Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Circulation. 2011 Sep 13;124(11):1223-31. doi: 10.1161/CIRCULATIONAHA.111.038968. Epub 2011 Aug 22.
Periodic limb movements during sleep (PLMS) cause repetitive sympathetic activation and may be associated with increased cardiovascular risk. We hypothesized that PLMS frequency (periodic limb movement index [PLMI]) and PLMS arousal frequency (periodic limb movement arousal index [PLMAI]) are predictive of incident cardiovascular disease, including coronary heart disease, peripheral arterial disease, and cerebrovascular disease, in an elderly male cohort.
A total of 2911 men in the observational Outcomes of Sleep Disorders in Older Men (MrOS) Sleep Study cohort underwent in-home polysomnography with PLMS measurement and were followed up for 4 years for the outcomes coronary heart disease, cerebrovascular disease, peripheral arterial disease, and all-cause cardiovascular disease, which included coronary heart disease, cerebrovascular disease, and peripheral arterial disease. Cox proportional hazards regression assessed the association between PLMI, PLMAI, and these outcomes. Models were minimally adjusted for age, clinic, and body mass index and then fully adjusted for conventional cardiovascular risk factors. During follow-up, 500 men experienced all-cause cardiovascular disease: 345 coronary heart disease, 117 cerebrovascular disease, and 98 peripheral arterial disease events. In fully adjusted models, men with PLMAI ≥5 compared with the referent PLMA <1 group had a 1.26-fold increased relative hazard for all-cause cardiovascular disease. Similar findings were observed for PLMI and all-cause cardiovascular disease. For peripheral arterial disease, men with PLMI ≥30 compared with the referent PLMI <5 group had a 2-fold increased relative hazard (95% confidence interval, 1.14 to 3.49; P=0.025). Compared with the referent group, men with PLMI ≥30 had an increased risk of coronary heart disease (relative hazard, 1.31; 95% confidence interval, 1.01 to 1.70; P=0.045) after minimal adjustment, but this association was attenuated after further adjustments. After stratification, risk of incident all-cause cardiovascular disease among high-PLMI and high-PLMAI groups was significantly elevated only for men without prevalent hypertension (P for interactions <0.10).
These findings provide evidence that PLMS frequency is associated with incident cardiovascular disease in community-dwelling elderly men.
睡眠周期性肢体运动（PLMS）导致反复的交感神经激活，可能与心血管风险增加有关。我们假设 PLMS 频率（周期性肢体运动指数[PLMI]）和 PLMS 觉醒频率（周期性肢体运动觉醒指数[PLMAI]）可预测老年男性队列中心血管疾病的发生，包括冠心病、外周动脉疾病和脑血管疾病。
共 2911 名参与观察性老年男性睡眠障碍研究（MrOS 睡眠研究）队列的男性在家中进行了多导睡眠图检查，并进行了 4 年的随访，以评估冠心病、脑血管疾病、外周动脉疾病和全因心血管疾病（包括冠心病、脑血管疾病和外周动脉疾病）的结局。Cox 比例风险回归评估了 PLMI、PLMAI 与这些结局之间的关系。模型最小调整了年龄、诊所和体重指数，然后充分调整了传统心血管危险因素。在随访期间，500 名男性发生了全因心血管疾病：345 例冠心病、117 例脑血管疾病和 98 例外周动脉疾病事件。在充分调整的模型中，与参照 PLMA<1 组相比，PLMAI≥5 的男性全因心血管疾病的相对危险增加了 1.26 倍。PLMI 与全因心血管疾病也有类似的发现。对于外周动脉疾病，与参照 PLMI<5 组相比，PLMI≥30 的男性发生外周动脉疾病的相对危险增加了 2 倍（95%置信区间，1.14 至 3.49；P=0.025）。与参照组相比，PLMI≥30 的男性在最小调整后发生冠心病的风险增加（相对危险，1.31；95%置信区间，1.01 至 1.70；P=0.045），但这种相关性在进一步调整后减弱。分层后，在没有高血压的患者中，高 PLMI 和高 PLMAI 组发生全因心血管疾病的风险显著升高（交互作用 P 值<0.10）。
这些发现提供了证据，表明 PLMS 频率与社区居住的老年男性发生心血管疾病有关。
