Clinical InvestigationSleep Disordered BreathingFrequent Periodic Leg Movement during Sleep Is Associated with Left Ventricular Hypertrophy and Adverse Cardiovascular Outcomes
Section snippets
Patient Population
All patients with indications for polysomnography because of sleep disorders and clinical suspicion of RLS4, 7 as assessed from their medical records (International Classification of Diseases, Ninth Revision, code 333.94) between January 2000 and August 2007 were included in the study. Because clinical diagnosis of RLS requires strict criteria and cannot be assessed from a retrospective review of medical records, the study focused on objective documentation of the severity of periodic leg
Patient Population
Of 584 patients with RLS referred for polysomnography who also had baseline echocardiograms, 274 (47%) had periodic movement index >35/hour. Table 1 summarizes baseline characteristics of the study population. No significant differences were present between the groups in the proportions of patients with prior diagnoses of hypertension, use of antihypertensive medications, diabetes mellitus, hyperlipidemia, prior myocardial infarctions, heart failure, stroke, and abnormal LV ejection fractions
Discussion
The main finding of our study is the recognition that frequent PLMS in patients with RLS referred for overnight polysomnography is an independent risk factor for the presence and severity of LVH and is associated with increased incidence of heart failure and mortality independent of other risk factors for cardiovascular disease.
RLS is one of the most common neurologic conditions,5 which increases with advancing age and is diagnosed clinically on the basis of four essential criteria as outlined
Conclusions
Frequent PLMS in patients with RLS referred for overnight polysomnography identifies those at risk for LVH, and recognizing that periodic movement index >35/hour provides incremental prognostic information to established risk factors makes it a promising risk marker for cardiovascular events in patients with RLS. Because RLS is a common clinical disorder that affects millions of Americans, insights into clinical factors and mechanisms that promote the substrates (such as LVH)22, 23, 24, 25, 26
Acknowledgments
We gratefully acknowledge the editorial assistance of Joe Grundle and Katie Klein and the figure preparation of Brian Miller and Brian Schurrer, all of Aurora Cardiovascular Services.
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Periodic Leg Movements During Sleep
2021, Sleep Medicine ClinicsModerate to severe but not mild RLS is associated with greater sleep-related sympathetic autonomic activation than healthy adults without RLS
2020, Sleep MedicineCitation Excerpt :Note that the sleep arousal processes as defined here are not limited to those events with cortical electroencephalogram (EEG) changes but include neurophysiological arousal events producing any of these three markers. These arousal events fragment sleep and, when unusually frequent, have been associated with increased risk of adverse health events [3–8]. The long-term health consequences of fragmented sleep have been considered to result from multiple metabolic effects of disrupting sleep processes [9], including abnormally frequent arousals producing sympathetic activation with transitory but relatively large increases in heart rate and blood pressure [10,11].
Effect of Adaptive Servo-Ventilation on Periodic Limb Movements in Sleep in Patients With Heart Failure
2019, American Journal of CardiologyCitation Excerpt :First, HF patients with CSA manifest more frequent PLMS compared with CSA patients without co-morbid HF; and second, PLMS increase significantly during treatment of CSA by ASV. Since PLMS are associated with adverse cardiovascular prognosis,4,5,22 the impact of post-ASV PLMS on cardiovascular risk warrants further investigation. Although only patients with CSA were assessed for the purpose of the study, our results are in line with previous reports showing prevalent PLMS in HF.23
Drs. Jahangir and Mirza's research effort was supported in part by grants R01 HL101240 and R01 HL089542 from the National Heart, Lung, and Blood Institute (Bethesda, MD).