Abstract
Sleep apnea has been recognized as a factor predisposing to atrial fibrillation recurrence and progression. The effect of other sleep-disturbing conditions on atrial fibrillation progression is not known. We sought to determine whether frequent periodic leg movement during sleep is a risk factor for progression of atrial fibrillation. In this retrospective study, patients with atrial fibrillation and a clinical suspicion of restless legs syndrome who were referred for polysomnography were divided into two groups based on severity of periodic leg movement during sleep: frequent (periodic movement index >35/h) and infrequent (≤35/h). Progression of atrial fibrillation to persistent or permanent forms between the two groups was compared using Wilcoxon rank-sum test, chi-square tests and logistic regression analysis. Of 373 patients with atrial fibrillation (77% paroxysmal, 23% persistent), 108 (29%) progressed to persistent or permanent atrial fibrillation during follow-up (median, 33 months; interquartile range, 16-50). Compared to patients with infrequent periodic leg movement during sleep (n=168), patients with frequent periodic leg movement during sleep (n=205) had a higher rate of atrial fibrillation progression (23% vs. 34%; p=0.01). Patients with frequent periodic leg movement during sleep were older and predominantly male; however, there were no significant differences at baseline in clinical factors that promote atrial fibrillation progression between both groups. On multivariate analysis, independent predictors of atrial fibrillation progression were persistent atrial fibrillation at baseline, female gender, hypertension and frequent periodic leg movement during sleep. In patients with frequent periodic leg movement during sleep, dopaminergic therapy for control of leg movements in patients with restless legs syndrome reduced risk of atrial fibrillation progression. Frequent leg movement during sleep in patients with restless legs syndrome is associated with progression of atrial fibrillation to persistent and permanent forms.
Highlights
Atrial fibrillation (AF), a common arrhythmia associated with increased morbidity and mortality, is increasingly recognized to be affected by sleep disturbances, obstructive sleep apnea [1,2,3]
From January 2000 to August 2007, 4,951 consecutive patients with a clinical suspicion of Restless legs syndrome (RLS) were referred for overnight polysomnography for sleep disturbance with an overall 8% prevalence of AF
No significant differences were found at baseline between the groups in the presence of major comorbidities that could potentially increase the risk for AF progression, such as hypertension, diabetes mellitus, coronary artery disease, myocardial infarction, heart failure, left ventricular ejection fraction or use of Class I or III antiarrhythmic agents
Summary
Atrial fibrillation (AF), a common arrhythmia associated with increased morbidity and mortality, is increasingly recognized to be affected by sleep disturbances, obstructive sleep apnea [1,2,3]. Periodic leg movement during sleep (PLMS) is common in patients with RLS and can be quantified by overnight polysomnography [6,7]. These movements manifest as involuntary leg-jerking movement during sleep, leading to disturbed sleep without the hypoxemia or changes in intrathoracic pressure seen with obstructive sleep apnea [8,9,10,11,12]. Repeated arousals from sleep are associated with an increased sympathetic drive and lead to mental and physical stress with nocturnal fluctuations in blood pressure, heart rate and other hemodynamic effects [12,13,14] that can adversely affect cardiac electrophysiology [15,16] and promote structural remodeling [13,14,17]. The objective of this study was to assess the impact of the severity of PLMS, and examine the association of periodic movement index on the progression of AF and whether treatment of RLS influences progression of AF in this patient population
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