Association between cerebral small vessel disease and periodic limb movements of sleep in patients with stroke/TIA

Abstract

Study objectives: Periodic limb movements (PLMs) of sleep, which may be linked to increased vascular events via nighttime sympathetic overactivity, have shown associations with cerebral small vessel disease (CSVD) in small studies. This study examined the relationship between PLMs and CSVD in a larger cohort, accounting for comorbidities.

Methods: Patients with first-ever stroke or transient ischemic attack (TIA) were retrospectively analyzed. Polysomnography assessed the PLM index (PLMI) and PLM arousal index (PLMAI). CSVD was measured using radiographic markers, including the Fazekas score, total age-related white matter changes (ARWMC) score, microbleed counts, and lacunar infarcts. Multivariable regression models analyzed the association between an elevated PLMI and PLMAI with CSVD markers.

Results: This study included 86 patients (mean age 62.2 ± 14.3 years, 66.3% male, mean BMI 28.1 ± 5.7), 36 with a PLMI ≥ 5 (41.9%) and 11 with a PLMAI ≥ 5 (12.8%). Regression analyses showed that PLMI ≥ 5 and PLMAI ≥ 5 both predicted increased Fazekas and ARWMC total scores after adjusting for age, sex, BMI, and other comorbidities. Sensitivity analyses using age- and sex-specific PLMI cutoffs also showed that a PLMI exceeding the upper limit of normal predicted an increased Fazekas score and approached significance for the ARWMC score. PLMI was not significantly associated with cerebral microbleeds or lacunar infarcts.

Conclusions: In patients with first-ever minor stroke and TIA, a significant association was observed between PLMI and PLMAI with white matter hyperintensities (WMHs) after adjusting for confounders. Future studies may help determine the directionality of this association and whether PLMs independently predict CSVD.

Clinical trial information: Name: Sleep Disorders Managed and Assessed Rapidly in Transient Ischemic Attack (TIA) and In Early Stroke (SMARTIES). URL: https://clinicaltrials.gov/study/NCT01528462 ClinicalTrials.gov ID: NCT01528462. Name: SLEep APnea Screening Using Mobile Ambulatory Recorders After TIA/Stroke (SLEAP SMART). URL: https://clinicaltrials.gov/study/NCT02454023. ClinicalTrials.gov ID: NCT02454023.

Keywords: Fazekas scale; age-related white matter changes; cerebral small vessel disease; periodic limb movements; stroke; transient ischemic attack; white matter hyperintensities.