Zeynep KAZAZ, Nuray CAN USTA, İsmet DURMUŞ, Vildan ALTUNAYANOĞLU ÇAKMAKl, Murat TOPBAŞ, Oğuzhan Ekrem TURAN

Huzursuz bacaklar sendromlu hastalarda kalp hızı değişkenliği ve ritim analizi: Bir prospektif olgukontrol çalışması

Amaç: Kalp hızı değişkenliği (KHD) analizi ile huzursuz bacaklar sendromu (HBS) hastalarında kardiyak otonomik tutulumu araştırmak. Yöntemler: Prospektif olgu-kontrol çalışması tipindeki bu çalışmaya HBS hastaları ve yaş/cinsiyet uyumlu sağlıklı kontroller dahil edildi. HBS tanısı Uluslararası Huzursuz Bacaklar Sendromu Çalışma Grubu tarafından belirlenen kriterlere göre konuldu. Demografik veriler ve hastalığın şiddeti kayıt edildi. Tüm hasta ve kontrol gruplarında 24 saatlik elektrokardiyografik Holter monitörizasyonu ile HRV analizi yapıldı. Bulgular: Çalışma grubunda 65 (50’si kadın), kontrol grubunda 58 (45’i kadın) hasta mevcuttu. Hastalar ve kontrol grupları yaş ve cinsiyet açısından benzerdi. HRV analizinde HBS hastaları ve kontrol grubu karşılaştırıldığında SDNN gece değerinin düşük olması dışında fark bulunmadı (p=0,03). KHD analizleri hastalık şiddetine göre karşılaştırıldığında SDNN gece değeri gruplar arasında anlamlı farklılık gösterdi (p=0,03). İkili karşılaştırmada şiddetli ve çok şiddetli gruplar arasındaki fark anlamlıydı (p=0,01) ve şiddetli grup, çok şiddetli gruba göre daha düşüktü. Sonuç: HBS'li hastalarda HRV ile kardiyak otonom sistemi değerlendiren bu çalışmada, gece saatlerinde parasempatik sinir sistemininde azalma saptanmıştır.

Heart rate variability and analysis of rhythm in patients with restless legs syndrome: A prospective case-control study

Aim: To investigate the involvement of cardiac autonomy by heart rate variability (HRV) analysis in patients with restless legs syndrome (RLS). Methods: Patients with RLS and age/sex matched healthy controls were included in this prospective case-control study. The diagnosis of RLS was made according to the criteria determined by the International Restless Legs Syndrome Study Group. Demographic data and severity of disease were recorded. The HRV analysis was performed with a 24-hour electrocardiographic Holter monitoring in all patients and the control group. Results: Sixty-five (of them, 50 female) patients and 58 (of them, 45 female) healthy individuals were enrolled into the study. Patients and control groups were similar for age and gender. No difference was found in the HRV analysis, except that the standard deviation of NN intervals (SDNN) at night was lower when RLS patients and the control group were compared (p=0.03). The HRV analyzes were compared according to disease severity, SDNN at night was significantly different between groups (p=0.03). In the pairwise comparison, the difference between the severe and very severe groups was significant (p=0.01) and severe group was lower than very severe group. Conclusions: In the present study which evaluate the cardiac autonomic system with HRV in patients with RLS, a decrease in parasympathetic nervous system was found at night time.

PDF

___

1. Klingelhoefer L, Bhattacharya K, Reichmann H. Restless legs syndrome. Clin Med (Lond). 2016;16:379-82.
2. Vellieux G, d'Ortho MP. Le syndrome des jambes sans repos [Restless legs syndrome]. Rev Med Interne. 2020;41:258-64.
3. Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005;165:1286-92.
4. Merlino G, Valente M, Serafini A, Gigli GL. Restless legs syndrome: diagnosis, epidemiology, classification and consequences. Neurol Sci. 2007;28 Suppl 1:S37-46.
5. Akpinar S. Treatment of restless legs syndrome with levodopa plus benserazide. Arch Neurol. 1982;39:739.
6. Garcia-Borreguero D, Larrosa O, de la Llave Y. Circadian aspects in the pathophysiology of the restless legs syndrome. Sleep Med. 2002;3 Suppl:S17-21.
7. Ruottinen HM, Partinen M, Hublin C, Bergman J, Haaparanta M, Solin O, et al. An FDOPA PET study in patients with periodic limb movement disorder and restless legs syndrome. Neurology. 2000;54:502-4.
8. Winkelman JW, Shahar E, Sharief I, Gottlieb DJ. Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study. Neurology. 2008;70:35-42.
9. Nakanishi K, Jin Z, Homma S, Elkind MSV, Rundek T, Lee SC, et al. Association Between Heart Rate and Subclinical Cerebrovascular Disease in the Elderly. Stroke. 2018;49:319-24.
10. Didato G, Di Giacomo R, Rosa GJ, Dominese A, de Curtis M, Lanteri P. Restless Legs Syndrome across the Lifespan: Symptoms, Pathophysiology, Management and Daily Life Impact of the Different Patterns of Disease Presentation. Int J Environ Res Public Health. 2020;17:3658.
11. Trenkwalder C, Allen R, Högl B, Clemens S, Patton S, Schormair B, et al. Comorbidities, treatment, and pathophysiology in restless legs syndrome. Lancet Neurol. 2018;17:994-1005.
12. Young HA, Benton D. Heart-rate variability: a biomarker to study the influence of nutrition on physiological and psychological health? Behav Pharmacol. 2018;29:140-51.
13. Cygankiewicz I, Zareba W. Heart rate variability. Handb Clin Neurol. 2013;117:379-93.
14. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043-65.
15. Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, et al. International Restless Legs Syndrome Study Group. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003;4:121-32.
16. Constantinescu V, Matei D, Constantinescu I, Cuciureanu DI. Cardiac autonomic modulation in drug-resistant epilepsy patients after vagus nerve stimulation therapy. Neurol Neurochir Pol. 2020;54:329-36
17. Sung SY, Han JH, Kim JH, Kwon KY, Park SW. The Relationship between Heart Rate Variability and Aortic Knob Width. Korean J Fam Med. 2019;40:39-44.
18. Yıldız A, Yıldız C, Karakurt A. Assessment of cardiac autonomic functions by heart rate variability in patients with restless leg syndrome. Turk Kardiyol Dern Ars. 2018;46:191-6.
19. Barone DA, Ebben MR, DeGrazia M, Mortara D, Krieger AC. Heart rate variability in restless legs syndrome and periodic limb movements of Sleep. Sleep Sci. 2017;10:80-6.
20. Cikrikcioglu MA, Hursitoglu M, Erkal H, Kınas BE, Sztajzel J, Cakirca M,et al. Oxidative stress and autonomic nervous system functions in restless legs syndrome. Eur J Clin Invest. 2011;41:734-42.
21. Bertisch SM, Muresan C, Schoerning L, Winkelman JW, Taylor JA. Impact of Restless Legs Syndrome on Cardiovascular Autonomic Control. Sleep. 2016;39:565-71.
22. Shneyder N, Adler CH, Hentz JG, Shill H, Caviness JN, Sabbagh MN, et al. Autonomic complaints in patients with restless legs syndrome. Sleep Med. 2013;14:1413-6.
23. Acar BA, Acar MAG, Acar T, Varım C, Alagöz AN, Demiryürek EB, et al. Patients with primary restless legs syndrome have higher prevalence of autonomic dysfunction and irritable bowel syndrome. Singapore Med J. 2018;59:539-44.
24. Bigger JT, Fleiss JL, Rolnitzky LM, Steinman RC. The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation. 1993;88:927-34.