Determinants of Periodic Limb Movements in Sleep within Patients with Restless Legs Syndrome 公开
Schultz, Jonathan Steven (2011)
Abstract
Purpose: Clinico-epidemiological surveys disagree on the
correlations between the
measurements of iron metabolism and Periodic Leg Movements in Sleep
(PLMS) in patients
with Restless Leg Syndrome (RLS). PLMS are a feature of RLS
patients that coincide
temporally with sympathetically mediated heart rate and blood
pressure elevations, and could
represent a plausible biological mechanism for some
RLS-comorbidities. This study evaluated
the clinical determinants of PLMS, specifically measurements of
iron metabolism in a clinical
cohort of patients enriched for RLS.
Methods: RLS patients seen at the Emory Sleep Center with
measured PLMS (n = 452) were
given a detailed questionnaire by a physician assessing health
habits, RLS symptoms, and co-
morbid conditions. PLMS were measured over 5 nights with an
accelerometer, one night
polysomnograph, or both. A retrospective chart review was conducted
to retrieve patient data
and determine significant clinical predictors and to explore how
medications affect PLMS.
Results: Total Iron Binding Capacity (TIBC) was found to
be a significantly correlated with
increased number of PLMS after controlling for potential
confounders. However, TIBC was not
a robust determinant in predicting categorical PLMS when taken as a
binary predictor. All other
iron metabolism measures were not significantly correlated with
PLMS, after controlling for
potential confounders. Exploratory analyses of medication effects
showed that dopamenergics
and both groups of selective serotonin reuptake inhibitors (SSRIs),
those with minimal and those
with higher norepinephrine reuptake inhibition, were significant
predictors of a 4 level
categorical PLMS index, while controlling for potential
confounders.
Conclusions: Prior studies have suggested that PLMS are
associated with anemia and that iron
deficiency might be one way to explain increased PLMS in RLS
patients. TIBC was found to be
weakly associated with increased number of PLMS, however this was
not found to be a very
robust finding. The blood iron panel was not associated with the
severity of PLMS in patients
with RLS. Future studies should investigate the potential of TIBC,
but different biological
mechanisms should be considered to understand the underlying
pathology of PLMS in patients
with RLS.
Table of Contents
Table of Contents
Introduction 1
Methods 5
Results 10
Discussion 14
Tables and Figures 18
References 27
Emory IRB Approval Letter 30
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