Sleep Med Psychophysiol.  2018 Dec;25(2):51-57. 10.14401/KASMED.2018.25.2.51.

Decreased Nocturnal Blood Pressure Dipping in Patients with Periodic Limb Movements in Sleep

• Lee MH
• Choi JW
• Oh SM
• Lee YJ

• KMID: 2434606
• DOI: http://doi.org/10.14401/KASMED.2018.25.2.51

Abstract

OBJECTIVES
Previous studies have shown that periodic limb movements in sleep (PLMS) could be one of risk factors for cardiovascular morbidity. The purpose of this study was to investigate the association between PLMS and blood pressure changes during sleep.
METHODS
We analyzed data from 358 adults (176 men and 182 women) aged 18 years and older who were free from sleep apnea syndrome (Respiratory Disturbance Index < 5) and sleep disorders such as REM sleep behavior disorder or narcolepsy. Demographic characteristics, polysomnography records, and clinical variable data including blood pressure, body mass index, alcohol, smoking, and current medications were collected. In addition, self-report questionnaires including the Beck Depression Index, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index were completed. Blood pressure change from bedtime to awakening was compared between the two periodic limb movement index (PLMI) groups [low PLMI (PLMI ≤ 15) and high PLMI (PLMI > 15)]. Blood pressure change patterns were compared using repeated measures analysis of variance.
RESULTS
Systolic blood pressure in the high PLMI group was lower than that in the low PLMI group (p = 0.036). These results were also significant when adjusted for gender and age, but were not statistically significant when adjusted for BMI, alcohol, smoking, anti-hypertension medication use and sleep efficiency (p = 0.098). Systolic blood pressure dropped by 9.7 mm Hg in the low PLMI group, and systolic blood pressure in the high PLMI group dropped by 2.9 mm Hg. There was a significant difference in delta systolic blood pressure after sleep between the two groups in women when adjusted for age, BMI, alcohol, smoking, antihypertensive medication use and sleep efficiency (p = 0.023).
CONCLUSION
PLMS was significantly associated with a decreasing pattern in nocturnal BP during sleep, and this association remained significant in women when adjusted for age, BMI, alcohol, smoking, antihypertension medication use and sleep efficiency related to blood pressure. We suggest that PLMS may be associated with cardiovascular morbidity.

Keyword

Periodic limb movements during sleep; Nocturnal blood pressure; Hypertension; Polysomnography

MeSH Terms

Adult
Blood Pressure*
Body Mass Index
Depression
Extremities*
Female
Humans
Hypertension
Male
Narcolepsy
Polysomnography
REM Sleep Behavior Disorder
Risk Factors
Sleep Apnea Syndromes
Sleep Wake Disorders
Smoke
Smoking
Smoke