Final_article_PLMS_prevalence_AF_IJC_2017.pdf

Background: Growing evidence indicates that periodic limb movements of sleep (PLMS) may be related to increased risk of developing cardiovascular disease. However, the association of PLMS with atrial fibrillation (AF) is unclear, especially in patientswith sleep-disordered breathing (SDB). This study sought to investigatewhether PLMS were associated with increased AF prevalence, independent of established risk factors. Methods: We performed a cross-sectional study of patients who underwent attended polysomnography atMayo Clinic from2011 to 2014. The association of PLMSwith AF prevalence was estimated by using logistic regression models. Results: 15,414 patients were studied, 76.3% of individuals with SDB defined by apnea-hypopnea index (AHI) ≥5/h, and 15.3% with a diagnosis of AF. In univariate logistic modelling, individuals with periodic limb movement index (PLMI) ≥30/h had higher odds of AF (odds ratio [OR] 1.96, 95% confidence interval [CI]1.79–2.16, p b 0.001) when compared to patients with PLMI b15/h. After multivariate adjustment (for age, race, sex, history of smoking, hypertension, diabetes, coronary artery disease, heart failure, cerebrovascular disease, renal disease, iron deficiency anemia, chronic obstructive pulmonary disease, AHI, arousal index), inmild SDB patients, a PLMI ≥30/h or periodic limbmovement arousal index (PLMAI) ≥5/h had significantly higher odds of AF than thosewith PLMI b15/h (OR 1.21, 95% CI 1.00–1.47, p=0.048) or PLMAI b1/h (OR 1.27, 95% CI 1.03–1.56, p= 0.024). Conclusions: Frequent PLMS are independently associated with AF prevalence in patients with mild SDB. Further studies are needed to better understand the relationship with incident AF.