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Volume 10 No. 01
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Accepted Papers

Scientific Investigations

Periodic Limb Movements during Sleep and Cardiac Arrhythmia in Older Men (MrOS Sleep)

Brian B. Koo, M.D.1; Reena Mehra, M.D., M.S., F.A.A.S.M.2; Terri Blackwell, M.A.3; Sonia Ancoli-Israel, Ph.D., F.A.A.S.M.4; Katie L. Stone, Ph.D.3; Susan Redline, M.D., M.P.H.5
1Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH; 2Department of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University School of Medicine, Cleveland, OH; 3Research Institute, California Pacific Medical Center, San Francisco, CA; 4Department of Psychiatry, University of California, San Diego, La Jolla, CA; 5Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Study Objectives:

To determine if periodic limb movements during sleep (PLMS) are associated with nocturnal cardiac arrhythmia.


2,793 community-dwelling older men underwent polysomnography with measurement of limb movements and EKG. Logistic regression assessed association of periodic limb movement index and periodic limb movement arousal index with arrhythmia including atrial fibrillation and non-sustained ventricular tachycardia detected by polysomnography. Models were adjusted for age, race, cardiovascular risk factors, and clinic site. Secondary analyses were subset to men without calcium channel/β-adrenergic medication usage, and stratified by congestive heart failure or myocardial infarction history.


In the overall cohort, periodic limb movement index, and periodic limb movement arousal index were not associated with ventricular or atrial arrhythmia after considering potential confounders. In men not taking calcium channel/β-blocking medication, increased adjusted odds of non-sustained ventricular tachycardia were observed for periodic limb movement index (OR = 1.30 per SD increase; 95% CI 1.00, 1.68) and periodic limb movement arousal index (OR = 1.29 per SD increase; 95% CI 1.03, 1.62). In men with CHF or MI, there was a suggested association of atrial fibrillation with periodic limb movement index (OR = 1.29, 95% CI 0.96, 1.73 per SD increase; p = 0.09) or periodic limb movement arousal index (OR = 1.21, 95% CI 0.94, 1.57 per SD increase; p = 0.14), although results were not statistically significant.


There is not an association between PLMS and cardiac arrhythmia in all older men but in subsets of men, particularly those with structural heart disease and not on calcium channel or β-adrenergic medication, cardiac arrhythmia does associate with PLMS.


Koo BB; Mehra R; Blackwell T; Ancoli-Israel S; Stone KL; Redline S; for the Osteoporotic Fractures in Men (MrOS) Study Group. Periodic limb movements during sleep and cardiac arrhythmia in older men (MrOS sleep). J Clin Sleep Med 2014;10(1):7-11.

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