Study on the characteristics and influencing factors of periodic limb movement in sleep for patients with acute cerebral infarction

Xu Xinran; Han Bingyu; Bian Zhijie; Zhao Cong; Pan Xinrui; Ma Xiaolong; Zheng Hao; Tuo Houzhen

doi:10.3969/j.issn.1672-5921.2025.12.002

Abstract：Objective To investigate the characteristics and influencing factors of periodic limb movement in sleep(PLMS)in patients with acute cerebral infarction.Methods A retrospective consecutive study was conducted on patients with acute cerebral infarction who were hospitalized in the Neurology Department of Beijing Friendship Hospital,Capital Medical University,from October 2020 to June 2024.General and clinical data of the patients,including age,sex,infarction location(frontal lobe,parietal lobe,temporal lobe,occipital lobe,insular lobe,cortical radiata,internal capsule,thalamus,basal ganglia,brainstem[midbrain,pons,medulla],cerebellum[cerebellar hemisphere,cerebellar vermis],patients with multiple cerebral infarctions record each infarction location),baseline National Institutes of Health stroke scale(NIHSS)score and modified Rankin scale(mRS)score,blood indicators on the day of admission or the next day(hemoglobin,platelets,glycosylated hemoglobin,creatinine,total cholesterol,low-density lipoprotein cholesterol),past medical history(hypertension,diabetes,atrial fibrillation,coronary heart disease,hyperlipidemia,chronic kidney disease,previous cerebral infarction),smoking history,drinking history and treatment method(standard drug treatment,standard drug treatment+endovascular treatment)were collected.The mini-mental state examination(MMSE)scale and Montreal cognitive assessment(MoCA)scale of patients who completed cognitive function assessment within 14 days after onset were collected.Collecte all the indicators of polysomnography(PSG),including periodic limb movement index(PLMI),sleep apnea,sleep efficiency,N1,N2,N3,R-phase sleep ratio,R-phase latency time,limb movement-related awakening times,limb movement-related awakening index,sleep apnea-hypopnea index,average blood oxygen saturation,and minimum blood oxygen saturation.Patients were divided into the PLMS group(PLMI≥5times/h)and the non-PLMS group(PLMI＜5times/h)based on PLMI.General and clinical data,and PSG-related indicators were compared between the PLMS group and non-PLMS group,variables with P＜0.1 were included in the multivariate Logistic regression analysis model using the forward stepwise regression based on maximum likelihood estimation to investigate the influencing factors of PLMS in patients with acute cerebral infarction.The goodness of fit of the model was tested using the Hosmer-Lemeshow test,and P＞0.05 was considered a high goodness of fit.Results A total of 220 patients with acute cerebral infarction were collected,including 163 males and 57 females,aged 30 to 86 years,with an average age of(62±10)years.Among them,130 patients(59.1%)were in the PLMS group and 90patients(40.9%)were in the non-PLMS group.(1)Compared with the non-PLMS group,patients in the PLMS group were older([64±10]years vs.[61±10]years,P=0.04),and had lower hemoglobin levels([138.83±15.19]g/L vs.[143.66±15.03]g/L,P=0.02),and there were no statistically significant differences in the other general and clinical data between the two groups(all P＞0.05).(2)Among 92 patients who completed cognitive function assessment,37 patients in the non-PLMS group and 55 patients in the PLMS group,the scores of MoCA scale of the PLMS group was lower than that of the non-PLMS group(24[19,26]points vs.26[22,28]points,P=0.02),and there was no statistically significant difference in MMSE scale score between the two groups(P=0.37).(3)The median PLMI of patients in the PLMS group was 19.90(11.90,44.03)times/h,and that of the non-PLMS group was 0.85(0.00,2.00)times/h and there was a statistically significant difference between the two groups(P＜0.01).Compared with the non-PLMS group,patients in the PLMS group had more limb movement-related awakening times(0.00[0.00,1.00]times vs.0.00[0.00,0.00]times,P＜0.01)and higher limb movement-related awakening index(0.00[0.00,0.85]times/h vs.0.00[0.00,0.00]times/h,P＜0.01).There were no statistically significant differences in the other PSG-related indicators between the two groups(all P＞0.05).(4)Age,hyperlipidemia,low-density lipoprotein cholesterol,hemoglobin,and the number of limb movement-related awakenings were included in the multivariate Logistic regression model.The results showed that hyperlipidemia might be an influencing factor for PLMS in patients with acute cerebral infarction(OR,0.49,95%CI 0.26-0.94,P＜0.05),but the goodness of fit of this model was low(Hosmer-Lemeshow test P=0.04).Conclusions The proportion of acute cerebral infarction patients who have PLMS is relatively high,and compared with patients without PLMS,they are older,and have lower hemoglobin levels,more limb movement-related awakenings during sleep,and lower MoCA scale scores.Hyperlipidemia might be an influencing factor for PLMS in patients with acute cerebral infarction,while this finding should be interpreted with caution.