A comprehensive review published in Circulation Research is drawing new attention to the cardiovascular consequences of restless legs syndrome, a condition that affects an estimated 5% to 10% of adults and is often dismissed as a minor nuisance.
The review by Yves Dauvilliers and colleagues, including Mayo Clinic cardiologist Virend Somers, examines decades of epidemiological and clinical data linking RLS and its hallmark periodic leg movements to hypertension, coronary artery disease, and stroke.
Leg Movements That Spike Blood Pressure
At the center of the concern are periodic leg movements during sleep, which occur in 60% to 80% of people with restless legs syndrome. These involuntary movements are not just a sleep disruption — each one triggers a measurable cardiovascular response.
Research cited in the review shows that individual leg movements cause heart rate increases of 10% to 20% and systolic blood pressure elevations of 25 to 30 mmHg, each lasting 10 to 15 seconds. Over the course of a night, hundreds of these spikes can accumulate.
Periodic leg movements during sleep are concomitant with an increase in blood pressure and heart rate, which may affect the physiological nocturnal blood pressure dip and lead to an increased incidence of cardiovascular disease.
The disruption of the normal overnight drop in blood pressure — known as "dipping" — is a well-established risk factor for heart disease and stroke.
The Numbers Behind the Risk
Large epidemiological studies have produced striking findings:
- The Wisconsin Sleep Cohort (2,821 participants) found that people with RLS had 2.6 times the odds of cardiovascular disease
- The Sleep Heart Health Study (2,546 participants) reported similarly elevated odds at 2.4 times
- Swedish population studies found RLS associated with heart problems at 2.5 times the odds in men and 2.1 times in women
- A Veterans Administration study linked RLS to a fourfold increase in coronary heart disease risk and a nearly fourfold increase in stroke risk
- Data from the Nurses' Health Study showed that women with RLS for three or more years had an 80% higher risk of nonfatal heart attack
Not all studies have found a significant association, and the reviewers note that symptom severity and duration appear to influence the strength of the link.
Beyond Sleep Loss
The review identifies several biological pathways connecting RLS to cardiovascular harm. Sleep fragmentation caused by the condition decreases insulin sensitivity by roughly 25% and shifts the nervous system toward heightened sympathetic activity — the "fight or flight" response that raises heart rate and constricts blood vessels.
Iron deficiency, a known driver of RLS, also appears independently associated with increased mortality in patients with coronary heart disease and type 2 diabetes, suggesting the two conditions may share common underlying mechanisms.
A Call for Collaboration
The authors argue that restless legs syndrome should no longer be treated in isolation by sleep specialists. They call for greater multidisciplinary collaboration between cardiologists and sleep medicine physicians, and recommend incorporating RLS screening into cardiovascular risk assessments.
They also suggest that clinical trials should examine whether treating RLS — through iron supplementation, newer medications, or emerging wearable devices — can reduce markers of cardiovascular risk such as sympathetic overactivity, vascular stiffness, and impaired glucose tolerance.
For the millions of people who spend their nights fighting the urge to move their legs, the message is clear: the condition deserves attention not just for better sleep, but for a healthier heart.
