Frequent Periodic Leg Movement During Sleep Is an Unrecognized Risk Factor for Progression of Atrial Fibrillation

Abstract

Sleep apnea has been recognized as a factor predisposing to atrial fibrillation recurrence and progression. The effect of other sleep-disturbing conditions on atrial fibrillation progression is not known. We sought to determine whether frequent periodic leg movement during sleep is a risk factor for progression of atrial fibrillation. In this retrospective study, patients with atrial fibrillation and a clinical suspicion of restless legs syndrome who were referred for polysomnography were divided into two groups based on severity of periodic leg movement during sleep: frequent (periodic movement index >35/h) and infrequent (≤35/h). Progression of atrial fibrillation to persistent or permanent forms between the two groups was compared using Wilcoxon rank-sum test, chi-square tests and logistic regression analysis. Of 373 patients with atrial fibrillation (77% paroxysmal, 23% persistent), 108 (29%) progressed to persistent or permanent atrial fibrillation during follow-up (median, 33 months; interquartile range, 16-50). Compared to patients with infrequent periodic leg movement during sleep (n=168), patients with frequent periodic leg movement during sleep (n=205) had a higher rate of atrial fibrillation progression (23% vs. 34%; p=0.01). Patients with frequent periodic leg movement during sleep were older and predominantly male; however, there were no significant differences at baseline in clinical factors that promote atrial fibrillation progression between both groups. On multivariate analysis, independent predictors of atrial fibrillation progression were persistent atrial fibrillation at baseline, female gender, hypertension and frequent periodic leg movement during sleep. In patients with frequent periodic leg movement during sleep, dopaminergic therapy for control of leg movements in patients with restless legs syndrome reduced risk of atrial fibrillation progression. Frequent leg movement during sleep in patients with restless legs syndrome is associated with progression of atrial fibrillation to persistent and permanent forms.

Selective downregulation of mitochondrial electron transport chain activity and increased oxidative stress in human atrial fibrillation

“…Fibers were mechanically separated along the longitudinal axis and permeabilized with saponin (30 -50 g/ml) for 30 min at 4°C. After permeabilization, myofibers were washed in ice-cold buffer containing (in mM) 110 K-MES (pH 7.4), 35 KCl, 1 EGTA, 5 KH2PO4, and 3 MgCl2·6H2O, and 0.02 blebbistatin with 5 mg/ml BSA and remained in the buffer until analysis at 4°C.…”

“…The incidence and prevalence of AF increase with advancing age and aging-associated diseases such as hypertension, ischemic heart disease, and heart failure (2, 40) and contribute to increased morbidity, particularly an increased risk for stroke, heart failure, and death (25,52). Although the pathophysiology of AF has been well characterized, the underlying mechanisms that contribute to the progression of AF in human atria have not been fully defined (33,35,57,58,60). Mitochondria, occupying 30% of cardiomyocyte volume, are critical for maintaining normal energetics of the heart, a highly aerobic organ dependent on oxidative phosphorylation (OXPHOS) for maintenance of its normal electrical and mechanical function (1, 61).…”

Cardiovascular comorbidity in patients with restless legs syndrome: current perspectives

“…However, the mean apnea/hypopnea index (AHI) was similar between the two groups. 51 In a cross-sectional study of 2,793 community-dwelling older men, Koo et al found no significant associations between PLMI and PLM arousal index with ventricular or atrial arrhythmias (after adjusting for potential confounders). 50 In summary, there are limited data between the association of PLMS and arrhythmias.…”

“…50,51 Sleep disruption due to other sleep disorders has been associated with increased prevalence of arrhythmias, including sleep apnea and insomnia. 52,53 This review presents the evidence concerning RLS/PLMS and heart arrhythmias.…”

“…Mirza et al 51 retrospectively analyzed 373 patients with atrial fibrillation (AF) and clinically suspected RLS. They aimed to evaluate whether PLMS is a risk factor for the progression of AF.…”