title: Impact on Clinical Outcomes of Periodic Leg Movements During Sleep in Hospitalized Patients Following Acute Decompensated Heart Failure.
abstract: Periodic leg movements during sleep (PLM) are characterized by regularly recurring movement of the legs during sleep. Although PLM is common and a predictor of death in patients with chronic heart failure, the clinical significance of PLM in hospitalized patients with a reduced left ventricular ejection fraction (LVEF) following acute decompensated heart failure (ADHF) remains unknown.
  
  
  
  After initial improvement of acute signs and symptoms of ADHF, 94 consecutive patients with reduced LVEF who underwent polysomnography were enrolled. They were divided into 2 groups based on the presence or absence of severe PLM defined as PLM index ≥30. The risks for clinical events, composite of all-cause death and rehospitalization, were assessed using a stepwise multivariable Cox proportional model including variables showing P<0.10 in univariate analyses. Severe PLM was observed in 21 patients (22%). At a median follow-up of 5.2 months, 30 patients experienced clinical events (32%). In the multivariable analysis, the presence of severe PLM was significantly associated with increasing clinical events (hazard ratio, 2.16; 95% confidence interval, 1.03-4.54; P=0.042) independent of hemoglobin level and the severity of sleep-disordered breathing.
  
  
  
  In hospitalized patients with systolic dysfunction following ADHF, severe PLM was prevalent and significantly associated with increased risk of death and/or rehospitalization.
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University School of Medicine.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Yatsu
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.forename: Shoko
authors.initials: S
authors.lastname: Suda
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Nanako
authors.initials: N
authors.lastname: Shiroshita
authors.forename: Mitsue
authors.initials: M
authors.lastname: Kato
authors.forename: Fusae
authors.initials: F
authors.lastname: Kawana
authors.forename: Azusa
authors.initials: A
authors.lastname: Murata
authors.forename: Takao
authors.initials: T
authors.lastname: Kato
authors.forename: Masaru
authors.initials: M
authors.lastname: Hiki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D000208:Acute Disease; D000368:Aged; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D054143:Heart Failure, Systolic / Q000150:complications / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012148:Restless Legs Syndrome / Q000401:mortality / Q000503:physiopathology*; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000401:mortality; D013318:Stroke Volume