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Autonomic dysfunction in restless legs syndrome

  • Yuksel ErdalEmail author
  • Ozlem Akdogan
  • Mecbure Nalbantoglu
  • Gokce Kavasoglu
  • Ufuk Emre
Sleep Breathing Physiology and Disorders • Original Article
  • 9 Downloads

Abstract

Objective

Autonomic dysfunction in patients with RLS has been described in some domains; however, detailed studies on this subject are limited and report conflicting results. In this study, we aimed to evaluate autonomic functions electrophysiologically and clinically in patients with restless legs syndrome (RLS).

Methods

Fifty-two adult patients with RLS and 40 healthy controls were enrolled in this prospective study. Electrophysiological tests of sympathetic skin response (SSR) and RR interval variability (RRIV) analysis were performed, and the SCOPA-AUT questionnaire was applied to evaluate autonomic functions.

Results

There was no significant difference in terms of SSR results between patients and controls (p > 0.05). However, there were significant differences between the patient and control groups in terms of RRIV analyses at rest, deep breathing, and valsalva, and also valsalva ratio (p = 0.037, p = 0.049, p = 0.017, p = 0.020). The mean SCOPA-AUT total score was higher in the RLS group compared with the control group (20.7 ± 10 vs 14.2 ± 8; p = 0.003). Significant differences were found regarding gastrointestinal, urinary, and cardiovascular domains (p = 0.01, p = 0.007, p = 0.049); on the other hand, pupillomotor, thermoregulatory, and sexual function did not significantly differ (p > 0.05).

Conclusion

Autonomic functions should be questioned in detail as well as motor and sensory symptoms of RLS, and care should be taken especially on cardiac dysfunction.

Keywords

Restless legs syndrome Sympathetic skin response RR interval variability, SCOPA-AUT Autonomic dysfunction 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, Zucconi M, Ferri R, Trenkwalder C, Lee HB, International Restless Legs Syndrome Study Group (2014) Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med 15:860–873CrossRefGoogle Scholar
  2. 2.
    Wijemanne S, Ondo W (2017) Restless legs syndrome: clinical features, diagnosis and a practical approach to management. Pract Neurol 17:444–452CrossRefGoogle Scholar
  3. 3.
    Ohayon MM, O'Hara R, Vitiello MV (2012) Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 16:283–295CrossRefGoogle Scholar
  4. 4.
    Trenkwalder C, Hogl B, Winkelmann J (2009) Recent advances in the diagnosis, genetics and treatment of restless legs syndrome. J Neurol 256:539–553CrossRefGoogle Scholar
  5. 5.
    Miglis MG (2017) Sleep and the autonomic nervous system. In: Sleep and neurologic disease, pp 227–241CrossRefGoogle Scholar
  6. 6.
    Fink AM, Bronas UG, Calik MW (2018) Autonomic regulation during sleep and wakefulness: a review with; implications for defning the pathophysiology of neurological disorders. Clin Auton Res 28:509–518CrossRefGoogle Scholar
  7. 7.
    Jain S (2011) Multi-organ autonomic dysfunction in Parkinson disease. Parkinsonism Relat Disord 17:77–83CrossRefGoogle Scholar
  8. 8.
    Shneyder N, Adler CH, Hentz JG, Shill H, Caviness JN, Sabbagh MN, Beach TG, Driver-Dunckley E (2013) Autonomic complaints in patients with restless legs syndrome. Sleep Med 14:1413–1416CrossRefGoogle Scholar
  9. 9.
    Isak B, Uluc K, Salcini C, Agan K, Tanridag T, Us O (2011) A neurophysiological approach to the complex organisation of the spine: f-wave duration and the cutaneous silent period in restless legs syndrome. Clin Neurophysiol 122:383–390CrossRefGoogle Scholar
  10. 10.
    Izzi F, Placidi F, Romigi A, Lauretti B, Marfia GA, Mercuri NB, Marciani MG, Rocchi C (2014) Is autonomic nervous system involved in restless legs syndrome during wakefulness? Sleep Med 15:1392–1397CrossRefGoogle Scholar
  11. 11.
    Tyvaert L, Laureau E, Hurtevent JP, Hurtevent JF, Derambure P, Monaca C (2009) A-delta and C-fibres function in primary restless legs syndrome. Neurophysiol Clin 39:267–274CrossRefGoogle Scholar
  12. 12.
    Shukla G, Goyal V, Srivastava A, Behari M (2012) Quantitative thermal sensory testing and sympathetic skin response in primary restless legs syndrome - a prospective study on 57 Indian patients. Ann Indian Acad Neurol 15:260–262CrossRefGoogle Scholar
  13. 13.
    Visser M, Marinus J, Stiggelbout A, Van Hilten JJ (2004) Assessment of autonomic dysfunction in Parkinson’s disease: the SCOPA-AUT. Mov Disord 19:1306–1312CrossRefGoogle Scholar
  14. 14.
    Yasar H, Senol MG, Tasdemir S et al (2016) Validity and reliability of the Turkish version of the scales for outcomes in Parkinson’s disease-autonomic questionnaire (SCOPA-AUT). Mov Disord 31(suppl 2):516-517Google Scholar
  15. 15.
    Walters AS et al (2003) Validation of the international restless legs syndrome study group rating scale for restless legs syndrome. Sleep Med 4:121–132CrossRefGoogle Scholar
  16. 16.
    Polydefkis M, Allen RP, Hauer P, Earley CJ, Griffin JW, McArthur JC (2000) Subclinical sensory neuropathy in late-onset restless legs syndrome. Neurology 55:1115–1121CrossRefGoogle Scholar
  17. 17.
    Iannaccone S, Zucconi M, Marchettini P, Ferini-Strambi L, Nemni R, Quattrini A, Palazzi S, Lacerenza M, Formaglio F, Smirne S (1995) Evidence of peripheral axonal neuropathy in primary restless legs syndrome. Mov Disord 10:2–9CrossRefGoogle Scholar
  18. 18.
    Pavy-Le Traon A, Amarenco G, Duerr S et al (2011) The movement disorders task force review of dysautonomia rating scales in Parkinson’s disease with regard to symptoms of orthostatic hypotension. Mov Disord 26:1985–1992CrossRefGoogle Scholar
  19. 19.
    Damon-Perrière N, Foubert-Samier A, De Cock VC et al (2012) Assessment of the Scopa-Aut questionnaire in multiple system atrophy: relation to UMSARS scores and progression over time. Parkinsonism Relat Disord 18:612–615CrossRefGoogle Scholar
  20. 20.
    Papapetropoulos S, Argyriou AA, Chroni E (2006) No correlation between the clinical severity of autonomic symptoms (SCOPA-AUT) and electrophysiological test abnormalities in advanced Parkinson’s disease. Mov Disord 21:430–431CrossRefGoogle Scholar
  21. 21.
    Ferini-Strambi L, Oertel W, Dauvilliers Y, Postuma RB, Marelli S, Iranzo A, Arnulf I, Birgit H, Manni R, Miyamoto T, Fantini ML, Puligheddu M, Jennum P, Sonka K, Santamaria J, Zucconi M, Rancoita PMV, Leu-Semenescu S, Frauscher B, Terzaghi M, Miyamoto M, Unger M, Stiasny-Kolster K, Desautels A, Wolfson C, Pelletier A, Montplaisir J (2014) Autonomic symptoms in idiopathic REM behavior disorder: a multicentre case-control study. J Neurol 261:1112–1118CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurologyIstanbul Training and Research HospitalIstanbulTurkey
  2. 2.Department of NeurologyDemiroglu Bilim University Medical FacultyIstanbulTurkey

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