Boulos Mark I, Murray Brian J, Muir Ryan T, Gao Fuqiang, Szilagyi Gregory M, Huroy Menal, Kiss Alexander, Walters Arthur S, Black Sandra E, Lim Andrew S, Swartz Richard H
L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.
Sleep. 2017 Mar 1;40(3). doi: 10.1093/sleep/zsw080.
Emerging evidence suggests that periodic limb movements (PLMs) may contribute to the development of cerebrovascular disease. White matter hyperintensities (WMHs), a widely accepted biomarker for cerebral small vessel disease, are associated with incident stroke and death. We evaluated the association between increased PLM indices and WMH burden in patients presenting with stroke or transient ischemic attack (TIA), while controlling for vascular risk factors and stroke severity.
Thirty patients presenting within 2 weeks of a first-ever minor stroke or high-risk TIA were prospectively recruited. PLM severity was measured with polysomnography. WMH burden was quantified using the Age Related White Matter Changes (ARWMC) scale based on neuroimaging. Partial Spearman's rank-order correlations and multiple linear regression models tested the association between WMH burden and PLM severity.
Greater WMH burden was correlated with elevated PLM index and stroke volume. Partial Spearman's rank-order correlations demonstrated that the relationship between WMH burden and PLM index persisted despite controlling for vascular risk factors. Multivariate linear regression models revealed that PLM index was a significant predictor of an elevated ARWMC score while controlling for age, stroke volume, stroke severity, hypertension, and apnea-hypopnea index.
The quantity of PLMs was associated with WMH burden in patients with first-ever minor stroke or TIA. PLMs may be a risk factor for or marker of WMH burden, even after considering vascular risk factors and stroke severity. These results invite further investigation of PLMs as a potentially useful target to reduce WMH and stroke burden.
新出现的证据表明，周期性肢体运动（PLMs）可能促使脑血管疾病的发展。白质高信号（WMHs）是脑小血管疾病广泛认可的生物标志物，与中风和死亡风险相关。我们评估首次发生中风或短暂性脑缺血发作（TIA）患者中，PLM指数升高与WMH负担之间的关联，同时控制血管危险因素和中风严重程度。
前瞻性招募30例在首次轻度中风或高危TIA发作2周内就诊的患者。通过多导睡眠图测量PLM严重程度。基于神经影像学，使用年龄相关白质变化（ARWMC）量表对WMH负担进行量化。偏斯皮尔曼等级相关分析和多元线性回归模型检验WMH负担与PLM严重程度之间的关联。
更高的WMH负担与PLM指数升高和中风体积相关。偏斯皮尔曼等级相关分析表明，即使控制血管危险因素，WMH负担与PLM指数之间的关系依然存在。多元线性回归模型显示，在控制年龄、中风体积、中风严重程度、高血压和呼吸暂停低通气指数后，PLM指数是ARWMC评分升高的显著预测因素。
首次发生轻度中风或TIA患者的PLM数量与WMH负担相关。即使考虑血管危险因素和中风严重程度，PLMs可能是WMH负担的危险因素或标志物。这些结果促使进一步研究PLMs作为减轻WMH和中风负担的潜在有用靶点。
