A Systematic Assessment of the Association of Polysomnographic Indices with Blood Pressure: The Multi-Ethnic Study of Atherosclerosis (MESA)

Dean, Dennis A.; Wang, Rui; Jacobs, David R.; Duprez, Daniel; Punjabi, Naresh M.; Zee, Phyllis C.; Shea, Steven; Watson, Karol E.; Redline, Susan

doi:10.5665/sleep.4576

Cited by 42 publications

(40 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, both systolic and diastolic blood pressures were significantly higher in patients with OSAS and PLM. In their 2014 study, Dean et al (12) reported that PLM (PLMI ≥5) was associated with higher diastolic blood pressure irrespective of AHI. The presence of PLM in patients with OSAS may be a factor of increased oxidative stress.…”

Section: Discussionmentioning

confidence: 99%

“…There are growing numbers of reports that suggest PLM as a novel risk factor in hypertension, cardiovascular, and cerebrovascular disorders (10,11). A recent study found a relationship between PLM and elevated diastolic blood pressure, irrespective of the apnea-hypopnea index (AHI) (12). PLM has also been reported to be a component of chronic diseases including congestive heart failure, chronic renal failure, Parkinson's disease, and sleep apnea (11).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Obstructive Sleep Apnea Syndrome, Periodic Limb Movements and Related Factors

Yalın¹,

Yılmaz²,

Sungur³

et al. 2015

tnd

View full text Add to dashboard Cite

Objective: Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive nocturnal apnea episodes. Periodic limb movements (PLMs) is known as the nocturnal, stereotypic, repetitive movements of the lower extremities. The aim of this study was to investigate the presence of PLMs in patients with OSAS, and the relationship between PLM and OSAS severity. Materials and Methods:One hundred forty-one patients who had a pre-diagnosis of OSAS were enrolled into the study. All subjects' blood pressure, heart rate measurements, and neurologic examinations were performed by the same neurologist. Sociodemographic characteristics were recorded. Overnight polysomnography (PSG) was performed in all patients and results were analyzed. Patients with an apnea-hypopnea index (AHI) of ≥5 were accepted as having OSAS, and a PLM index (PLMI) of ≥5 were accepted as having PLM. Results:One hundred two patients were diagnosed as having OSAS. The control group consisted of 39 patients who had normal polysomnographic findings. The patients with OSAS were older and their body mass indexes (BMI) were higher compared with the control group. Systolic blood pressure was higher in the OSAS group. Alcohol use was found to be a risk factor for OSAS. PLM was more common in the OSAS group than in the control group (30.3-10.2%). PLM frequency was associated with the severity of OSAS. Conclusion:The presence of PLM was associated with OSAS severity, higher systolic and diastolic blood pressure, and REM sleep depletion in OSAS. PLM seen in patients with OSAS may be regarded as an indicator of disease severity, and should alert the physician to increased complications. Keywords: Obstructive sleep apnea syndrome, periodic limb movements, polysomnographyAmaç: Obstrüktif uyku apne sendromu (OUAS) uykuda sık tekrarlayan apneler ile karakterize bir bozukluktur. Periyodik bacak hareketleri (PBH) alt ekstremitelerde uyku sırasında ortaya çıkan, tekrarlayıcı ve stereotipik özelliği olan hareketlerdir. Bu çalışmada OUAS'da PHB varlığı ve PBH'nin OUAS şiddeti ile ilişkisi araştırıldı. Gereç ve Yöntem:OUAS ön tanılı 141 birey çalışmaya dahil edildi. Katılımcıların kan basıncı, nabız ölçümleri, nörolojik muayeneleri yapıldı. Hastaların tümüne 1 gece süreyle polisomnografi incelemesi yapıldı ve sonuçlar analiz edildi. Polisomnografi incelemesinde apne hipopne indeksi (AHİ) ≥5 olması OUAS, periyodik bacak hareket indeksi (PBHİ) ≥5 olması PBH olarak kabul edildi. Bulgular: Yüz iki hasta OUAS tanısı aldı. Polisomnografi incelemesi normal saptanan 39 birey kontrol grubunu oluşturdu. OUAS hastaları daha yaşlı ve vücut kitle indeksi (VKİ) daha yüksek bulundu. Sistolik kan basıncı OUAS grubunda daha yüksekti. Alkol kullanımı OUAS için risk faktörü olarak saptandı. PBH'nin OUAS hastalarında kontrol grubuna göre daha sık olduğu gözlendi (%30,3-10,2). PBH sıklığı OUAS şiddetine paralel olarak artmaktaydı.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome, Periodic Limb Movements and Related Factors

Yalın¹,

Yılmaz²,

Sungur³

et al. 2015

tnd

View full text Add to dashboard Cite

show abstract

“…The Multi-Ethnic Study of Atherosclerosis (MESA) concluded that OSA is a risk marker for increased blood pressure, whereas limb movements with arousals were independently associated with increased diastolic blood pressure. 8 In the current study, patients with significant PLMS had higher arterial stiffness at baseline, overnight, and in the morning, compared to ageand BMI-matched controls, and were generally comparable to those of patients with moderate/severe OSA. These findings may reflect the importance of PLMS in the development of CVD but also the applicability of using a validated marker of large artery stiffness, SI DVP , in large-scale studies through conventional pulse oximetry recordings, even without the utilization of commercial devices or sophisticated algorithms.…”

mentioning

confidence: 74%

“…8,9,11,27 Although conventional methods of measuring large artery stiffness would not be applicable during an overnight sleep study, new validated methods provide this option. SI DVP derived from photoplethysmography shares the same principles as pulse oximetry, allowing for overnight analysis in patients with various sleep conditions.…”

Section: Discussionmentioning

confidence: 99%

“…2 Published data suggest that the magnitude of increments of blood pressure during PLMS, especially those associated with electroencephalographic (EEG) arousals, could be on average 22 mmHg for systolic blood pressure and 11 mmHg for diastolic blood pressure, 7 and they have also been associated independently with diastolic blood pressure. 8 Although the 1,4 relationship between PLMS and hypertension remains unclear, prior large-scale, community-based studies have suggested an association between PLMS and prevalent hypertension, particularly in black men. 9 More convincing evidence exists for a relationship between PLMS and incident cardiovascular disease BRIEF SUMMARY Current Knowledge/Study Rationale: Periodic limb movements during sleep are a relatively common finding in sleep studies and even though not yet established, increasing evidence supports their possible effect on the development of cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Derived Arterial Stiffness is Increased in Patients with Obstructive Sleep Apnea and Periodic Limb Movements during Sleep

Drakatos

Higgins

Pengo

et al. 2016

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Both periodic limb movements during sleep (PLMS) and obstructive sleep apnea (OSA) have been associated with increased risk of cardiovascular disease (CVD). OSA has also been linked to increased large arterial stiffness, which is considered an independent risk factor for CVD. We utilized a previously validated index of large artery stiffness (SI DVP ) derived from the digital volume pulse (DVP) to seek comparison in patients with PLMS and OSA. Methods: Forty-nine adult male subjects, without known comorbidities that could affect arterial stiffness or on vasoactive medication, were retrospectively identified and categorized into controls (n = 8), PLMS (n = 13), OSA (n = 17), and OSA/PLMS (n = 11). The cutoff for PLMS was a periodic limb movement index (PLMI) > 15 events/h, and for OSA an apnea-hypopnea index (AHI) > 10 events/h. SI DVP was derived from the raw data of photoplethysmography of the nocturnal polysomnography, averaged for 2 min prior to sleep study initiation (baseline), after completion in the morning, and every half hour after sleep onset. Results: The groups were age/body mass index-matched. Controls showed lower baseline, morning, and overall SI DVP compared to the other groups (p < 0.01). Patients with PLMS (PLMI: 50.69 ± 9.7 events/h) and the OSA group (AHI: 29.7 ± 2 events/h) demonstrated similar overall SI DVP (6.78 ± 0.08 versus 6.94 ± 0.04, respectively, p = 0.5), whereas the OSA/PLMS (AHI: 29.35 ± 8, PLMI: 50.63 ± 7.2) group demonstrated the highest (7.40 ± 0.06, p < 0.001). Conclusions: Based on an easily reproducible and applicable marker of large arterial stiffness, patients with significant PLMS had higher SI DVP when compared to controls and comparable to those with moderate/severe OSA. The OSA/PLMS group had the highest SI DVP , implying a possible additive effect of OSA and PLMS on arterial stiffness.

show abstract