0811 Periodic Limb Movements In Patients With Dysautonomia

Abstract

Abstract Introduction Periodic Limb Movements in Sleep (PLM) have been thought to result in increase in sympathetic tone in sleep, tachycardia, elevated systolic blood pressure and therefore elevation in risk of cardiovascular disease. However, evidence of a direct causative relationship has been elusive. We discuss the presence of PLM in patients with dysautonomia, proposing that autonomic dysfunction may be either a causative factor for PLM or share common pathogenesis with PLM. Methods Three patients with dysautonomia, referred to the TIRR Memorial Hermann Hospital neurological sleep disorders center with varying sleep-related symptoms were studied with polysomnography, recorded under AASM guidelines. PLM were scored using standard criteria described in the AASM scoring manual. Results The three patients described all carried a diagnosis of dysautonomia, diagnosed by tilt table testing. The first patient was an 18 year old woman with complaints of palpitations during sleep and frequent arousals. Her PLM index was 49.8. Serum ferritin level was pending. The second patient was a 35-year-old woman who complained of nonrestorative sleep. Polysomnogram demonstrated a PLM index of 17.6. Ferritin level was 36 ng/mL. The third patient was a 34-year-old woman with insomnia who was also found to have a PLM index of 15.1. Her serum ferritin level was 24. She underwent therapeutic iron infusions and experienced substantial improvement in subjective sleep quality. None of the patient described symptoms of restless legs syndrome or had any bleeding disorders to explain low ferritin levels. Conclusion The patients described above all were relatively healthy young women with symptoms of dysautonomia and disturbed sleep. It would be unusual for young individuals to present with PLM which are commonly associated with advancing age. In at least one patient, iron infusions improved sleep quality dramatically. Work needs to be done to establish relationship between autonomic imbalance and PLM, suggesting that the previously thought unidirectional relationship, [i.e. PLM causing change in sympathetic tone] may actually be bidirectional. Support None