Critical periodic limb movement disorder followed by cardio-pulmonary arrest (CPA) two months later: a case report

Abstract

One of the causes of epidemiological association of restless legs syndrome and cardiovascular disease is thought of as periodic limb movement during sleep associated with substantial elevation in heart rate (HR) and blood pressure. We describe a pacemaker-implanted patient with bradycardiac atrial fibrillation (AF), who was diagnosed with periodic limb movement disorder without marked HR elevation on polysomnographic examination, and progressed to CPA two months later. A 79-year old man came to our clinic because of daytime sleepiness. He had multiple histories, a cardiac pace-maker for bradycardiac AF and old myocardial infarction, hypertension, diabetes mellitus, coagulation factor deficiency, and renal failure. Polysomnography showed short sleep latency (1 min) with few respiratory events (AHI = 4.3) and few arousals (arousal index = 8.0). Sleep structure was poor with increased N1, decreased N2 and R. Periodic leg movement (PLM) during sleep index was 93.0. Heart rate increments for PLM without arousal and PLM with arousal are 0.585 ± 2.006 (0–36) and 1.029 ± 1.834 (0–10), respectively. Percentage of PLMs with HR elevation was only 27.8%. This patient is a good example of critical PLM, with higher PLM index, decreased percentage of PLM associated HR elevation and decreased HR increments. This was not an industry supported study. The author has indicated no financial conflict of interest.