Periodic limb movements during sleep and cardiac arrhythmia in older men (MrOS sleep)

Abstract

Study objectives: To determine if periodic limb movements during sleep (PLMS) are associated with nocturnal cardiac arrhythmia.

Methods: 2,793 community-dwelling older men underwent polysomnography with measurement of limb movements and EKG. Logistic regression assessed association of periodic limb movement index and periodic limb movement arousal index with arrhythmia including atrial fibrillation and non-sustained ventricular tachycardia detected by polysomnography. Models were adjusted for age, race, cardiovascular risk factors, and clinic site. Secondary analyses were subset to men without calcium channel/β-adrenergic medication usage, and stratified by congestive heart failure or myocardial infarction history.

Results: In the overall cohort, periodic limb movement index, and periodic limb movement arousal index were not associated with ventricular or atrial arrhythmia after considering potential confounders. In men not taking calcium channel/β-blocking medication, increased adjusted odds of non-sustained ventricular tachycardia were observed for periodic limb movement index (OR = 1.30 per SD increase; 95% CI 1.00, 1.68) and periodic limb movement arousal index (OR = 1.29 per SD increase; 95% CI 1.03, 1.62). In men with CHF or MI, there was a suggested association of atrial fibrillation with periodic limb movement index (OR = 1.29, 95% CI 0.96, 1.73 per SD increase; p = 0.09) or periodic limb movement arousal index (OR = 1.21, 95% CI 0.94, 1.57 per SD increase; p = 0.14), although results were not statistically significant.

Conclusions: There is not an association between PLMS and cardiac arrhythmia in all older men but in subsets of men, particularly those with structural heart disease and not on calcium channel or β-adrenergic medication, cardiac arrhythmia does associate with PLMS.

Keywords: PLMS; arrhythmia; cardiac; leg; periodic.

Figure 1. Non-sustained ventricular tachycardia outcome: interaction of PLMS and use of β-adrenergic or calcium channel blocking medication

In subjects not using β-adrenergic or calcium channel blocking medications, there was significantly increased odds of NSVT associated with PLMI (OR 1.30 per SD increase; 95% CI 1.00, 1.68) and PLMAI (OR 1.29 per SD increase; 95% CI 1.03, 1.62). Adjusted for clinic site, age, race, BMI, smoking, alcohol use, physical activity, AHI, prevalent hypertension, history of coronary heart disease, history of diabetes, history of congestive heart failure.*p-value < 0.05 NSVT, non-sustained ventricular tachycardia; OR, odds ratio; PLMAI, periodic limb movement arousal index; PLMI, periodic limb movement index; SD, standard deviation.

Figure 2. Atrial fibrillation outcome: interaction of PLMS and history of CHF or MI

For those subjects with structural heart disease, CHF or MI, there was a suggestion of an association with AF and PLMI (OR = 1.29, 95% CI 0.96, 1.73 per SD increase; p = 0.09) and PLMAI (OR = 1.21, 95% CI 0.94, 1.57 per SD increase; p = 0.14), although results did not reach statistical significance. Adjusted for clinic site, age, race, BMI, smoking, alcohol use, physical activity, AHI, prevalent hypertension, history of coronary heart disease, history of diabetes, and β-blocker or calcium channel blocker use. CHF, congestive heart failure; OR, odds ratio; MI, myocardial infarction; PLMAI, periodic limb movement arousal index; PLMI, periodic limb movement index.