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Published in: Sleep and Breathing 1/2009

01-02-2009 | Original Article

The prevalence and significance of periodic leg movements during sleep in patients with congestive heart failure

Authors: Robert Skomro, Rogerio Silva, Rosana Alves, Adelaide Figueiredo, Geraldo Lorenzi-Filho

Published in: Sleep and Breathing | Issue 1/2009

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Abstract

Purpose

The aim of this study was to evaluate (1) the prevalence of periodic leg movements during sleep (PLMs) in a consecutive sample of congestive heart failure (CHF) outpatients; (2) the presence of correlation between PLMs, subjective daytime sleepiness, and sleep architecture; and (3) the heart rate response to PLMs in CHF.

Materials and methods

Seventy-nine [50 men, age 59 ± 11 years, body mass index (BMI) 26 ± 5 kg/m2] consecutive adult stable outpatients with CHF [left ventricular ejection fraction (LVEF) 36 ± 6%] were prospectively evaluated. The patients underwent assessment of echocardiography, sleepiness (Epworth Scale), and overnight in-lab polysomnography.

Results

Fifteen patients (19%) had PLM index >5. These subjects were similar in sex distribution, BMI, subjective somnolence, LVEF, and apnea–hypopnea index (AHI), but were significantly older than subjects without PLMs. Sleep architecture was similar in subjects with and without PLMs. There was a small but significant elevation of heart rate after PLMs (80.1 ± 9.4 vs. 81.5 ± 9.2; p < 0.001). The cardiac acceleration was also present in absence of electroencephalogram activation.

Conclusion

The prevalence of PLMs in consecutive sample of adult CHF outpatients was 19%. There were no differences in subjective daytime sleepiness, sleep architecture, AHI, and severity of CHF in subjects with and without PLMs. PLMs caused a small but statistically significant cardiac acceleration.
Literature
1.
go back to reference Hanly P, Zuberi-Khokhar N (1995) Daytime sleepiness in patients with congestive heart failure and Cheyne–Stokes respiration. Chest 107:952–958CrossRefPubMed Hanly P, Zuberi-Khokhar N (1995) Daytime sleepiness in patients with congestive heart failure and Cheyne–Stokes respiration. Chest 107:952–958CrossRefPubMed
2.
go back to reference Dunbar SB, Clark PC, Deaton C, Parker KP, De AK, Smith AL, O’Brien MC (2001) Correlates of sleep and daytime sleepiness in persons with heart failure. J Heart Failure 7(5 suppl 2):77 Dunbar SB, Clark PC, Deaton C, Parker KP, De AK, Smith AL, O’Brien MC (2001) Correlates of sleep and daytime sleepiness in persons with heart failure. J Heart Failure 7(5 suppl 2):77
3.
go back to reference Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD (1999) Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 160(4):1101–1106PubMed Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD (1999) Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 160(4):1101–1106PubMed
4.
go back to reference Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, Roselle GA (1998) Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 97(21):2154–2159PubMed Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, Roselle GA (1998) Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 97(21):2154–2159PubMed
5.
go back to reference Javaheri S (2006) Sleep disorders in systolic heart failure: a prospective study of 100 male patients. The final report. Intern J Cardiol 106:21–28CrossRef Javaheri S (2006) Sleep disorders in systolic heart failure: a prospective study of 100 male patients. The final report. Intern J Cardiol 106:21–28CrossRef
6.
go back to reference Bradley TD, Floras JS (1996) Pathophysiologic and therapeutic implications of sleep apnea in congestive heart failure. J Card Fail 2(3):223–240CrossRefPubMed Bradley TD, Floras JS (1996) Pathophysiologic and therapeutic implications of sleep apnea in congestive heart failure. J Card Fail 2(3):223–240CrossRefPubMed
7.
go back to reference Ohayon MM, Roth T (2002) Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res 53(1):547–554CrossRefPubMed Ohayon MM, Roth T (2002) Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res 53(1):547–554CrossRefPubMed
8.
go back to reference Bixler EO, Kales A, Vela-Bueno A, Jacoby JA, Scarone S, Soldatos CR (1982) Nocturnal myoclonus and nocturnal myoclonic activity in the normal population. Res Commun Chem Pathol Pharmacol 36(1):129–140PubMed Bixler EO, Kales A, Vela-Bueno A, Jacoby JA, Scarone S, Soldatos CR (1982) Nocturnal myoclonus and nocturnal myoclonic activity in the normal population. Res Commun Chem Pathol Pharmacol 36(1):129–140PubMed
9.
go back to reference Dickel MJ, Mosko SS (1990) Morbidity cut-offs for sleep apnea and periodic leg movements in predicting subjective complaints in seniors. Sleep 13(2):155–166PubMed Dickel MJ, Mosko SS (1990) Morbidity cut-offs for sleep apnea and periodic leg movements in predicting subjective complaints in seniors. Sleep 13(2):155–166PubMed
10.
go back to reference Droste DW, Krauss JK, Hagedorn G, Kaps M (1996) Periodic leg movements are part of the B-wave rhythm and the cyclic alternating pattern. Acta Neurol Scand 94(5):347–352CrossRefPubMed Droste DW, Krauss JK, Hagedorn G, Kaps M (1996) Periodic leg movements are part of the B-wave rhythm and the cyclic alternating pattern. Acta Neurol Scand 94(5):347–352CrossRefPubMed
11.
go back to reference Fantini ML, Michaud M, Gosselin N, Lavigne G, Montplaisir J (2002) Periodic leg movements in REM sleep behavior disorder and related autonomic and EEG activation. Neurology 59(12):1889–1894PubMed Fantini ML, Michaud M, Gosselin N, Lavigne G, Montplaisir J (2002) Periodic leg movements in REM sleep behavior disorder and related autonomic and EEG activation. Neurology 59(12):1889–1894PubMed
12.
go back to reference Gosselin N, Lanfranchi P, Michaud M, Fantini L, Carrier J, Lavigne G, Montplaisir J (2003) Age and gender effects on heart rate activation associated with periodic leg movements in patients with restless legs syndrome. Clin Neurophysiol 114(11):2188–2195CrossRefPubMed Gosselin N, Lanfranchi P, Michaud M, Fantini L, Carrier J, Lavigne G, Montplaisir J (2003) Age and gender effects on heart rate activation associated with periodic leg movements in patients with restless legs syndrome. Clin Neurophysiol 114(11):2188–2195CrossRefPubMed
13.
go back to reference Sforza E, Nicolas A, Lavigne G, Gosselin A, Petit D, Montplaisir J (1999) EEG and cardiac activation during periodic leg movements in sleep: support for a hierarchy of arousal responses. Neurology 52(4):786–791PubMed Sforza E, Nicolas A, Lavigne G, Gosselin A, Petit D, Montplaisir J (1999) EEG and cardiac activation during periodic leg movements in sleep: support for a hierarchy of arousal responses. Neurology 52(4):786–791PubMed
14.
go back to reference Sforza E, Juony C, Ibanez V (2002) Time-dependent variation in cerebral and autonomic activity during periodic leg movements in sleep: implications for arousal mechanisms. Clin Neurophysiol 113(6):883–891CrossRefPubMed Sforza E, Juony C, Ibanez V (2002) Time-dependent variation in cerebral and autonomic activity during periodic leg movements in sleep: implications for arousal mechanisms. Clin Neurophysiol 113(6):883–891CrossRefPubMed
15.
go back to reference Winkelman JW (1999) The evoked heart rate response to periodic leg movements of sleep. Sleep 22(5):575–580PubMed Winkelman JW (1999) The evoked heart rate response to periodic leg movements of sleep. Sleep 22(5):575–580PubMed
16.
go back to reference Ali NJ, Davies RJ, Fleetham JA, Stradling JR (1991) Periodic movements of the legs during sleep associated with rises in systemic blood pressure. Sleep 14(2):163–165PubMed Ali NJ, Davies RJ, Fleetham JA, Stradling JR (1991) Periodic movements of the legs during sleep associated with rises in systemic blood pressure. Sleep 14(2):163–165PubMed
17.
go back to reference Johns MW (1991) A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 14(6):540–545PubMed Johns MW (1991) A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 14(6):540–545PubMed
18.
go back to reference Rechtschaffen A, Kales A, eds (1968) A Manual of Standardized Terminology: Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles, CA: UCLA Brain Information Service/Brain Research Institute Rechtschaffen A, Kales A, eds (1968) A Manual of Standardized Terminology: Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles, CA: UCLA Brain Information Service/Brain Research Institute
19.
go back to reference American Sleep Disorders Association (ASDA) (1992) Atlas Task Force—EEG arousals: scoring rules and examples. Sleep 15(2):174–84 American Sleep Disorders Association (ASDA) (1992) Atlas Task Force—EEG arousals: scoring rules and examples. Sleep 15(2):174–84
20.
go back to reference American Academy of Sleep Medicine (AASM) (1999) Task Force—sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–89 American Academy of Sleep Medicine (AASM) (1999) Task Force—sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–89
21.
go back to reference American Sleep Disorders Association (ASDA) (1993) Atlas Task Force. Recording and scoring leg movements. Sleep 16:748–759 American Sleep Disorders Association (ASDA) (1993) Atlas Task Force. Recording and scoring leg movements. Sleep 16:748–759
22.
go back to reference Hanly P, Zuberi-Khokhar N (1996) Periodic limb movements during sleep in patients with congestive heart failure. Chest 109(6):1497–1502CrossRefPubMed Hanly P, Zuberi-Khokhar N (1996) Periodic limb movements during sleep in patients with congestive heart failure. Chest 109(6):1497–1502CrossRefPubMed
23.
go back to reference Nicolas A, Lesperance P, Montplaisir J (1998) Is excessive daytime sleepiness with periodic leg movements during sleep a specific diagnostic category? Eur Neurol 40(1):22–26CrossRefPubMed Nicolas A, Lesperance P, Montplaisir J (1998) Is excessive daytime sleepiness with periodic leg movements during sleep a specific diagnostic category? Eur Neurol 40(1):22–26CrossRefPubMed
24.
go back to reference Mendelson WB (1996) Are periodic leg movements associated with clinical sleep disturbance? Sleep 19(3):219–223PubMed Mendelson WB (1996) Are periodic leg movements associated with clinical sleep disturbance? Sleep 19(3):219–223PubMed
25.
go back to reference Chervin RD (2001) Periodic leg movements and sleepiness in patients evaluated for sleep-disordered breathing. Am J Respir Crit Care Med 164(8):1454–1458PubMed Chervin RD (2001) Periodic leg movements and sleepiness in patients evaluated for sleep-disordered breathing. Am J Respir Crit Care Med 164(8):1454–1458PubMed
26.
27.
go back to reference Floras JS (2003) Sympathetic activation in human heart failure: diverse mechanisms, therapeutic opportunities. Acta Physiol Scand 177(3):391–398CrossRefPubMed Floras JS (2003) Sympathetic activation in human heart failure: diverse mechanisms, therapeutic opportunities. Acta Physiol Scand 177(3):391–398CrossRefPubMed
28.
go back to reference Li YF, Patel KP (2003) Paraventricular nucleus of the hypothalamus and elevated sympathetic activity in heart failure: the altered inhibitory mechanisms. Acta Physiol Scand 177(1):17–26CrossRefPubMed Li YF, Patel KP (2003) Paraventricular nucleus of the hypothalamus and elevated sympathetic activity in heart failure: the altered inhibitory mechanisms. Acta Physiol Scand 177(1):17–26CrossRefPubMed
29.
go back to reference Cunha AB, Cunha DM, Pedrosa RC, Flammini F, Silva AJ, Saad EA, Kopiler DA (2003) Norepinephrine and heart rate variability: a marker of dysautonomia in chronic Chagas cardiopathy. Rev Port Cardiol 22(1):29–52PubMed Cunha AB, Cunha DM, Pedrosa RC, Flammini F, Silva AJ, Saad EA, Kopiler DA (2003) Norepinephrine and heart rate variability: a marker of dysautonomia in chronic Chagas cardiopathy. Rev Port Cardiol 22(1):29–52PubMed
30.
go back to reference Teixeira AL Jr., Fontoura BF, Freire-Maia L, Chiari E, Machado CR, Teixeira MM (2001) Camargos ER. Cardiac autonomic denervation and functional response to neurotoxins during acute experimental Chagas’ disease in rats. Auton Neurosci 89(1–2):128–132CrossRefPubMed Teixeira AL Jr., Fontoura BF, Freire-Maia L, Chiari E, Machado CR, Teixeira MM (2001) Camargos ER. Cardiac autonomic denervation and functional response to neurotoxins during acute experimental Chagas’ disease in rats. Auton Neurosci 89(1–2):128–132CrossRefPubMed
31.
go back to reference Machado CR, Camargos ER, Guerra LB, Moreira MC (2000) Cardiac autonomic denervation in congestive heart failure: comparison of Chagas’ heart disease with other dilated cardiomyopathy. Hum Pathol 31(1):3–10CrossRefPubMed Machado CR, Camargos ER, Guerra LB, Moreira MC (2000) Cardiac autonomic denervation in congestive heart failure: comparison of Chagas’ heart disease with other dilated cardiomyopathy. Hum Pathol 31(1):3–10CrossRefPubMed
32.
go back to reference Davila DF, Inglessis G, Mazzei de Davila CA (1998) Chagas’ heart disease and the autonomic nervous system. Int J Cardiol 66(2):123–127CrossRefPubMed Davila DF, Inglessis G, Mazzei de Davila CA (1998) Chagas’ heart disease and the autonomic nervous system. Int J Cardiol 66(2):123–127CrossRefPubMed
33.
go back to reference Marin Neto JA, Gallo L Jr., Manco JC, Rassi A, Amorim DS (1980) Mechanisms of tachycardia on standing: studies in normal individuals and in chronic Chagas’ heart patients. Cardiovasc Res 14(9):541–550CrossRefPubMed Marin Neto JA, Gallo L Jr., Manco JC, Rassi A, Amorim DS (1980) Mechanisms of tachycardia on standing: studies in normal individuals and in chronic Chagas’ heart patients. Cardiovasc Res 14(9):541–550CrossRefPubMed
34.
go back to reference Coleman RM, Pollak CP, Weitzman ED (1980) Periodic movements in sleep (nocturnal myoclonus): relation to sleep disorders. Ann Neurol 8(4):416–421CrossRefPubMed Coleman RM, Pollak CP, Weitzman ED (1980) Periodic movements in sleep (nocturnal myoclonus): relation to sleep disorders. Ann Neurol 8(4):416–421CrossRefPubMed
35.
go back to reference Ancoli-Israel S, Kripke DF, Mason W, Messin S (1981) Sleep apnea and nocturnal myoclonus in a senior population. Sleep 4(4):349–358PubMed Ancoli-Israel S, Kripke DF, Mason W, Messin S (1981) Sleep apnea and nocturnal myoclonus in a senior population. Sleep 4(4):349–358PubMed
36.
go back to reference Ancoli-Israel S, Kripke DF, Mason W, Messin S (1981) Comparisons of home sleep recordings and polysomnograms in older adults with sleep disorders. Sleep 4(3):283–291PubMed Ancoli-Israel S, Kripke DF, Mason W, Messin S (1981) Comparisons of home sleep recordings and polysomnograms in older adults with sleep disorders. Sleep 4(3):283–291PubMed
37.
go back to reference Kripke DF, Ancoli-Israel S, Okudaira N (1982) Sleep apnea and nocturnal myoclonus in the elderly. Neurobiol Aging 3(4):329–336CrossRefPubMed Kripke DF, Ancoli-Israel S, Okudaira N (1982) Sleep apnea and nocturnal myoclonus in the elderly. Neurobiol Aging 3(4):329–336CrossRefPubMed
38.
go back to reference American Academy of Sleep Medicine (2005) International classification of sleep disorders 2nd edition: diagnostic and coding manual (ICSD-2). AASM, Westchester American Academy of Sleep Medicine (2005) International classification of sleep disorders 2nd edition: diagnostic and coding manual (ICSD-2). AASM, Westchester
Metadata
Title
The prevalence and significance of periodic leg movements during sleep in patients with congestive heart failure
Authors
Robert Skomro
Rogerio Silva
Rosana Alves
Adelaide Figueiredo
Geraldo Lorenzi-Filho
Publication date
01-02-2009
Publisher
Springer-Verlag
Published in
Sleep and Breathing / Issue 1/2009
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-008-0207-5

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