Frequent Periodic Leg Movement during Sleep Is Associated with Left Ventricular Hypertrophy and Adverse Cardiovascular Outcomes

Abstract

Background Sleep disturbance caused by obstructive sleep apnea is recognized as a contributing factor to adverse cardiovascular outcomes. However, the effect of restless legs syndrome (RLS), another common cause of fragmented sleep, on cardiac structure, function and long-term outcomes is not known. We assessed the effect of frequent leg movement during sleep on cardiac structure and outcomes in patients with RLS. Methods In our retrospective study, RLS patients referred for polysomnography were divided into those with frequent (periodic movement index >35/hour) and infrequent (≤35/hour) leg movement during sleep. Long-term outcomes were determined using Kaplan-Meier and logistic regression models. Results Of 584 patients, 47% had periodic movement index >35/hour. Despite similarly preserved left ventricular ejection fraction, the group with periodic movement index >35/hour had significantly higher left ventricular mass and mass index reflective of left ventricular hypertrophy (LVH). There were no significant baseline differences in the proportion of patients with hypertension, diabetes, hyperlipidemia, prior myocardial infarction, stroke or heart failure or use of antihypertensive medications between the groups. Patients with frequent periodic movement index were older, predominantly male and had more prevalent coronary artery disease and atrial fibrillation. However, on multivariate analysis, periodic movement index >35/hour remained the strongest predictor for LVH (odds ratio 2.45, 95% confidence interval 1.67–3.59, P<0.001). Advanced age, female sex and apnea-hypopnea index were other predictors for LVH. Patients with periodic movement index >35/hour had significantly higher heart failure and mortality rates over 33-month median follow-up. Conclusions Frequent periodic leg movement during sleep is an independent predictor of severe LVH and associated with increased cardiovascular morbidity and mortality.

Restless legs syndrome does not affect 3-year mortality in hemodialysis patients

“…PLMS severity was reported to be associated with high mortality in patients with end-stage renal disease [44]. In addition, our group has reported that HD patients with severe PLMS were found to exhibit significant alternations in cardiac structure [45], which has been also confirmed in patients with idiopathic RLS [46]. Interestingly, in this previous study [45], the severity of RLS, in contrast to the severity of PLMS, was not related to structural cardiac abnormalities.…”

Cardiovascular comorbidity in patients with restless legs syndrome: current perspectives

“…6,23,96,97 However, a large study did not find association with RLS and mortality, 98 and some studies showed increased mortality in females but not in males. 99,100 Studies of mortality and RLS/ PLMS have been limited by a small number of patients, epidemiological/cross-sectional designs, short follow-up period, and different definitions to classify RLS/PLMS patients.…”

“…The ejection fraction (EF) was not different between the groups. 6 A study of 23 men with severe, stable CHF (all with EF <35%) and 9 healthy controls found that 52% of CHF patients have a PLMI >25/h. Of those, one-third had a PLMI >50/h, compared with control …”

Cardiovascular Disease and Sleep

“…There is no abnormal sensation in the extremities, unless PLMS is complicated by RLS. High-frequency PLM may be associated with left ventricular hypertrophy and incident HF 31) , through an increase in SNA in association with PLMS-related arousals.…”