Restless Legs Syndrome Associated With Increased Cardiovascular Mortality

Women with restless legs syndrome (RLS) have an increased risk for total and cardiovascular disease (CVD) mortality, which increases with longer RLS duration, according to the results of a large-scale, prospective cohort analysis from the Nurses’ Health Study, published in Neurology.

A total of 57,417 women without cancer, renal failure, and CVD were included in the study. Overall, 2.0% (n=1151) of participants reported physician-diagnosed RLS. Mean patient age was 67 years. Participating women with RLS tended to be older, white, have a higher body mass index, have a higher prevalence of chronic disease (eg, hypertension, diabetes mellitus, arthritis, and hypercholesterolemia), have a higher prevalence of sleep disorders (eg, snoring and short/prolonged sleep duration), and report an increased use of iron supplements, antidepressants, and antihypertensive agents, compared with those without RLS.

During 10 years of follow-up (2002 to 2012), the investigators recorded a total of 6448 deaths (1125 deaths from CVD, 1943 deaths from cancer, and 3380 deaths from other causes). In the age-adjusted model, women with RLS had a significantly higher risk for total mortality compared with those without RLS (hazard ratio [HR] 1.32; 95% CI, 1.13-1.54; P =.0005). Following adjustment for other possible confounders, no significant association was observed between the presence of physician-diagnosed RLS and a high risk for total mortality (adjusted HR 1.15; 95% CI, 0.98-1.34; P =.09).

Regarding cause-specific mortality, participants with RLS had a significantly higher risk for CVD mortality compared with those without RLS, following adjustment for potential confounders (adjusted HR 1.43; 95% CI, 1.02-2.00; P =.04). Moreover, longer duration of RLS was significantly associated with a higher risk for CVD mortality (P for trend =.04).

When study participants with common comorbidities (eg, snoring, short or prolonged sleep duration) were excluded from the analysis, the association between RLS and total mortality was strengthened (adjusted HR 1.43; 95% CI, 1.03-1.97), as was the association between RLS and CVD mortality (adjusted HR 2.27; 95% CI, 1.21-4.28). No significant association was observed between RLS and mortality from cancer or other diseases.

The investigators concluded that the higher risk for CVD mortality reported among women with RLS cannot be totally explained by the existence of common comorbidities of RLS in these patients.

Reference

Li Y, Li Y, Winkelman JW, Walters AS, et al. Prospective study of restless legs syndrome and total and cardiovascular mortality among women. Neurology. 2018;90(2):e135-e141.