Center for Integrative Research on Cardiovascular Aging, Aurora University of Wisconsin Medical Group, Milwaukee, Wisconsin 53215, USA.
J Am Soc Echocardiogr. 2013 Jul;26(7):783-90. doi: 10.1016/j.echo.2013.03.018. Epub 2013 Apr 24.
Sleep disturbance caused by obstructive sleep apnea is recognized as a contributing factor to adverse cardiovascular outcomes. However, the effect of restless legs syndrome, another common cause of fragmented sleep, on cardiac structure, function, and long-term outcomes is not known. The aim of this study was to assess the effect of frequent leg movement during sleep on cardiac structure and outcomes in patients with restless legs syndrome.
In our retrospective study, patients with restless legs syndrome referred for polysomnography were divided into those with frequent (periodic movement index > 35/hour) and infrequent (≤ 35/hour) leg movement during sleep. Long-term outcomes were determined using Kaplan-Meier and logistic regression models.
Of 584 patients, 47% had a periodic movement index > 35/hour. Despite similarly preserved left ventricular ejection fraction, the group with periodic movement index > 35/hour had significantly higher left ventricular mass and mass index, reflective of left ventricular hypertrophy (LVH). There were no significant baseline differences in the proportion of patients with hypertension, diabetes, hyperlipidemia, prior myocardial infarction, stroke or heart failure, or the use of antihypertensive medications between the groups. Patients with frequent periodic movement index were older, predominantly male, and had more prevalent coronary artery disease and atrial fibrillation. However, on multivariate analysis, periodic movement index > 35/hour remained the strongest predictor of LVH (odds ratio, 2.45; 95% confidence interval, 1.67-3.59; P < .001). Advanced age, female sex, and apnea-hypopnea index were other predictors of LVH. Patients with periodic movement index > 35/hour had significantly higher rates of heart failure and mortality over median 33-month follow-up.
Frequent periodic leg movement during sleep is an independent predictor of severe LVH and is associated with increased cardiovascular morbidity and mortality.
阻塞性睡眠呼吸暂停引起的睡眠障碍被认为是导致不良心血管结局的一个因素。然而，另一种常见的睡眠碎片化原因——不宁腿综合征对心脏结构、功能和长期结局的影响尚不清楚。本研究旨在评估睡眠中频繁腿部运动对不宁腿综合征患者心脏结构和结局的影响。
在我们的回顾性研究中，因不宁腿综合征而行多导睡眠图检查的患者根据睡眠中腿部频繁运动（周期性运动指数>35/小时）和不频繁运动（≤35/小时）分为两组。采用 Kaplan-Meier 和逻辑回归模型确定长期结局。
在 584 例患者中，47%的患者周期性运动指数>35/小时。尽管左心室射血分数相似，但周期性运动指数>35/小时组的左心室质量和质量指数明显更高，反映出左心室肥厚（LVH）。两组患者在高血压、糖尿病、高脂血症、既往心肌梗死、卒中和心力衰竭的比例以及降压药物的使用方面无显著基线差异。周期性运动指数频繁的患者年龄较大，主要为男性，且更常见冠状动脉疾病和心房颤动。然而，多变量分析显示，周期性运动指数>35/小时仍然是 LVH 的最强预测因素（比值比，2.45；95%置信区间，1.67-3.59；P<0.001）。年龄较大、女性和呼吸暂停-低通气指数也是 LVH 的其他预测因素。周期性运动指数>35/小时的患者在中位 33 个月随访期间心力衰竭和死亡率显著更高。
睡眠中频繁的周期性腿部运动是严重 LVH 的独立预测因素，并与心血管发病率和死亡率增加相关。
