Periodic limb movements in sleep are associated with stroke and cardiovascular risk factors in patients with renal failure

Abstract

SUMMARYPeriodic limb movements in sleep (PLMS) is prevalent among dialysed patients and is associated with increased risk of mortality. Our study aimed to determine the prevalence of this disease in a sample of transplanted and waiting-list haemodialysed patients. One hundred transplanted and 50 waiting-list patients underwent polysomnography. Moderate and severe diseases were defined as periodic limb movements in sleep index (PLMSI) higher than 15 and 25 events h )1 , respectively. The 10-year coronary heart disease risk was estimated for all patients using the Framingham Score. Moreover, the 10-year estimated risk of stroke was calculated according to the modified version of the Framingham Stroke Risk Profile. PLMS was present in 27% of the transplanted and 42% of the waiting-list group (P = 0.094); the proportion of severe disease was twice as high in waitinglist versus transplanted patients (32 versus 16%, P = 0.024). Patients with severe disease had a higher 10-year estimated risk of stroke in the transplanted group [10 (7-17) versus 5 (4-10); P = 0.002] and a higher 10-year coronary heart disease risk in both the transplanted [18 (8-22) versus 7 (4-14); P = 0.002], and the waiting-list groups [11 (5-18) versus 4 (1-9); P = 0.032]. In multivariable linear regression models the PLMSI was associated independently with the Framingham cardiovascular and cerebrovascular scores after adjusting for important covariables. Higher PLMSI is an independent predictor of higher cardiovascular and cerebrovascular risk score in patients with chronic kidney disease. Severe PLMS is less frequent in kidney transplant recipients compared to waiting-list dialysis patients.

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

“…A higher prevalence of CVD has been shown in patients with PLMS in recent reviews [1,2,6]. However, current studies on the incidence of CVA between patients with and without PLMS have reported inconsistent results [7][8][9].…”

“…Table 2). Therefore, 8 articles were eligible for the current meta-analysis (Table 1) [7][8][9][29][30][31][32][33].…”

Cardiovascular comorbidity in patients with restless legs syndrome: current perspectives

“…111 Besides RLS, PLMS is also claimed to increase the risk of CVD in renal patients. In a study of kidney-transplanted patients and waiting-list subjects, Lindner et al 112 found that subjects with severe PLMS in either group, defined as PLMI >25/h, showed increased 10-year risk of coronary heart disease (by Framingham Score) compared with less severe PLMI (transplanted patients 18% vs 7%, P=0.002; waiting-list subjects 10% vs 4%, P=0.032). In the transplant group, severe PLMS also showed an increased 10-year risk of stroke (P=0.002).…”

“…The cross-sectional design of this study precludes any directional or causal conclusions. 112 In another single hemodialysis center study, ESRD with PLMS (defined as PLMI ≥15/h) showed an increased risk of cardiovascular events (P=0.010) and mortality (P=0.008). Interestingly, the AHI and the oxygen desaturation index were not associated with mortality in this study, but the sample was small.…”

Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome

“…The reduction in total sleep time caused by the syndrome and the association with the PLMs may suggest that an increase in sympathetic activity and even increased insulin resistance may occur in the long term. However, RLS is also more frequent in patients with renal, hepatic, neurological and reumatic diseases 36,37 , and may even increase cardiovascular risk in these patients 38,39 .…”