Frequency of and Factors Associated With Obstructive Sleep Apnea and Periodic Limb Movements in Stroke and TIA Patients

Gadodia, Gaurav; Rangaraju, Srikant; Raza, Syed Ali; Razzak, Ammar; Marmarchi, Labib; Davis, Brittaine; Henríquez, Laura; Trotti, Lynn Marie; Rye, David B.; Nahab, Fadi

doi:10.1097/nrl.0000000000000180

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…As formerly reported in the literature, the vast majority of patients with acute stroke and PLMS in our cohort were men [36,38]. Furthermore, no significant difference was documented regarding the rate of PLMS between AIS and ICH (77% and 71%, respectively).…”

Section: Discussionsupporting

confidence: 66%

“…PLMS prevalence among our acute stroke patients was more than twice as high as the one estimated in a recent meta-analysis, which included ten previous studies (76% versus 32%, respectively) [8,[32][33][34][35][36][37][38][39][40]. Moreover, only three of the aforementioned studies evaluated patients during the acute phase of stroke using a PLMSI ≥ 10 or PLMSI ≥ 15 as a cut-off point [33,35,38].…”

Section: Discussionmentioning

confidence: 69%

“…Based on the results of a prospective study and a meta-analysis, increasing age, hypertension, AHI and BMI were significantly associated with the likelihood of detecting PLMS in patients with acute stroke [9,38]. On the other hand, the same parameters did not emerge as predictors of PLMS according to the results of three other observational studies [33,34,36]. In our study population, none of the baseline characteristics, including the aforementioned factors, except for the presence of SDB, was independently associated with higher odds of PLMS.…”

Section: Discussionmentioning

confidence: 99%

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Periodic Limb Movements during Sleep in Acute Stroke: Prevalence, Severity and Impact on Post-Stroke Recovery

Plomaritis,

Theodorou,

Michalaki

et al. 2023

JCM

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Background: Periodic Limb Movements during Sleep (PLMS) have been described to be frequently present in stroke patients. We aimed to evaluate the prevalence and severity of PLMS in acute stroke patients and clarify the association between PLMS and coexisting Sleep Disordered Breathing (SDB). Additionally, we focused on identifying variables that could independently predict the presence of PLMS in patients with acute stroke. The potential impact of PLMS on stroke outcome at three months was investigated as well. Methods: In this study, we performed overnight polysomnography on consecutive stroke patients within 72 h from symptom onset. Data regarding clinical and imaging characteristics were prospectively collected. National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Epworth-Sleepiness Scale (ESS) were used to evaluate stroke severity on admission, stroke outcome at three months and history of daytime sleepiness, respectively. We documented PLMS and SDB using standard polysomnography criteria. Results: We prospectively assessed 126 patients with acute stroke [109 with ischemic and 17 with hemorrhagic stroke, mean age 60 ± 11 years, 68% men, median NIHSS score on admission: 3 (IQR: 2–7)]. The overall rate of PLMS in our cohort was 76%, and the rate of SDB among patients with PLMS was 83%. PLMS detection rates differed significantly (p-value: <0.001) according to SDB, with PLMS prevalence increasing with greater SDB severity. SDB could independently (OR:4.869, 95% CI: 1.884–12.784, p-value: 0.001) predict the presence of PLMS in the acute stroke phase in multivariable analyses adjusting for potential confounders. Moreover, baseline stroke severity (NIHSS-score increase in per-1 point: OR: 0.819, 95% CI: 0.737–0.895, p-value < 0.001) and PLMS (OR:0.099, 95% CI: 0.009–0.482, p-value = 0.015) were significantly associated with the likelihood of excellent functional outcome (mRS-scores: 0–1) at 3 months. Conclusion: The common presence of mostly severe PLMS in patients with acute stroke and their negative effect on stroke outcomes point out the necessity for early PLMS detection and treatment.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Periodic Limb Movements during Sleep in Acute Stroke: Prevalence, Severity and Impact on Post-Stroke Recovery

Plomaritis,

Theodorou,

Michalaki

et al. 2023

JCM

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“…However, further information on the pathophysiology of a worse PLMS severity in stroke patients is still controversial. To date, the proposed theories have been indirect deductions, for example, a high prevalence of hypertension in stroke patients [36]; or animal models, for example, central dopamine system dysfunction [37]. Further studies on the pathophysiology of a worse PLMS in stroke patients are warranted.…”

Section: Discussionmentioning

confidence: 99%

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

Lin

Zeng

Chen³

et al. 2018

Cerebrovasc Dis

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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.

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Lack of Association between Periodic Limb Movements during Sleep and Neuroimaging Signatures of Cerebral Small Vessel Disease in Stroke-Free Community-Dwelling Older Adults. The Atahualpa Project

Brutto

Mera

Brutto

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Frequency of and Factors Associated With Obstructive Sleep Apnea and Periodic Limb Movements in Stroke and TIA Patients

Abstract: A significant number of stroke and TIA patients who underwent PSG have PLMs and moderate-severe OSA. Stroke and TIA patients with atrial fibrillation are more likely to have moderate-severe OSA and may benefit from PSG evaluation.

Cited by 3 publications

References 25 publications

Periodic Limb Movements during Sleep in Acute Stroke: Prevalence, Severity and Impact on Post-Stroke Recovery

Periodic Limb Movements during Sleep in Acute Stroke: Prevalence, Severity and Impact on Post-Stroke Recovery

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

Lack of Association between Periodic Limb Movements during Sleep and Neuroimaging Signatures of Cerebral Small Vessel Disease in Stroke-Free Community-Dwelling Older Adults. The Atahualpa Project

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