Cerebrovascular Accident Risk in a Population with Periodic Limb Movements of Sleep: A Preliminary Meta-Analysis

Abstract

Background and Purpose: Periodic limb movements of sleep (PLMS) are usually comorbid with hypertension, tachycardia, and coronary arterial diseases, which are also risk factors for cerebrovascular accidents (CVA). However, evidence about the relationship between CVA and PLMS is still weak. The aim of this study was to investigate (1) the prevalence of CVA in patients with PLMS, and (2) the severity of PLMS in patients with or without CVA through a meta-analysis. Methods: The electronic databases of PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov were searched. The inclusion criteria were (1) articles investigating comorbidity between PLMS and CVA, and (2) clinical trials in humans. Results: This meta-analysis included (1) 9,823 patients with PLMS and 9,416 controls from 5 studies to analyze the prevalence of CVA in PLMS, and (2) 158 patients with PLMS with CVA and 88 PLMS controls without CVA from 3 studies to analyze the severity of PLMS with and without CVA. The results showed (1) significantly higher comorbidity rates of CVA in the patients with PLMS than in the controls without PLMS (OR 1.267, p = 0.019), and (2) higher PLM index in the patients with CVA than in the controls (Hedges’ g = 0.860, p = 0.001; means difference: 4.435, p = 0.016). Conclusions: The results revealed (1) a worse severity of PLMS in the patients with CVA, and (2) increased prevalence of CVA in the patients with PLMS. Based on our results, the patients had a higher prevalence of CVA within 8 years of a diagnosis of PLMS compared to those without PLMS by about 1.3-fold. Whether (1) patients with PLMS receiving treatment have a similar incidence of stroke to those without PLMS, and (2) secondary stroke prevention can lower the severity of PLMS or whether those with severe PLMS have a higher risk of stroke is still inconclusive. Future studies investigating the prevalence of CVA in patients with PLMS should use a follow-up period of over 8 years.

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

“…Systematic reviews: Two systematic reviews on RLS including 18 studies and eight studies, respectively, were considered [101,102]. For PLMS there is a recent systematic review that included five studies [103]. The original studies included in the systematic review were of class II and III quality.…”

“…Systematic reviews: A recent systematic review of three studies on PLMS was included [103]. The original studies included in the systematic review were of class II and III quality.…”

“…The meta-analysis evaluated 158 PLMS patients with stroke and 88 PLMS patients without stroke from three studies [103]: a higher PLMI was found in stroke patients (Hedges'g=0.860, mean difference: 4.43) (table e20).…”

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

“…Overview of the evidence. The meta-analysis evaluated 158 PLMS patients with stroke and 88 PLMS patients without stroke from three studies [103]: a higher PLMI was found in stroke patients (Hedges' g = 0.860, mean difference 4.43) (Table S20).…”

Sleep problems worsen health-related quality of life and participation during the first 12 months of stroke rehabilitation

“…[1][2][3] Sleep impairment and poor sleep, in addition to being secondary symptoms of diseases such as stroke, can result from diagnosable (and treatable) sleep disorders such as obstructive sleep apnea, insomnia disorder, and restless legs syndrome. The strokesleep literature has focused primarily on obstructive sleep apnea, known to be both a risk factor and consequence of stroke, [4][5][6][7][8][9][10] and to negatively impact functional outcomes after stroke. 11,12 Insomnia is also problematic in persons with stroke, according to a recent meta-analysis that found insomnia diagnoses and insomnia symptoms are more prevalent in persons following stroke than in the general population.…”