Periodic limb movements during sleep and blood pressure changes in sleep apnoea: Data from the European Sleep Apnoea Database.
cardiovascular disease
clinical epidemiology
obstructive sleep apnoea
sleep disorder
Journal
Respirology (Carlton, Vic.)
ISSN: 1440-1843
Titre abrégé: Respirology
Pays: Australia
ID NLM: 9616368
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
22
03
2019
revised:
25
10
2019
accepted:
19
11
2019
pubmed:
25
12
2019
medline:
25
6
2021
entrez:
25
12
2019
Statut:
ppublish
Résumé
OSA and PLMS are known to induce acute BP swings during sleep. Our current study aimed to address the independent effect of PLMS on BP in an unselected OSA patient cohort. This cross-sectional analysis included 1487 patients (1110 males, no previous hypertension diagnosis or treatment, mean age: 52.5 years, mean BMI: 30.5 kg/m The univariate analysis of SBP showed an increment of BP equal to 4.70 mm Hg (P < 0.001) in patients with significant PLMS compared to patients without significant PLMS. This increment remained significant after implementing a multivariate regression model (2.64 mm Hg, P = 0.044). No significant increment of BP was observed for DBP and PP. PLMS is associated with a rise in SBP regardless of AHI, independent of clinical and sociodemographic confounders. A PLMS phenotype may carry an increased risk for cardiovascular disease in OSA patients.
Sections du résumé
BACKGROUND AND OBJECTIVE
OSA and PLMS are known to induce acute BP swings during sleep. Our current study aimed to address the independent effect of PLMS on BP in an unselected OSA patient cohort.
METHODS
This cross-sectional analysis included 1487 patients (1110 males, no previous hypertension diagnosis or treatment, mean age: 52.5 years, mean BMI: 30.5 kg/m
RESULTS
The univariate analysis of SBP showed an increment of BP equal to 4.70 mm Hg (P < 0.001) in patients with significant PLMS compared to patients without significant PLMS. This increment remained significant after implementing a multivariate regression model (2.64 mm Hg, P = 0.044). No significant increment of BP was observed for DBP and PP.
CONCLUSION
PLMS is associated with a rise in SBP regardless of AHI, independent of clinical and sociodemographic confounders. A PLMS phenotype may carry an increased risk for cardiovascular disease in OSA patients.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
872-879Subventions
Organisme : European Sleep Research Society (ESRS)
Organisme : European Respiratory Society (ERS)
Organisme : European Union COST Action B26
Investigateurs
Anttalainen U
(A)
Barbé F
(B)
Bonsignore Mr
(B)
Basoglu Ok
(B)
Bielicki P
(B)
Dogas Z
(D)
Dorkova Z
(D)
Escourrou P
(E)
Fietze I
(F)
Grote L
(G)
Hedner J
(H)
Hein H
(H)
Joppa P
(J)
Kvamme Ja
(K)
Levy P
(L)
Lombardi C
(L)
Marrone O
(M)
Masa Jf
(M)
McNicholas Wt
(M)
Montserrat Jm
(M)
Parati G
(P)
Pataka A
(P)
Penzel T
(P)
Petiet E
(P)
Pépin Jl
(P)
Plywaczewski R
(P)
Pretl M
(P)
Riha Rl
(R)
Roisman G
(R)
Ryan S
(R)
Saaresranta T
(S)
Schiza S
(S)
Schulz R
(S)
Sliwinski P
(S)
Pepin Jl
(P)
Tasbakan Ms
(T)
Tkacova R
(T)
Staats R
(S)
Steiropoulos P
(S)
Varoneckas G
(V)
Verbraecken J
(V)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 Asian Pacific Society of Respirology.
Références
Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir. Med. 2015; 3: 310-8.
Lombardi C, Tobaldini E, Montano N, Losurdo A, Parati G. Obstructive sleep apnea syndrome (OSAS) and cardiovascular system. Med. Lav. 2017; 108: 276-82.
Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, Lévy P, Riha R, Bassetti C, Narkiewicz K et al.; EU COST Action B26 Members. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur. Respir. J. 2013; 41: 523-38.
Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, Levy P, Riha R, Bassetti C, Narkiewicz K et al.; European Respiratory Society; EU COST ACTION B26 Members. Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J. Hypertens. 2012; 30: 633-46.
American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd edn. Darien, IL, American Academy of Sleep Medicine, 2014.
Haba-Rubio J, Marti-Soler H, Marques-Vidal P, Tobback N, Andries D, Preisig M, Waeber G, Vollenweider P, Kutalik Z, Tafti M et al. Prevalence and determinants of periodic limb movements in the general population. Ann. Neurol. 2016; 79: 464-74.
Haba-Rubio J, Marti-Soler H, Tobback N, Andries D, Marques-Vidal P, Vollenweider P, Preisig M, Heinzer R. Clinical significance of periodic limb movements during sleep: the HypnoLaus study. Sleep Med. 2018; 41: 45-50.
Fulda S, Heinzer R, Haba-Rubio J. Characteristics and determinants of respiratory event-associated leg movements. Sleep 2018; 41: 1-11. https://doi.org/10.1093/sleep/zsx206.
Ferri R, Fulda S, Allen RP, Zucconi M, Bruni O, Chokroverty S, Ferini-Strambi L, Frauscher B, Garcia-Borreguero D, Hirshkowitz M et al.; International and European Restless Legs Syndrome Study Groups (IRLSSG and EURLSSG). World Association of Sleep Medicine (WASM) 2016 standards for recording and scoring leg movements in polysomnograms developed by a joint task force from the International and the European Restless Legs Syndrome Study Groups (IRLSSG and EURLSSG). Sleep Med. 2016; 26: 86-95.
Hedner J, Grote L, Bonsignore M, McNicholas W, Lavie P, Parati G, Sliwinski P, Barbé F, De Backer W, Escourrou P et al. The European Sleep Apnoea Database (ESADA): report from 22 European sleep laboratories. Eur. Respir. J. 2011; 38: 635-42.
Iber C, Ancoli-Israel S, Chesson AL Jr, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, 1st edn. Westchester, IL, American Academy of Sleep Medicine. 2007.
Hedner T, Narkiewicz K, Kjeldsen SE, Oparil S. New ESH/ESC guidelines signal progress in hypertension management. Blood Press. 2007; 16: 132-4.
Pennestri M-H, Montplaisir J, Fradette L, Lavigne G, Colombo R, Lanfranchi PA. Blood pressure changes associated with periodic leg movements during sleep in healthy subjects. Sleep Med. 2013; 14: 555-61.
Alessandria M, Provini F. Periodic limb movements during sleep: a new sleep-related cardiovascular risk factor? Front. Neurol. 2013; 4: 116.
Bara-Jimenez W, Aksu M, Graham B, Sato S, Hallett M. Periodic limb movements in sleep: state-dependent excitability of the spinal flexor reflex. Neurology 2000; 54: 1609-16.
Pennestri MH, Montplaisir J, Colombo R, Lavigne G, Lanfranchi PA. Nocturnal blood pressure changes in patients with restless legs syndrome. Neurology 2007; 68: 1213-8.
Sforza E, Juony C, Ibanez V. Time-dependent variation in cerebral and autonomic activity during periodic leg movements in sleep: implications for arousal mechanisms. Clin. Neurophysiol. 2002; 113: 883-91.
Montplaisir J, Boucher S, Gosselin A, Poirier G, Lavigne G. Persistence of repetitive EEG arousals (K-alpha complexes) in RLS patients treated with L-DOPA. Sleep 1996; 19: 196-9.
Karadeniz D, Ondze B, Besset A, Billiard M. EEG arousals and awakenings in relation with periodic leg movements during sleep. J. Sleep Res. 2000; 9: 273-7.
Pepin J-L, Borel A-L, Tamisier R, Baguet J-P, Levy P, Dauvilliers Y. Hypertension and sleep: overview of a tight relationship. Sleep Med. Rev. 2014; 18: 509-19.
Cassel W, Kesper K, Bauer A, Grieger F, Schollmayer E, Joeres L, Trenkwalder C. Significant association between systolic and diastolic blood pressure elevations and periodic limb movements in patients with idiopathic restless legs syndrome. Sleep Med. 2016; 17: 109-20.
Koo BB, Sillau S, Dean DA, Lutsey PL, Redline S. Periodic limb movements during sleep and prevalent hypertension in the multi-ethnic study of atherosclerosis novelty and significance. Hypertension 2015; 65: 70-7.
Koo BB, Blackwell T, Ancoli-Israel S, Stone KL, Stefanick ML, Redline S; for the Osteoporotic Fractures in Men (MrOS) Study Group. Association of incident cardiovascular disease with periodic limb movements during sleep in older men: outcomes of sleep disorders in older men (MrOS) study. Circulation 2011; 124: 1223-31.
Giannini G, Zanigni S, Melotti R, Gögele M, Provini F, Facheris MF, Cortelli P, Pramstaller PP. Association between restless legs syndrome and hypertension: a preliminary population-based study in South Tyrol, Italy. Eur. J. Neurol. 2014; 21: 72-8.
Zanigni S, Calandra-Buonaura G, Giannini G, Tonon C, Cortelli P, Provini F. The association between restless legs syndrome, cardiovascular and metabolic diseases: hypotheses and evidence from the literature. Arch. Ital. Biol. 2015; 153: 170-83.
Nannapaneni S, Ramar K. Periodic limb movements during sleep and their effect on the cardiovascular system: is there a final answer? Sleep Med. 2014; 15: 379-84.
Lindner A, Fornadi K, Lazar AS, Czira ME, Dunai A, Zoller R, Veber O, Szentkiralyi A, Kiss Z, Toronyi E et al. Periodic limb movements in sleep are associated with stroke and cardiovascular risk factors in patients with renal failure. J. Sleep Res. 2012; 21: 297-307.
Benz RL, Pressman MR, Hovick ET, Peterson DD. Potential novel predictors of mortality in end-stage renal disease patients with sleep disorders. Am. J. Kidney Dis. 2000; 35: 1052-60.
Xie J, Chahal CAA, Covassin N, Schulte PJ, Singh P, Srivali N, Somers VK, Caples SM. Periodic limb movements of sleep are associated with an increased prevalence of atrial fibrillation in patients with mild sleep-disordered breathing. Int. J. Cardiol. 2017; 241: 200-4.
Winkelman JW, Blackwell T, Stone K, Ancoli-Israel S, Redline S. Associations of incident cardiovascular events with restless legs syndrome and periodic leg movements of sleep in older men, for the outcomes of sleep disorders in older men study (MrOS Sleep Study). Sleep 2017; 40: 1-11. https://doi.org/10.1093/sleep/zsx023.
Kendzerska T, Kamra M, Murray BJ, Boulos MI. Incident cardiovascular events and death in individuals with restless legs syndrome or periodic limb movements in sleep: a systematic review. Sleep 2017; 40: 1-14. https://doi.org/10.1093/sleep/zsx013.
Manconi M, Fanfulla F, Ferri R, Miano S, Haba-Rubio J, Heinzer R, Horvath T, Proserpio P, Young P, Moschovitis G et al. Periodic limb movements during sleep in stroke/TIA: prevalence, course, and cardiovascular burden. Neurology 2018; 90: e1663-72.
Cuellar NG. The effects of periodic limb movements in sleep (PLMS) on cardiovascular disease. Heart Lung 2013; 42: 353-60.
Safar ME, Nilsson PM, Blacher J, Mimran A. Pulse pressure, arterial stiffness, and end-organ damage. Curr. Hypertens. Rep. 2012; 14: 339-44.
Al-Alawi A. Prevalence, risk factors and impact on daytime sleepiness and hypertension of periodic leg movements with arousals in patients with obstructive sleep apnea. J. Clin. Sleep Med. 2006; 2: 7.
Pépin JL, Bailly S, Tamisier R. Incorporating polysomnography into obstructive sleep apnoea phenotyping: moving towards personalised medicine for OSA. Thorax 2018; 73: 409-11.
Zinchuk AV, Jeon S, Koo BB, Yan X, Bravata DM, Qin L, Selim BJ, Strohl KP, Redeker NS, Concato J et al. Polysomnographic phenotypes and their cardiovascular implications in obstructive sleep apnoea. Thorax 2018; 73: 472-80.
Mokros Ł, Kuczyński W, Franczak Ł, Białasiewicz P. Morning diastolic blood pressure may be independently associated with severity of obstructive sleep apnea in non-hypertensive patients: a cross-sectional study. J. Clin. Sleep Med. 2017; 13: 905-10.
Crinion SJ, Ryan S, Kleinerova J, Kent BD, Gallagher J, Ledwidge M, McDonald K, McNicholas WT. Nondipping nocturnal blood pressure predicts sleep apnea in patients with hypertension. J. Clin. Sleep Med. 2019; 15: 957-63.
Hardy ST, Loehr LR, Butler KR, Chakladar S, Chang PP, Folsom AR, Heiss G, MacLehose RF, Matsushita K, Avery CL. Reducing the blood pressure-related burden of cardiovascular disease: impact of achievable improvements in blood pressure prevention and control. J. Am. Heart Assoc. 2015; 4: e002276.