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. 2016 Feb;25(1):47-56.
doi: 10.1111/jsr.12335.

Association of incident restless legs syndrome with outcomes in a large cohort of US veterans

Miklos Z Molnar, Jun L Lu, Kamyar Kalantar-Zadeh, Csaba P Kovesdy

Association of incident restless legs syndrome with outcomes in a large cohort of US veterans

Miklos Z Molnar et al. J Sleep Res. 2016 Feb.

Abstract

Restless legs syndrome is a common sleep disorder, but there is a paucity of large cohort studies examining the association of restless legs syndrome with clinical outcomes, including all-cause mortality, incident coronary heart disease, stroke and chronic kidney disease. From a nationally representative prospective cohort of over 3 million US veterans [93% male, median follow-up time of 8.1 years (interquartile range: 7.0-8.5 years)] with baseline estimated glomerular filtration rate ≥ 60 mL min(-1) 1.73 m(-2), a propensity-matched cohort of 7392 patients was created, and the association between incident restless legs syndrome and the following was examined: (1) all-cause mortality; (2) incident coronary heart disease; (3) incident strokes; and (4) incident chronic kidney disease defined as estimated glomerular filtration rate <60 mL min(-1) 1.73 m(-2). Associations were examined using Cox models. The mean ± SD age of the propensity-matched cohort at baseline was 59 ± 12 years; 89 and 8% of patients were white and black, respectively; 31% of the patients were diabetic; and the mean baseline estimated glomerular filtration rate was 83.9 ± 15.1 mL min(-1) 1.73 m(-2). Propensity matching resulted in a balanced cohort, with the disappearance in baseline differences in comorbidities. Compared with restless legs syndrome-negative patients, incident restless legs syndrome was associated with 88% higher mortality risk [hazard ratio and 95% confidence interval: 1.88 (1.70-2.08)], and almost four times higher risk of coronary heart disease and stroke [hazard ratio: 3.97 (3.26-4.84) and 3.89 (3.07-4.94), respectively]. The risk of incident chronic kidney disease was also significantly higher in incident restless legs syndrome patients [hazard ratio: 3.17 (2.74-3.66)] compared with restless legs syndrome-negative counterparts. In this large and contemporary cohort of US veterans, incident restless legs syndrome was associated with higher risk of mortality, incident coronary heart disease, stroke and chronic kidney disease.

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Conflict of interest statement

Conflict of interest

None.

Figures

Figure 1
Figure 1
Flow chart of patients’ selection
Figure 2
Figure 2
Association between incident restless legs syndrome and outcomes (panel A: mortality; panel B: CHD free survival; panel C: ischemic stroke event free survival and panel D: CKD free survival) using Kaplan-Meiers curves in the propensity matched cohort Abbreviations: CHD: coronary heart disease; CKD: Chronic Kidney Disease; RLS: Restless Legs Syndrome
Figure 3
Figure 3
Association between incident restless legs syndrome and outcomes in different subgroups of patients (panel A: mortality; panel B: incident CHD; panel C: incident ischemic stroke event and panel D: CKD) in the propensity matched cohort Abbreviations: AA: African-American; BMI: Body mass index; CHD: coronary heart disease; CKD: Chronic Kidney Disease; DM: Diabetes mellitus; eGFR: Estimated glomerular filtration rate; PAD: Peripheral artery disease; RLS: Restless Legs Syndrome
Figure 3
Figure 3
Association between incident restless legs syndrome and outcomes in different subgroups of patients (panel A: mortality; panel B: incident CHD; panel C: incident ischemic stroke event and panel D: CKD) in the propensity matched cohort Abbreviations: AA: African-American; BMI: Body mass index; CHD: coronary heart disease; CKD: Chronic Kidney Disease; DM: Diabetes mellitus; eGFR: Estimated glomerular filtration rate; PAD: Peripheral artery disease; RLS: Restless Legs Syndrome
Figure 3
Figure 3
Association between incident restless legs syndrome and outcomes in different subgroups of patients (panel A: mortality; panel B: incident CHD; panel C: incident ischemic stroke event and panel D: CKD) in the propensity matched cohort Abbreviations: AA: African-American; BMI: Body mass index; CHD: coronary heart disease; CKD: Chronic Kidney Disease; DM: Diabetes mellitus; eGFR: Estimated glomerular filtration rate; PAD: Peripheral artery disease; RLS: Restless Legs Syndrome
Figure 3
Figure 3
Association between incident restless legs syndrome and outcomes in different subgroups of patients (panel A: mortality; panel B: incident CHD; panel C: incident ischemic stroke event and panel D: CKD) in the propensity matched cohort Abbreviations: AA: African-American; BMI: Body mass index; CHD: coronary heart disease; CKD: Chronic Kidney Disease; DM: Diabetes mellitus; eGFR: Estimated glomerular filtration rate; PAD: Peripheral artery disease; RLS: Restless Legs Syndrome
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