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Study links restless leg syndrome with erectile dysfunction in older men

Author: Tamer M. Fouad, M.D. | Submitted: January 03, 2010. Updated: September 26, 2010.

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A study in the Jan. 1 issue of the journal Sleep shows that erectile dysfunction was more common in older men with restless leg syndrome (RLS) than in those without RLS, and the magnitude of this association increased with a higher frequency of RLS symptoms.1

Data were collected from 23,119 men who participated in the Health Professionals Follow-up study, a large ongoing U.S. cohort of male dentists, optometrists, osteopaths, podiatrists, pharmacists and veterinarians. Participants were between the ages of 56 and 91 years, with a mean age of 69 years. To reduce possible misclassification of RLS, participants with diabetes and arthritis were excluded.

Participants were questioned in 2002 about RLS diagnosis and severity based on the International RLS study group criteria. RLS was defined as having unpleasant leg sensations combined with restlessness and an urge to move; with symptoms appearing only at rest, improving with movement, worsening in the evening or at night compared with the morning, and occurring five or more times per month.

About four percent of participants had RLS (944 of 23,119 men), and about 41 percent (9,433 men) had erectile dysfunction. Men with RLS were older and were more likely to be Caucasian. The prevalence of erectile dysfunction also increased with age.

Results show that erectile dysfunction was 16 percent more likely in men with RLS symptoms that occur five to 14 times per month (odds ratio of 1.16) and 78 percent more likely in men whose RLS symptoms occur 15 or more times a month (OR=1.78). The associations were independent of age, body mass index, use of antidepressants, anxiety and other possible risk factors for RLS. Fifty-three percent of RLS patients and 40 percent of participants without RLS reported having erectile dysfunction, which was defined as a poor or very poor ability to have and maintain an erection sufficient for intercourse.

The results suggest it is likely that the two disorders share common mechanisms, said lead author Xiang Gao, MD, PhD, instructor at Harvard Medical School, associate epidemiologist at Brigham and Women’s Hospital and research scientist at the Harvard School of public health in Boston, Mass.

“The mechanisms underlying the association between RLS and erectile dysfunction could be caused by hypofunctioning of dopamine in the central nervous system, which is associated with both conditions,” said Gao.

The authors noted that the association between RLS and erectile dysfunction also could be related in part to other sleep disorders that co-occur with RLS. For example, obstructive sleep apnea and sleep deprivation may decrease circulating testosterone levels.

They also pointed out that the cross-sectional design of the study did not allow for a determination of causality. Further epidemiological studies are needed to clarify the relationship between the RLS and erectile dysfunction and to explore the biological mechanisms underlying the association.

CITE THIS ARTICLE:
Tamer M. Fouad, M.D.. Study links restless leg syndrome with erectile dysfunction in older men. Doctors Lounge Website. Available at: http://www.doctorslounge.com/index.php/blogs/page/310. Accessed September 30 2014.

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March 02, 2010 03:13 AM

M. Jagesh Kamath, M.D.'s avatar

Very interesting.The common factor relating to both would be nitric oxide which is a main vasoactive agent in Erectile Dysfunction and also in restless leg syndrome where variant association NOS1 gene is found.Mov Disord. 2008 Feb 15;23(3):350-8.

Variants in the neuronal nitric oxide synthase (nNOS, NOS1) gene are associated with restless legs syndrome.
Winkelmann J, Lichtner P, Schormair B, Uhr M, Hauk S, Stiasny-Kolster K, Trenkwalder C, Paulus W, Peglau I, Eisensehr I, Illig T, Wichmann HE, Pfister H, Golic J, Bettecken T, Pütz B, Holsboer F, Meitinger T, Müller-Myhsok B.

Institute of Human Genetics, GSF-National Research Center for Environment and Health, Munich, Germany. .(JavaScript must be enabled to view this email address)
May be some thing to work on.Thank you Dr.Fouad for a very thought provoking blog.

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March 03, 2010 04:04 AM

Tamer M. Fouad, M.D.'s avatar

Thank you Dr. Kamath for your kind comments.

I believe the point you make is very interesting. It would indeed be interesting to know whether these patients received drugs such as Sildenafil citrate (Viagra - approved in 1998, before the study was conducted).

The authors here were confirming an earlier observation which they published linking Parkinson’s disease to erectile dysfunction and suggesting a role for central dopaminergic hypofunction.

There are several limitations of cross sectional studies in general, but I think a complete evaluation of erectile dysfunction is warranted. This is a very common disease with well known risk factors all of which should be evaluated - depression / intake of SSRI antidepressants, medication history (use of thiazides for hypertension), neurological disease and testosterone levels. Diabetes mellitus, an important risk factor for erectile dysfunction and whose neurological complications can be confused with RLS was excluded from the study. However, cardiovascular disease is an equally important risk factor. It is widely known that erectile dysfunction could be an early sign of future cardiovascular disease and conversely, that cardiovascular disease can also lead to erectile dysfunction. It is hypothesized that endothelial dysfunction is a common incriminating factor for both disease. The Health Professionals Follow-Up Study (HPFS), from which this cross sectional analysis was taken, was conducted to evaluate the risks of chronic diseases such as cardiovascular diseases and cancer in men.

Thank you again for sharing your ideas. Your note is completely justified!

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jane wrote:

April 22, 2010 11:13 AM

i just have a question, at what age is it likely to affect the performance of the man?

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April 22, 2010 10:19 PM

M. Jagesh Kamath, M.D.'s avatar

Sixty percent of men remain potent at 5th decade while 33% at 70 years.ED increases with age and may be related to atheroslerosis,medications,smoking,alcohol,diabetes,cholesterol and injuries.

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September 26, 2010 03:07 PM

M. Aroon Kamath, M.D.'s avatar

Dear Dr. Tamer,
Thank you for sharing this interesting study with us. There is at least one study which had observed a significant ethnic difference in the prevalence of restless legs syndrome especially in women. Non-African-American women (Caucasian) reportedly experienced restless legs syndrome (RLS) four times more often than their African-American counterparts [1]. In the article you have cited, of course, only a cohort of men were studied! However, it might be interesting to see the ethnic breakdown of the group studied.

References:
1. Wahid Rashidzada, MD, Syed I. Nabi, MD, Ammar Alkhazna, MD et al. Racial Differences in the Prevalence of Restless Legs Syndrome. Paper presented at American College of Chest Physicians CHEST conference 2009.

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September 26, 2010 04:17 PM

Tamer M. Fouad, M.D.'s avatar

A valid point Dr. Aroon, and one that could have easily been disclosed. Frankly I think it would have been more compelling than the link with erectile dysfunction. As I mentioned earlier in this discussion, the authors were out to confirm an earlier study which they published linking Parkinson’s disease to erectile dysfunction and suggesting a role for central dopaminergic hypofunction.

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