Longitudinal relationships of periodic limb movements during sleep and incident atrial fibrillation

Abstract

Objectives Examine relationships of periodic limb movements during sleep (PLMS) and incident atrial fibrillation/flutter (AF). Methods Prospective multicenter cohort (n=2,273: adjudicated AF group, n=843: self-reported AF group) of community-dwelling men without prevalent AF were followed an average of 8.3yr (adjudicated) and 6.5yr (self-reported). PLMS index (PLMI, <5 (ref), ≥5 to <30, ≥30) and PLM arousal index (PLMAI, <1 (ref), ≥1 to <5, ≥5) were measured by polysomnography. Incident adjudicated and self-reported AF were analyzed via Cox proportional hazards or logistic regression, respectively, and adjusted for age, clinic, race, body mass index, alcohol use, cholesterol level, cardiac medications, pacemaker, apnea-hypopnea index, renal function, and cardiac risk. The interaction of age and PLMS was examined. Results In this primarily Caucasian (89.8%) cohort of older men (mean age 76.1±5.5 years) with BMI of 27.2±3.7, there were 261 cases (11.5%) of adjudicated and 85 cases (10.1%) of self-reported incident AF. In the overall cohort, PLMI and PLMAI were not associated with adjudicated or self-reported AF. There was some evidence of an interaction of age and PLMI (p=0.08, adjudicated AF) and PLMAI (p≤0.06, both outcomes). Among men aged≥76, the highest PLMI tertile was at increased risk of adjudicated AF (≥30 vs. <5; HR=1.63, 1.01-2.63) and the middle PLMAI tertile predicted increased risk of both outcomes (1 to <5 vs. <1; adjudicated, HR=1.65, 1.05-2.58; self-reported HR=5.76, 1.76-18.84). No associations were found in men<76. Conclusions Although PLMS do not predict AF incidence in the overall cohort, findings suggest PLMS increases incident AF risk in the older subgroup.

Periodic limb movements during sleep are associated with cardiovascular diseases: A systematic review and meta‐analysis

“…In our previous report, PLMS contributed to the basal sympathetic tone independent of the presence of functional impairments in the daytime (Wu et al, ). Autonomic nervous system dysfunction related to PLMS has also been observed by other trials (Dean et al, ; May et al, ). Therefore, in the current study, we intended to demonstrate the “differences in heart disease risk” between subjects with defined “High PLMI” (named as PLMS in the included studies) and subjects with defined “Low PLMI” (named as no PLMS).…”

“…Fourth, although the rationale of the current study was to compare the differences in heart disease risk in subjects with high or low PLMI, the subgroups of PLMS and no PLMS among the recruited studies ranged widely. Some studies used cut‐off points as low as 5 (May et al, ), and some used cut‐offs as high as 35 (Mirza et al, ). This heterogeneity could contribute bias to the clinical implications of our study.…”

Sleep Disturbances as a Risk Factor for Stroke

“…Repeated nocturnal fluctuations in heart rate and blood pressure that are associated with PLM and related microarousals cause daytime hypertension, subsequently increasing the risk for cerebrovascular diseases [ 227 , 228 ]. In a prospective study of 3,116 elderly men, PLM increased atrial fibrillation risk in age-dependent manner [ 239 ].…”

Cardiac Involvement in Movement Disorders

“…98 In addition, as PLMS is present in more than 80% of patients with RLS, a high frequency of leg movements (usually hundreds per night) can cause repetitive sympathetic activation, increasing HRV, resulting in hypertension and left ventricular hypertrophy. 88,97,[99][100][101][102] Lastly, comorbidities associated with RLS/PLMS, such as renal failure, diabetes mellitus, iron deficiency, and insomnia or sleep fragmentation may predispose patients to heart disease. 96,103 Randomized interventional studies specifically targeting treatment of PLMS and evaluating the effect on cardiovascular disease morbidity and mortality are required.…”