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, 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, 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, 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
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.
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Source: PubMed