Figorilli Michela, Puligheddu Monica, Congiu Patrizia, Ferri Raffaele
Neurophysiology Unit, Sleep Disorder Center, University of Cagliari, SS 554 Bivio Sestu, Monserrato, Cagliari, 09042, Italy.
Department of Neurology I.C. Sleep Research Center, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), via C. Ruggero 73, Troina, 94018, Italy.
Curr Treat Options Neurol. 2017 Mar;19(3):10. doi: 10.1007/s11940-017-0446-5.
Periodic leg movements during sleep (PLMS) are commonly found in patients with restless leg syndrome (RLS), but they may occur in other sleep disorders and several medical conditions. Their prevalence increases with age, but they can also be observed in children. During the last decades, very active research has been devoted to determine and understand the pathophysiology, associated events, and clinical significance of PLMS. This chapter tries to sum up the most relevant PLMS-related findings, focusing on the relationship between PLMS and the cardiovascular system, in order to understand the clinical implication of this complex motor phenomenon. PLMS have been associated with sympathetic overactivity, namely surges in nocturnal blood pressure and heart rate, without modification in global autonomic balance. Also, PLMS have been related to inflammatory cellular pathways, with elevated level of inflammatory markers, which are associated with cardiovascular risk. The PLMS-related modulation of the autonomic system and of inflammation may increase cardiovascular and cerebrovascular risk in subjects with frequent PLMS. Moreover, also, comorbidities associated with PLMS may play a synergic role in worsening the cardiovascular risk and the consequent mortality and morbidity. Furthermore, little is known about pathophysiological correlates in children with PLMS and their chronic implication on the cardiovascular and cerebrovascular systems. A few studies have suggested that treating PLMS with dopaminergic drugs may reduce their associated sympathetic overactivity and modify disease progression. Definitely, further research is needed to assess the clinical impact of PLMS, associated or not with RLS, and above all the long-term impact of treating PLMS on cardiovascular risk, morbidity, and mortality.
睡眠期周期性腿部运动（PLMS）常见于不宁腿综合征（RLS）患者，但也可能出现在其他睡眠障碍及多种内科疾病中。其患病率随年龄增长而增加，但在儿童中也可观察到。在过去几十年里，人们致力于确定和理解PLMS的病理生理学、相关事件及临床意义，开展了非常积极的研究。本章试图总结与PLMS最相关的研究结果，重点关注PLMS与心血管系统之间的关系，以便理解这一复杂运动现象的临床意义。PLMS与交感神经过度活跃有关，即夜间血压和心率波动，而整体自主神经平衡无改变。此外，PLMS还与炎症细胞途径有关，炎症标志物水平升高，而这些标志物与心血管风险相关。PLMS相关的自主神经系统调节和炎症可能会增加频繁出现PLMS的受试者的心血管和脑血管风险。此外，与PLMS相关的合并症可能在加重心血管风险及随之而来的死亡率和发病率方面起协同作用。此外，关于PLMS儿童的病理生理相关性及其对心血管和脑血管系统的慢性影响知之甚少。一些研究表明，用多巴胺能药物治疗PLMS可能会降低其相关的交感神经过度活跃并改变疾病进展。当然，还需要进一步研究来评估PLMS（无论是否与RLS相关）的临床影响，尤其是治疗PLMS对心血管风险、发病率和死亡率的长期影响。
