Periodic limb movements during sleep in patients with congestive heart failure

The prevalence of periodic limb movements (PLM) during sleep and their effect on sleep and daytime alertness were determined in 23 men with severe, stable congestive heart failure (CHF) and 9 healthy control subjects. Each subject had overnight polysomnography and the following day completed a subjective assessment of daytime sleepiness (Epworth Sleepiness Scale [ESS]) and a multiple sleep latency test (MSLT). The proportion of CHF patients with moderately severe PLM (>25/h) was significantly higher (52%) than control subjects (11%). CHF patients were subdivided into two groups, those with more than 10 PLM per hour (group 1, n=15) and those with less than 10 PLM per hour (group 2, n=8). Group 1 had a significantly higher frequency of PLM (group 1, 73 +/- 50; group 2, 4 +/- 4; control, 11 +/- 12/h) and associated arousals from sleep (group 1, 14 +/- 13; group 2, 2 +/- 3; control subjects, 1 +/- 1/h) than group 2 and the control group, and had more stage 1 and 2 nonrapid eye movement sleep than the control group (group 1, 77 +/- 11; group 2, 71 +/- 11; control, 63 +/- 9% total sleep time). Mean sleep latency on the MSLT was significantly shorter in group 1 than the control group (group 1, 6.1 +/- 2.9; group 2, 9 +/- 6.7; control subjects, 12.4 +/- 1.9 min). Although the ESS score was highest in group 1, this did not reach statistical significance. We conclude that PLM are more prevalent in patients with CHF and may contribute to their sleep/wake complaints.