Compromised Dynamic Cerebral Autoregulation in Patients with Restless Legs Syndrome

Yanan Zhang,1 Qianqian Chen,1 Qingqing Sun,1 Mingyang Tang,1 Yi Yang,1,2 Zhen-Ni Guo,1,2 Zan Wang1,2 1Sleep Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, People’s Republic of China; 2Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, People’s Republic of ChinaCorrespondence: Zhen-Ni Guo, Stroke Center, Department of Neurology, The First Hospital of Jilin University, Xinmin Street 1#, Chang Chun, 130021, People’s Republic of China, Tel +86-431-88782378, Email zhen1ni2@jlu.edu.cn Zan Wang, Sleep Center, Department of Neurology, The First Hospital of Jilin University, Xinmin Street 1#, Chang Chun, 130021, People’s Republic of China, Tel +86-431-88782378, Email wangzan@jlu.edu.cnBackground: Restless legs syndrome (RLS) is a prevalent sensorimotor nervous system disorder in patients accompanied with insomnia, blood pressure fluctuation, and sympathetic dysfunction. These symptoms may disrupt cerebral hemodynamics. Dynamic cerebral autoregulation (dCA) describes the temporary response of cerebrovascular system to abrupt fluctuations in blood pressure, which keep cerebral blood flow stable and serve as a marker of cerebrovascular system ability.Objective: This research aimed to assess dCA in RLS patients.Methods: In this study, RLS patients were recruited and subsequently classified into four groups (mild, moderate, severe, and very severe) based on the International RLS Rating Scale (IRLS). Healthy controls matched for age and sex were enrolled. All participants were evaluated dCA by assessing phase difference (PD). A portion of patients with RLS was reassessed for dCA after one month of medication therapy (pramipexole [0.125 mg/day] and gabapentin [300 mg/day]).Results: There were altogether 120 patients with RLS and 30 controls completed the polysomnography and dCA assessment. PD was lower in the moderate, severe, and very severe RLS groups than that in the controls and mild RLS groups. Periodic limb movement index (PLMI), arousal index, and IRLS all showed a linear correlation with PD in RLS patients. Additionally, PD increased in RLS patients after therapy.Conclusion: The dCA was compromised in moderate, severe, and very severe RLS patients and was negatively correlated with the IRLS, arousal index, and PLMI. After 1 month of therapy, dCA improved in RLS patients.Keywords: restless legs syndrome, dynamic cerebral autoregulation, autonomic nerve dysfunction, dopaminergic