Can RLS Cause Heart Problems?
Restless Legs Syndrome (RLS) itself does not directly cause heart disease, but emerging evidence suggests an association between RLS and increased cardiovascular risk, likely mediated through periodic leg movements that trigger repetitive blood pressure and heart rate surges, along with sleep fragmentation that may increase sympathetic nervous system activity. 1, 2
Understanding the Cardiovascular Connection
The relationship between RLS and cardiovascular disease remains an area of active investigation, with mixed but concerning findings:
Periodic leg movements during sleep (PLMS), which occur in 60-80% of RLS patients, are associated with brief, recurrent elevations in heart rate and blood pressure approximately every 15-30 seconds throughout the night. 3, 1
These repetitive cardiovascular surges may affect the normal physiological nocturnal blood pressure dip, potentially leading to increased cardiovascular disease incidence over time. 1
Cross-sectional and longitudinal epidemiologic studies have reported associations between RLS and both cardiovascular disease and hypertension, though the magnitude and direction of these associations remain inconclusive. 1, 4
Potential Mechanisms of Cardiovascular Risk
Several pathways may explain how RLS could contribute to cardiovascular problems:
Sleep fragmentation and deprivation linked to sensory discomfort in RLS may increase sympathetic nervous system tone, contributing to elevated cardiovascular risk. 1, 2
Iron deficiency, a key pathophysiologic feature of RLS, is emerging as an independent risk factor for cardiovascular disease. 2
Increased central sympathetic outflow, impaired baroreflex function, and diminished heart rate and blood pressure variability may occur, similar to mechanisms seen in obstructive sleep apnea. 2
Potential metabolic consequences including glucose intolerance and reduced insulin sensitivity from chronic sleep disturbance may contribute to cardiovascular risk. 2
Clinical Implications and Quality of Life Impact
Beyond potential cardiovascular effects, RLS significantly impacts overall health:
RLS affects quality of life at least as severely as other common chronic illnesses, particularly resulting in insomnia, anxiety, and depression. 5
Severe RLS symptoms can negatively impact sleep, mood, and quality of life, with moderate-to-severe disease affecting at least 2.7% of the population. 5
RLS may be a risk factor for cardiovascular disease, though this relationship requires further investigation to establish causality. 6
Important Caveats
The epidemiologic evidence is mixed—not all cross-sectional and longitudinal studies have found meaningful associations between RLS and cardiovascular disease. 2
Comorbidities and associated sleep disorders may synergistically increase cardiovascular risk, making it difficult to isolate RLS as an independent causative factor. 1
The relationship may be bidirectional or confounded by shared risk factors rather than representing direct causation. 1
Management to Reduce Cardiovascular Risk
Treating RLS effectively may theoretically reduce cardiovascular risk by addressing the underlying mechanisms:
First-line treatment with alpha-2-delta ligands (gabapentin, gabapentin enacarbil, or pregabalin) can reduce symptoms and improve sleep quality. 7
Correcting iron deficiency (when ferritin ≤75 ng/mL or transferrin saturation <20%) addresses both RLS pathophysiology and a potential independent cardiovascular risk factor. 7, 2
Avoiding medications that worsen RLS (tricyclic antidepressants, SSRIs, lithium, dopamine antagonists) prevents symptom exacerbation. 3
Greater multidisciplinary collaboration between cardiologists and sleep specialists is needed to better identify, understand, and manage patients with RLS who may be at cardiovascular risk. 1