Atenolol as antihypertensive treatment decreases nocturnal periodic limb movements (PLM) more than isradipine SR in hypertensive sleep apneic patients

Abstract

Sleep disorders, including sleep apnea, may accompany nocturnal periodic limb movements (PLM) which are stereotyped repetitive muscle jerks in the extremities during sleep. We studied the effect of four different antihypertensive medications on the prevalence of PLM. Eighteen patients with upper airway obstruction and hypertension were randomized in a double blind crossover fashion to receive each of the four different antihypertensive medications (beta-blocking agent atenolol (AT) 50 mg, diuretic hydrochlorothiazide (HCTZ) 25 mg, Ca-antagonist isradipine SRO (ISR) 2,5 mg and ACE-inhibitor spirapril (SP) 6 mg once a day for eight weeks with a 2–3 week washout period between the different medications. Sleep study using the static charge-sensitive bed method was performed both at the beginning and the end of each medication. The amount of PLM was visually analyzed by a single neurophysiologist (ER) and calculated as percentage of time in bed. Reliable sleep data was available from 15 patients. The amount of PLM during the baseline nights varied between 0 and 50 % of time in bed among the patients (mean 7.5 % (SD 11.5 %). AT decreased the amount of PLM 1.54 % (SD 6.13 %) of time in bed and spirapril 1.1 % (12.0 %). Instead ISR increased the amount of PLM 3.2 % (7.7 %) of time in bed and HCTZ 0.68 % (11.0 %). The difference between AT and ISR was statistically significant (p=0.05). Atenolol decreased the amount of PLM more than isradipine SR. However the difference was so small, that it was not of clinical significance, although it was statistically significant.