Longitudinal relationships of periodic limb movements during sleep and incident atrial fibrillation |
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| Affiliation: | 1. Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA;2. California Pacific Medical Center Research Institute, San Francisco, CA, USA;3. Electrophysiology Section, University of Colorado Anschutz Medical Campus, Denver, CO, USA;4. VA Eastern Colorado Health Care System, Denver, CO, USA;5. Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver, CO, USA;6. Division of Sleep Medicine, Brigham and Women''s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;7. Department of Neurology, Yale School of Medicine, New Haven, CT, USA;8. Neurologic Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA;1. Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea;2. Department of Neurology, Dankook University College of Medicine, Dankook University Hospital, Cheonan, Republic of Korea;1. Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain;2. CIBERNED, Barcelona, Spain;1. Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea;2. Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea;3. Department of Biomedical Engineering, Keimyung University School of Medicine, Daegu, Republic of Korea;4. Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA |
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| Abstract: | ObjectivesThis study aimed to examine relationship between periodic limb movements during sleep (PLMS) and incident atrial fibrillation/flutter (AF).MethodsProspective multicenter cohort (n = 2273: adjudicated AF group; n = 843: self-reported AF group) of community-dwelling men without prevalent AF were followed for an average of 8.3 years (adjudicated) and 6.5 years (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 by Cox proportional hazards and logistic regression, respectively, and adjusted for age, clinic, race, body mass index (BMI), alcohol use, cholesterol level, cardiac medications, pacemaker, apnea–hypopnea index, renal function, and cardiac risk. The interaction of age and PLMS was examined.ResultsIn 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 years, the highest PLMI tertile was at increased risk of adjudicated AF (≥30 vs. <5; hazard ratio (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 such associations were found in men aged <76 years.ConclusionsAlthough PLMS do not predict AF incidence in the overall cohort, the findings suggest PLMS increases incident AF risk in the older subgroup. |
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