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Periodic Limb Movements and White Matter Hyperintensities in First-Ever Minor Stroke or High-Risk Transient Ischemic
Mark I Boulos1,2,3,4,2, Brian J Murray1,2,3,4, Ryan T Muir1,2
1L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Study Objectives:
Emerging evidence suggests that periodic limb movements (PLMs) may contribute to the development of cerebrovascular disease. White matter hyperintensities (WMHs), a widely accepted biomarker for cerebral small vessel disease, are associated with incident stroke and death. We evaluated the association between increased PLM indices and WMH burden in patients presenting with stroke or transient ischemic attack (TIA), while controlling for vascular risk factors and stroke severity.
Methods:
Thirty patients presenting within 2 weeks of a first-ever minor stroke or high-risk TIA were prospectively recruited. PLM severity was measured with polysomnography. WMH burden was quantified using the Age Related White Matter Changes (ARWMC) scale based on neuroimaging. Partial Spearman's rank-order correlations and multiple linear regression models tested the association between WMH burden and PLM severity.
Results:
Greater WMH burden was correlated with elevated PLM index and stroke volume. Partial Spearman's rank-order correlations demonstrated that the relationship between WMH burden and PLM index persisted despite controlling for vascular risk factors. Multivariate linear regression models revealed that PLM index was a significant predictor of an elevated ARWMC score while controlling for age, stroke volume, stroke severity, hypertension, and apnea-hypopnea index.
Conclusion:
The quantity of PLMs was associated with WMH burden in patients with first-ever minor stroke or TIA. PLMs may be a risk factor for or marker of WMH burden, even after considering vascular risk factors and stroke severity. These results invite further investigation of PLMs as a potentially useful target to reduce WMH and stroke burden.
Insights
Periodic limb movements (PLMs) are linked to white matter hyperintensities (WMHs) in stroke and TIA patients. This suggests PLMs may be a risk factor or marker for WMH burden, warranting further research.
Area of Science:
- Neurology
- Sleep Medicine
- Vascular Medicine
Background:
- Periodic limb movements (PLMs) are increasingly implicated in cerebrovascular disease development.
- White matter hyperintensities (WMHs) serve as a key biomarker for cerebral small vessel disease, predicting stroke and mortality.
- The relationship between PLMs and WMH burden in stroke/TIA patients requires further elucidation.
Purpose of the Study:
- To investigate the association between periodic limb movement (PLM) indices and white matter hyperintensity (WMH) burden.
- To assess this association in patients presenting with stroke or transient ischemic attack (TIA).
- To control for confounding factors including vascular risk factors and stroke severity.
Main Methods:
- Prospective recruitment of 30 patients with recent minor stroke or high-risk TIA.
- Measurement of PLM severity using polysomnography.
- Quantification of WMH burden via the Age Related White Matter Changes (ARWMC) scale from neuroimaging.
- Statistical analysis using partial Spearman's rank-order correlations and multiple linear regression.
Main Results:
- A significant correlation was found between greater WMH burden and elevated PLM index, as well as stroke volume.
- The association between WMH burden and PLM index remained significant after controlling for vascular risk factors.
- PLM index emerged as a significant predictor of elevated ARWMC scores, independent of age, stroke volume, stroke severity, hypertension, and apnea-hypopnea index.
Conclusions:
- The study demonstrates an association between the quantity of PLMs and WMH burden in patients experiencing their first minor stroke or TIA.
- PLMs may represent a risk factor or marker for WMH burden, even when accounting for established vascular risk factors and stroke severity.
- These findings highlight the potential of PLMs as a therapeutic target for reducing WMH and overall stroke burden, meriting further investigation.
