Individual periodic limb movements with arousal are temporally associated with nonsustained ventricular tachycardia: a case-crossover analysis-Reference-Cited by-同舟云学术

Individual periodic limb movements with arousal are temporally associated with nonsustained ventricular tachycardia: a case-crossover analysis

Published:2019-07-17 Issue:11 Volume:42 Page:
ISSN:0161-8105
Container-title:Sleep
language:en
Short-container-title:

Author:

May Anna M¹^ORCID,May Ryan D²^ORCID,Bena James³,Wang Lu³,Monahan Ken⁴^ORCID,Stone Katie L⁵,Barrett-Connor Elizabeth⁶,Koo Brian B⁷,Winkelman John W⁸,Redline Susan⁹¹⁰,Mittleman Murray A⁹,Mehra Reena¹¹,Stone K L,Bauer D C,Cummings S R,Goldschlager N,Varosy P,Yaffe K,Cawthon P M,Fullman R,Benard R,Blackwell T,Concepcion L,Diehl J,Ewing S,Fox C,Jaime-Chavez M,Kwan E,Litwack S,Liu W,Lui L Y,Schneider J,Scott R,Tanaka D,Ziarno J,Orwoll E,Phipps K,Marshall L,Babich Blank J,Lambert L,Chan B,Neevel D,Lewis C E,Shikany J,Johnson P,Oden C,House S,Webb N,Hardy K,Felder S,Wilkoff J,King J,Johnsey T,Young M,Smith J,Sassaman C,Collier C,Atkins C,Ensrud K,Fink H,King D,Michaels N,Nelson N,Bird C,Blanks D,Imker-Witte F,Moen K,Paudel M,Slindee M,Stefanick M,Hoffman A,Kent K,Malig B,Wong S,Cauley J,Zmuda J,Danielson M,Harper L,Buck L,Nasim M,Cusick D,Gorecki M,Watson N,Bashada C,Newman C,Barrett-Connor E,Ancoli-Israel S,Dam T,Carrion-Petersen M L,Miller P,Kamantigue N,Redline S,Surovec S,Scott N,Rueschman M,Johnson N,Arnold J,Nawabit R,Romaniuk J,Seicean S,

Affiliation:

1. Sleep Medicine Section, Louis Stokes Cleveland VA Medical Center, Cleveland, OH

2. Department of Engineering, Case Western Reserve University, Cleveland, OH

3. Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH

4. Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN

5. California Pacific Medical Center Research Institute, San Francisco, CA

6. University of California, San Diego, San Diego, CA

7. Department of Neurology, Yale School of Medicine, New Haven, CT

8. Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA

9. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

10. Department of medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

11. Sleep Center, Neurologic Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

Abstract

AbstractStudy ObjectivesBoth periodic limb movements during sleep (PLMS) and arousals are associated with sympathetic nervous system activation and may be arrhythmogenic. We hypothesize a temporal relationship exists between individual PLMS, particularly with arousal, and nonsustained ventricular tachycardia (NSVT) events.MethodsA bidirectional time-stratified case-crossover design was used to assess temporal associations between PLMS and NSVT during sleep in 49 Osteoporotic Fractures in Men Sleep Study participants with NSVT in a community-based cohort (n = 2,911). Sleep time was divided into approximate 30-min segments. For each NSVT (n = 141), we selected a preceding 30-s hazard period and three randomly chosen 30-s control periods from sleep within the same segment and evaluated for PLMS, respiratory events, minimum saturation, and arousals. Odds ratios and 95% confidence intervals—OR (95% CI)—were determined by conditional logistic regression; covariates included EEG arousals, minimum saturation, and respiratory events in the same hazard/control period.ResultsParticipants with NSVT were 79.5 ± 6.2 years with a PLMS index of 32.1 (IQR: 10.1, 61.4) and apnea–hypopnea index of 17.1 (IQR: 9.4, 26.1). PLMS without arousal were not significantly associated with NSVT (OR = 0.80, 95% CI: 0.41–1.59). PLMS with arousal were associated with NSVT in unadjusted analyses (OR = 2.50, 95% CI: 1.11–5.65) and after adjustment (OR = 2.31, 95% CI: 1.02–5.25). Arousals associated with PLMS were associated with NSVT in unadjusted (OR = 2.84, 95% CI: 1.23–6.56) and adjusted analyses (OR = 2.61, 95% CI: 1.13–6.05).ConclusionsPLMS with (but not without) arousals are temporally associated with a greater than twofold higher odds of subsequent NSVT episodes. PLMS-related arousals may be physiologically important ventricular arrhythmia triggers.Clinical Trial RegistrationClinicalTrials.gov, NCT00070681.

Funder

National Institutes of Health

National Institute on Aging

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Center for Advancing Translational Sciences

NIH Roadmap for Medical Research

National Heart, Lung, and Blood Institute

Sleep Medicine Neurobiology and Epidemiology

ASPIRE

Publisher

Oxford University Press (OUP)

Subject