能有不良健康后果（如心血管疾病）的RLS严重程度的水平。由于三分之二的RLS患者患有轻度甚至间歇性疾病，因此包括所有RLS在内的患者可能会错过RLS的潜在健康后果。
IntroductionRestless legs syndrome (RLS) patients have been found to have high rates of transitory increases in the activity of the sympathetic autonomic nervous system with increases in heart rate and blood pressure. These were identified by evaluating heart rate or blood pressure changes independent of any leg movement analyses. There has been an implicit assumption this high rate of sympathetic activations is abnormal, but there has been no direct comparison for similar measures with a healthy population free of RLS. Thus, it is not known if during sleep the rates of sympathetic nervous system activation are greater for RLS than for a healthy population. The objectives of this study were to determine if: (1) RLS patients compared to healthy controls have a greater frequency of sympathetic nervous system activation (significant heart rate increases) with a higher percentage of leg movements associated with these activations; (2) the sympathetic activation frequency and its relation to leg movements correlate significantly with RLS severity in RLS patients; and (3) there is some minimum threshold for RLS severity defining an RLS population where most (eg 85%) have abnormally high rates of sympathetic activation.MethodsSleep data on 32 RLS patients and 21 matched healthy controls were obtained from a prior study. All leg movements during sleep (LMS) and periodic leg movements in sleep (PLMS) were identified following the new WASM criteria; LMS that were not PLMS were considered isolated leg movements in sleep (ILMS). All episodes with significant heart rate increases were identified following procedures established by Cassel et al., (2016, see further on for citation) ie a slope of linear regression ≥2.5 beats per minute over five consecutive heartbeats. Severity of RLS was evaluated using the International Restless Legs Study Group Scale (IRLS).ResultsRLS patients had significantly more heart rate increases than controls (67.88/hr vs. 9.87/hr). RLS patients had a significantly greater percentage of both LMS and PLMS occurring with heart rate increases than controls (44% vs. 30%; 48% vs. 18%, respectively). These measures correlated significantly with IRLS and also PLMS/hr. 85% of the RLS patients with IRLS scores >22 or PLMS >50/hr had rates of sympathetic activation that were >90th percentile for the healthy controls.ConclusionThis is the first paper documenting that RLS patients showed clearly increased sympathetic activation when identified independent of PLMS. This, however, occurs for more severe RLS and not milder RLS. It has been proposed that the abnormally high rate of sympathetic activation for RLS patients relates to development of adverse cardiovascular health consequences observed in some studies. Thus, these data may provide a basic standard for possible use in epidemiological studies to identify the level of RLS severity more likely to have adverse health consequences (eg, cardiovascular disease). Since two-thirds of RLS patients have mild to even intermittent disease, including all RLS is likely to miss the potential health consequences of RLS.