Zinchuk Andrey, Srivali Narat, Qin Li, Jeon Sangchoon, Ibrahim Ahmad, Sands Scott A, Koo Brian, Yaggi Henry K
Section of Pulmonary, Critical Care and Sleep Medicine Yale University School of Medicine New Haven CT USA.
Center for Outcomes Research and Evaluation Yale University School of Medicine New Haven CT USA.
J Am Heart Assoc. 2024 Feb 6;13(3):e031630. doi: 10.1161/JAHA.123.031630. Epub 2024 Jan 19.
Obstructive sleep apnea is a well-established risk factor for cardiovascular disease (CVD). Recent studies have also linked periodic limb movements during sleep to CVD. We aimed to determine whether periodic limb movements during sleep and obstructive sleep apnea are independent or synergistic factors for CVD events or death.
We examined data from 1049 US veterans with an apnea-hypopnea index (AHI) <30 events/hour. The primary outcome was incident CVD or death. Cox proportional hazards regression assessed the relationships between the AHI, periodic limb movement index (PLMI), and the AHI×PLMI interaction with the primary outcome. We then examined whether AHI and PLMI were associated with primary outcome after adjustment for age, sex, race and ethnicity, obesity, baseline risk of mortality, and Charlson Comorbidity Index. During a median follow-up of 5.1 years, 237 of 1049 participants developed incident CVD or died. Unadjusted analyses showed an increased risk of the primary outcome with every 10-event/hour increase in PLMI (hazard ratio [HR], 1.08 [95% CI, 1.05-1.13]) and AHI (HR, 1.17 [95% CI, 1.01- 1.37]). Assessment associations of AHI and PLMI and their interaction with the primary outcome revealed no significant interaction between PLMI and AHI. In fully adjusted analyses, PLMI, but not AHI, was associated with an increased risk of primary outcome: HR of 1.05 (95% CI, 1.00-1.09) per every 10 events/hour. Results were similar after adjusting with Framingham risk score.
Our study revealed periodic limb movements during sleep as a risk factor for incident CVD or death among those who had AHI <30 events/hour, without synergistic association between periodic limb movements during sleep and obstructive sleep apnea.
阻塞性睡眠呼吸暂停是心血管疾病（CVD）公认的危险因素。最近的研究还将睡眠期间的周期性肢体运动与心血管疾病联系起来。我们旨在确定睡眠期间的周期性肢体运动和阻塞性睡眠呼吸暂停是心血管疾病事件或死亡的独立因素还是协同因素。
我们检查了1049名美国退伍军人的数据，其呼吸暂停低通气指数（AHI）<30次/小时。主要结局是发生心血管疾病或死亡。Cox比例风险回归评估了AHI、周期性肢体运动指数（PLMI）以及AHI×PLMI相互作用与主要结局之间的关系。然后，我们在调整了年龄、性别、种族和民族、肥胖、基线死亡风险和Charlson合并症指数后，检查了AHI和PLMI是否与主要结局相关。在中位随访5.1年期间，1049名参与者中有237人发生了心血管疾病或死亡。未调整分析显示，PLMI每增加10次/小时（风险比[HR]，每增加10次/小时（风险比[HR]，1.08[95%CI，1.05-1.13]）和AHI（HR，1.17[95%CI，1.01-1.37]），主要结局风险增加。评估AHI和PLMI及其与主要结局的相互作用，结果显示PLMI和AHI之间无显著相互作用。在完全调整分析中，PLMI而非AHI与主要结局风险增加相关：每10次/小时的HR为1.05（95%CI，1.00-1.09）。用弗雷明汉风险评分调整后结果相似。
我们的研究表明，在AHI<30次/小时的人群中，睡眠期间的周期性肢体运动是发生心血管疾病或死亡的危险因素，睡眠期间的周期性肢体运动与阻塞性睡眠呼吸暂停之间无协同关联。
