Drakatos Panagis, Higgins Sean, Pengo Martino F, Kent Brian D, Muza Rex, Karkoulias Kiriakos, Leschziner Guy, Williams Adrian
Guy's and St Thomas' NHS Foundation Trust, UK.
University Hospital of Padova, Italy.
J Clin Sleep Med. 2016 Feb;12(2):195-202. doi: 10.5664/jcsm.5484.
Both periodic limb movements during sleep (PLMS) and obstructive sleep apnea (OSA) have been associated with increased risk of cardiovascular disease (CVD). OSA has also been linked to increased large arterial stiffness, which is considered an independent risk factor for CVD. We utilized a previously validated index of large artery stiffness (SIDVP) derived from the digital volume pulse (DVP) to seek comparison in patients with PLMS and OSA.
Forty-nine adult male subjects, without known comorbidities that could affect arterial stiffness or on vasoactive medication, were retrospectively identified and categorized into controls (n = 8), PLMS (n = 13), OSA (n = 17), and OSA/PLMS (n = 11). The cutoff for PLMS was a periodic limb movement index (PLMI) > 15 events/h, and for OSA an apnea-hypopnea index (AHI) > 10 events/h. SIDVP was derived from the raw data of photoplethysmography of the nocturnal polysomnography, averaged for 2 min prior to sleep study initiation (baseline), after completion in the morning, and every half hour after sleep onset.
The groups were age/body mass index-matched. Controls showed lower baseline, morning, and overall SIDVP compared to the other groups (p < 0.01). Patients with PLMS (PLMI: 50.69 ± 9.7 events/h) and the OSA group (AHI: 29.7 ± 2 events/h) demonstrated similar overall SIDVP (6.78 ± 0.08 versus 6.94 ± 0.04, respectively, p = 0.5), whereas the OSA/PLMS (AHI: 29.35 ± 8, PLMI: 50.63 ± 7.2) group demonstrated the highest (7.40 ± 0.06, p < 0.001).
Based on an easily reproducible and applicable marker of large arterial stiffness, patients with significant PLMS had higher SIDVP when compared to controls and comparable to those with moderate/severe OSA. The OSA/PLMS group had the highest SIDVP, implying a possible additive effect of OSA and PLMS on arterial stiffness.
睡眠期周期性肢体运动（PLMS）和阻塞性睡眠呼吸暂停（OSA）均与心血管疾病（CVD）风险增加有关。OSA还与大动脉僵硬度增加有关，而大动脉僵硬度被认为是CVD的独立危险因素。我们利用先前验证的源自数字容积脉搏（DVP）的大动脉僵硬度指数（SIDVP），对PLMS和OSA患者进行比较。
回顾性纳入49名成年男性受试者，这些受试者无已知可能影响动脉僵硬度的合并症或未服用血管活性药物，并将其分为对照组（n = 8）、PLMS组（n = 13）、OSA组（n = 17）和OSA/PLMS组（n = 11）。PLMS的截断值为周期性肢体运动指数（PLMI）>15次/小时，OSA的截断值为呼吸暂停低通气指数（AHI）>10次/小时。SIDVP源自夜间多导睡眠图的光电容积描记原始数据，在睡眠研究开始前2分钟（基线）、早晨完成后以及睡眠开始后每半小时进行平均。
各组在年龄/体重指数方面匹配。与其他组相比，对照组的基线、早晨及总体SIDVP较低（p < 0.01）。PLMS患者（PLMI：50.69±9.7次/小时）和OSA组（AHI：29.7±2次/小时）的总体SIDVP相似（分别为6.78±0.08和6.94±0.04，p = 0.5），而OSA/PLMS组（AHI：29.35±8，PLMI：50.63±7.2）的SIDVP最高（7.40±0.06，p < 0.001）。
基于一种易于重现和应用的大动脉僵硬度标志物，与对照组相比，显著PLMS患者的SIDVP更高，且与中度/重度OSA患者相当。OSA/PLMS组的SIDVP最高，这意味着OSA和PLMS对动脉僵硬度可能存在叠加效应。
