Individual periodic limb movements with arousal are temporally associated with nonsustained ventricular tachycardia: a case-crossover analysis
Authors: May Anna M , May Ryan D , Bena James , Wang Lu , Monahan Ken , Stone Katie L , Barrett-Connor Elizabeth , Koo Brian B , Winkelman John W , Redline Susan , Mittleman Murray A , Mehra Reena ,   for the Osteoporotic Fractures in Men (MrOS) Study Group, Stone K L , Bauer D C , Cummings S R , Goldschlager N , Varosy P , Yaffe K , Cawthon P M , Fullman R , Benard R , Blackwell T , Concepcion L , Diehl J , Ewing S , Fox C , Jaime-Chavez M , Kwan E , Litwack S , Liu W , Lui L Y , Schneider J , Scott R , Tanaka D , Ziarno J , Orwoll E , Phipps K , Marshall L , Babich Blank J , Lambert L , Chan B , Neevel D , Lewis C E , Shikany J , Johnson P , Oden C , House S , Webb N , Hardy K , Felder S , Wilkoff J , King J , Johnsey T , Young M , Smith J , Sassaman C , Collier C , Atkins C , Ensrud K , Fink H , King D , Michaels N , Nelson N , Bird C , Blanks D , Imker-Witte F , Moen K , Paudel M , Slindee M , Stefanick M , Hoffman A , Kent K , Malig B , Wong S , Cauley J , Zmuda J , Danielson M , Harper L , Buck L , Nasim M , Cusick D , Gorecki M , Watson N , Bashada C , Newman C , Barrett-Connor E , Ancoli-Israel S , Dam T , Carrion-Petersen M L , Miller P , Kamantigue N , Redline S , Surovec S , Scott N , Rueschman M , Johnson N , Arnold J , Nawabit R , Romaniuk J , Seicean S 
Published: October 2019

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.