Individual periodic limb movements with arousal are temporally associated with nonsustained ventricular tachycardia: a case-crossover analysis

Anna M May; Ryan D May; James Bena; Lu Wang; Ken Monahan; Katie L Stone; Elizabeth Barrett-Connor; Brian B Koo; John W Winkelman; Susan Redline; Murray A Mittleman; Reena Mehra; Osteoporotic Fractures in Men (MrOS) Study Group

doi:10.1093/sleep/zsz165

Individual periodic limb movements with arousal are temporally associated with nonsustained ventricular tachycardia: a case-crossover analysis

Sleep. 2019 Oct 21;42(11):zsz165. doi: 10.1093/sleep/zsz165.

Authors

Collaborators

Osteoporotic Fractures in Men (MrOS) Study Group:
K L Stone, D C Bauer, S R Cummings, N Goldschlager, P Varosy, K Yaffe, P M Cawthon, R Fullman, R Benard, T Blackwell, L Concepcion, J Diehl, S Ewing, C Fox, M Jaime-Chavez, E Kwan, S Litwack, W Liu, L Y Lui, J Schneider, R Scott, D Tanaka, J Ziarno, E Orwoll, K Phipps, L Marshall, J Babich Blank, L Lambert, B Chan, D Neevel, C E Lewis, J Shikany, P Johnson, C Oden, S House, N Webb, K Hardy, S Felder, J Wilkoff, J King, T Johnsey, M Young, J Smith, C Sassaman, C Collier, C Atkins, K Ensrud, H Fink, D King, N Michaels, N Nelson, C Bird, D Blanks, F Imker-Witte, K Moen, M Paudel, M Slindee, M Stefanick, A Hoffman, K Kent, B Malig, S Wong, J Cauley, J Zmuda, M Danielson, L Harper, L Buck, M Nasim, D Cusick, M Gorecki, N Watson, C Bashada, C Newman, E Barrett-Connor, S Ancoli-Israel, T Dam, M L Carrion-Petersen, P Miller, N Kamantigue, S Redline, S Surovec, N Scott, M Rueschman, N Johnson, J Arnold, R Nawabit, J Romaniuk, S Seicean

Affiliations

¹ Sleep Medicine Section, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
² Department of Engineering, Case Western Reserve University, Cleveland, OH.
³ Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH.
⁴ Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN.
⁵ California Pacific Medical Center Research Institute, San Francisco, CA.
⁶ University of California, San Diego, San Diego, CA.
⁷ Department of Neurology, Yale School of Medicine, New Haven, CT.
⁸ Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA.
⁹ Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
¹⁰ Department of medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
¹¹ Sleep Center, Neurologic Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.

Abstract

Study objectives: Both periodic limb movements during sleep (PLMS) and arousals are associated with sympathetic nervous system activation and may be arrhythmogenic. We hypothesize a temporal relationship exists between individual PLMS, particularly with arousal, and nonsustained ventricular tachycardia (NSVT) events.

Methods: A bidirectional time-stratified case-crossover design was used to assess temporal associations between PLMS and NSVT during sleep in 49 Osteoporotic Fractures in Men Sleep Study participants with NSVT in a community-based cohort (n = 2,911). Sleep time was divided into approximate 30-min segments. For each NSVT (n = 141), we selected a preceding 30-s hazard period and three randomly chosen 30-s control periods from sleep within the same segment and evaluated for PLMS, respiratory events, minimum saturation, and arousals. Odds ratios and 95% confidence intervals-OR (95% CI)-were determined by conditional logistic regression; covariates included EEG arousals, minimum saturation, and respiratory events in the same hazard/control period.

Results: Participants with NSVT were 79.5 ± 6.2 years with a PLMS index of 32.1 (IQR: 10.1, 61.4) and apnea-hypopnea index of 17.1 (IQR: 9.4, 26.1). PLMS without arousal were not significantly associated with NSVT (OR = 0.80, 95% CI: 0.41-1.59). PLMS with arousal were associated with NSVT in unadjusted analyses (OR = 2.50, 95% CI: 1.11-5.65) and after adjustment (OR = 2.31, 95% CI: 1.02-5.25). Arousals associated with PLMS were associated with NSVT in unadjusted (OR = 2.84, 95% CI: 1.23-6.56) and adjusted analyses (OR = 2.61, 95% CI: 1.13-6.05).

Conclusions: PLMS with (but not without) arousals are temporally associated with a greater than twofold higher odds of subsequent NSVT episodes. PLMS-related arousals may be physiologically important ventricular arrhythmia triggers.

Clinical trial registration: ClinicalTrials.gov, NCT00070681.

Keywords: arrhythmia; nonsustained tachycardia; periodic limb movements.

Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2019.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Arousal / physiology*
Female
Humans
Male
Movement / physiology*
Polysomnography
Sleep / physiology*
Tachycardia, Ventricular / physiopathology*

Associated data

ClinicalTrials.gov/NCT00070681

Abstract

Publication types

MeSH terms

Associated data

Grants and funding