title: Periodic limb movements during sleep and prevalent hypertension in the multi-ethnic study of atherosclerosis.
abstract: Periodic limb movements during sleep (PLMS) are associated with immediate increases in blood pressure. Both PLMS and hypertension have different distributions across racial/ethnic groups. We sought to determine whether PLMS is associated with hypertension among various racial/ethnic groups. A total of 1740 men and women underwent measurement of blood pressure and polysomnography with quantification of PLMS. Hypertension was defined as systolic blood pressure (SBP) ≥140, diastolic BP ≥90, or taking antihypertensive medication. For those taking antihypertensives, an estimated pretreatment SBP value was derived based on observed SBP and medication type/dose. Measures of PLMS, PLMS index, and PLMS arousal index were the main explanatory variables. Hypertension and SBP were modeled with logistic and multivariable regression adjusted for age, sex, body mass index, cardiovascular risk factors, lifestyle/habitual factors, apnea-hypopnea index, and race/ethnicity. In the overall cohort, prevalent hypertension was modestly associated with PLMS index (10 U; odds ratio, 1.05; 95% confidence interval, 1.00-1.10) and PLMS arousal index (1 U; 1.05; 1.01-1.09) after adjusting for confounders. Association in the overall cohort was influenced by large effect sizes in blacks, in whom the odds of prevalent hypertension increased by 21% (1%-45%) for 10 U PLMS index increase and 20% (2%-42%) for 1-U PLMS arousal index increase. In blacks, every 1-U PLMS arousal index increase was associated with SBP 1.01 mm Hg higher (1.01; 0.04-1.98). Associations between PLMS and blood pressure outcomes were also suggested among Chinese-Americans but not in whites or Hispanics. In a multiethnic cohort of community-dwelling men and women, prevalent hypertension and SBP are associated with PLMS frequency in blacks.
authors.affiliation: From the Department of Neurology, Yale University School of Medicine, New Haven, CT (B.B.K.); Department of Neurology, Connecticut Veterans Affairs Health System, West Haven (B.B.K.); Department of Biostatistics, University of Washington School of Public Health, Seattle (S.S.); Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (D.A.D., S.R.); and Department of Epidemiology, University of Minnesota, Minneapolis (P.L.L.). koobri@gmail.com.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Koo
authors.affiliation: From the Department of Neurology, Yale University School of Medicine, New Haven, CT (B.B.K.); Department of Neurology, Connecticut Veterans Affairs Health System, West Haven (B.B.K.); Department of Biostatistics, University of Washington School of Public Health, Seattle (S.S.); Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (D.A.D., S.R.); and Department of Epidemiology, University of Minnesota, Minneapolis (P.L.L.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Sillau
authors.affiliation: From the Department of Neurology, Yale University School of Medicine, New Haven, CT (B.B.K.); Department of Neurology, Connecticut Veterans Affairs Health System, West Haven (B.B.K.); Department of Biostatistics, University of Washington School of Public Health, Seattle (S.S.); Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (D.A.D., S.R.); and Department of Epidemiology, University of Minnesota, Minneapolis (P.L.L.).
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Dean
authors.affiliation: From the Department of Neurology, Yale University School of Medicine, New Haven, CT (B.B.K.); Department of Neurology, Connecticut Veterans Affairs Health System, West Haven (B.B.K.); Department of Biostatistics, University of Washington School of Public Health, Seattle (S.S.); Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (D.A.D., S.R.); and Department of Epidemiology, University of Minnesota, Minneapolis (P.L.L.).
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
authors.affiliation: From the Department of Neurology, Yale University School of Medicine, New Haven, CT (B.B.K.); Department of Neurology, Connecticut Veterans Affairs Health System, West Haven (B.B.K.); Department of Biostatistics, University of Washington School of Public Health, Seattle (S.S.); Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (D.A.D., S.R.); and Department of Epidemiology, University of Minnesota, Minneapolis (P.L.L.).
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D050197:Atherosclerosis / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology*; D005006:Ethnicity; D005121:Extremities / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D017286:Polysomnography; D015995:Prevalence; D011446:Prospective Studies; D012890:Sleep; D014481:United States / Q000453:epidemiology
keywords: PLMS; blood pressure; continental population groups; ethnicity; hypertension