Anna M May1, Ryan D May2, James Bena3, Lu Wang3, Ken Monahan4, Katie L Stone5, Elizabeth Barrett-Connor6, Brian B Koo7, John W Winkelman8, Susan Redline9,10, Murray A Mittleman9, Reena Mehra11. 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. Published by Oxford University Press on behalf of Sleep Research Society (SRS) 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. Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2019.
Authors: S F Quan; B V Howard; C Iber; J P Kiley; F J Nieto; G T O'Connor; D M Rapoport; S Redline; J Robbins; J M Samet; P W Wahl Journal: Sleep Date: 1997-12 Impact factor: 5.849
Authors: Richard B Berry; Rohit Budhiraja; Daniel J Gottlieb; David Gozal; Conrad Iber; Vishesh K Kapur; Carole L Marcus; Reena Mehra; Sairam Parthasarathy; Stuart F Quan; Susan Redline; Kingman P Strohl; Sally L Davidson Ward; Michelle M Tangredi Journal: J Clin Sleep Med Date: 2012-10-15 Impact factor: 4.062
Authors: Reena Mehra; Olga A Tjurmina; Olujimi A Ajijola; Rishi Arora; Donald C Bolser; Mark W Chapleau; Peng-Sheng Chen; Colleen E Clancy; Brian P Delisle; Michael R Gold; Jeffrey J Goldberger; David S Goldstein; Beth A Habecker; M Louis Handoko; Robert Harvey; James P Hummel; Thomas Hund; Christian Meyer; Susan Redline; Crystal M Ripplinger; Marc A Simon; Virend K Somers; Stavros Stavrakis; Thomas Taylor-Clark; Bradley Joel Undem; Richard L Verrier; Irving H Zucker; George Sopko; Kalyanam Shivkumar Journal: JACC Basic Transl Sci Date: 2022-01-26