Association between periodic limb movements in sleep and cerebrovascular changes in children with sickle cell disease

Jenny Lin, Kerry A. Morrone, Deepa G. Manwani, Rina Chernin, Ellen J. Silver, Keivan Shifteh, Sanghun Sin, Raanan Arens, Katharina Graw-Panzer

Research output: Contribution to journalArticle

Abstract

Study Objectives: Periodic limb movements (PLMs) have been associated with increased risk of stroke, but there is currently scarce research exploring this relationship in the setting of sickle cell disease (SCD). The aim of this study was to explore whether increased PLMs in children with SCD are associated with increased risk of cerebrovascular disease and to determine if there are any clinical or laboratory differences between children with SCD with elevated periodic limb movement index (PLMI) versus those with normal PLMI. Methods: This study is a comprehensive review of medical records of 129 children with SCD (aged ≤ 18 years) who had undergone polysomnography for evaluation of sleep-disordered breathing. Results: Elevated PLMI (PLMI > 5 events/h) was present in 42% (54/129) of children with SCD. Children with elevated PLMI were found to have higher percentage of hemoglobin S, lower total iron, higher arousal index and tendency toward elevated transcranial Doppler velocity (P = .063, odds ratio = 3.9, 95% CI 0.93–16.22). While association between elevated PLMI and isolated cerebrovascular stenosis (P = .050, odds ratio 5.6, 95% CI 1.0–31.10) trended toward significance, there was significantly greater proportion of children with elevated PLMI who had cerebrovascular stenosis with Moyamoya disease (P = .046) as demonstrated by magnetic resonance imaging (MRI). Conclusions: The prevalence of elevated PLMI in children with SCD was higher than in previously published data. Elevated PLMI was significantly associated with greater rates of cerebrovascular disease as detected by MRI.

Original languageEnglish (US)
Pages (from-to)1011-1019
Number of pages9
JournalJournal of Clinical Sleep Medicine
Volume15
Issue number7
DOIs
StatePublished - Jan 1 2019

Fingerprint

Sickle Cell Anemia
Sleep
Extremities
Cerebrovascular Disorders
Pathologic Constriction
Odds Ratio
Magnetic Resonance Imaging
Moyamoya Disease
Sickle Hemoglobin
Polysomnography
Sleep Apnea Syndromes
Arousal
Medical Records
Iron
Stroke

Keywords

  • Cerebrovascular disease
  • Children
  • Magnetic resonance imaging
  • Periodic limb movements in sleep
  • Polysomnography
  • Sickle cell disease
  • Transcranial doppler

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

@article{71ed91e45d844423952ccbb8bbc4fed5,
title = "Association between periodic limb movements in sleep and cerebrovascular changes in children with sickle cell disease",
abstract = "Study Objectives: Periodic limb movements (PLMs) have been associated with increased risk of stroke, but there is currently scarce research exploring this relationship in the setting of sickle cell disease (SCD). The aim of this study was to explore whether increased PLMs in children with SCD are associated with increased risk of cerebrovascular disease and to determine if there are any clinical or laboratory differences between children with SCD with elevated periodic limb movement index (PLMI) versus those with normal PLMI. Methods: This study is a comprehensive review of medical records of 129 children with SCD (aged ≤ 18 years) who had undergone polysomnography for evaluation of sleep-disordered breathing. Results: Elevated PLMI (PLMI > 5 events/h) was present in 42{\%} (54/129) of children with SCD. Children with elevated PLMI were found to have higher percentage of hemoglobin S, lower total iron, higher arousal index and tendency toward elevated transcranial Doppler velocity (P = .063, odds ratio = 3.9, 95{\%} CI 0.93–16.22). While association between elevated PLMI and isolated cerebrovascular stenosis (P = .050, odds ratio 5.6, 95{\%} CI 1.0–31.10) trended toward significance, there was significantly greater proportion of children with elevated PLMI who had cerebrovascular stenosis with Moyamoya disease (P = .046) as demonstrated by magnetic resonance imaging (MRI). Conclusions: The prevalence of elevated PLMI in children with SCD was higher than in previously published data. Elevated PLMI was significantly associated with greater rates of cerebrovascular disease as detected by MRI.",
keywords = "Cerebrovascular disease, Children, Magnetic resonance imaging, Periodic limb movements in sleep, Polysomnography, Sickle cell disease, Transcranial doppler",
author = "Jenny Lin and Morrone, {Kerry A.} and Manwani, {Deepa G.} and Rina Chernin and Silver, {Ellen J.} and Keivan Shifteh and Sanghun Sin and Raanan Arens and Katharina Graw-Panzer",
year = "2019",
month = "1",
day = "1",
doi = "10.5664/jcsm.7884",
language = "English (US)",
volume = "15",
pages = "1011--1019",
journal = "Journal of Clinical Sleep Medicine",
issn = "1550-9389",
publisher = "American Academy of Sleep Medicine",
number = "7",

}

TY - JOUR

T1 - Association between periodic limb movements in sleep and cerebrovascular changes in children with sickle cell disease

AU - Lin, Jenny

AU - Morrone, Kerry A.

AU - Manwani, Deepa G.

AU - Chernin, Rina

AU - Silver, Ellen J.

AU - Shifteh, Keivan

AU - Sin, Sanghun

AU - Arens, Raanan

AU - Graw-Panzer, Katharina

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Study Objectives: Periodic limb movements (PLMs) have been associated with increased risk of stroke, but there is currently scarce research exploring this relationship in the setting of sickle cell disease (SCD). The aim of this study was to explore whether increased PLMs in children with SCD are associated with increased risk of cerebrovascular disease and to determine if there are any clinical or laboratory differences between children with SCD with elevated periodic limb movement index (PLMI) versus those with normal PLMI. Methods: This study is a comprehensive review of medical records of 129 children with SCD (aged ≤ 18 years) who had undergone polysomnography for evaluation of sleep-disordered breathing. Results: Elevated PLMI (PLMI > 5 events/h) was present in 42% (54/129) of children with SCD. Children with elevated PLMI were found to have higher percentage of hemoglobin S, lower total iron, higher arousal index and tendency toward elevated transcranial Doppler velocity (P = .063, odds ratio = 3.9, 95% CI 0.93–16.22). While association between elevated PLMI and isolated cerebrovascular stenosis (P = .050, odds ratio 5.6, 95% CI 1.0–31.10) trended toward significance, there was significantly greater proportion of children with elevated PLMI who had cerebrovascular stenosis with Moyamoya disease (P = .046) as demonstrated by magnetic resonance imaging (MRI). Conclusions: The prevalence of elevated PLMI in children with SCD was higher than in previously published data. Elevated PLMI was significantly associated with greater rates of cerebrovascular disease as detected by MRI.

AB - Study Objectives: Periodic limb movements (PLMs) have been associated with increased risk of stroke, but there is currently scarce research exploring this relationship in the setting of sickle cell disease (SCD). The aim of this study was to explore whether increased PLMs in children with SCD are associated with increased risk of cerebrovascular disease and to determine if there are any clinical or laboratory differences between children with SCD with elevated periodic limb movement index (PLMI) versus those with normal PLMI. Methods: This study is a comprehensive review of medical records of 129 children with SCD (aged ≤ 18 years) who had undergone polysomnography for evaluation of sleep-disordered breathing. Results: Elevated PLMI (PLMI > 5 events/h) was present in 42% (54/129) of children with SCD. Children with elevated PLMI were found to have higher percentage of hemoglobin S, lower total iron, higher arousal index and tendency toward elevated transcranial Doppler velocity (P = .063, odds ratio = 3.9, 95% CI 0.93–16.22). While association between elevated PLMI and isolated cerebrovascular stenosis (P = .050, odds ratio 5.6, 95% CI 1.0–31.10) trended toward significance, there was significantly greater proportion of children with elevated PLMI who had cerebrovascular stenosis with Moyamoya disease (P = .046) as demonstrated by magnetic resonance imaging (MRI). Conclusions: The prevalence of elevated PLMI in children with SCD was higher than in previously published data. Elevated PLMI was significantly associated with greater rates of cerebrovascular disease as detected by MRI.

KW - Cerebrovascular disease

KW - Children

KW - Magnetic resonance imaging

KW - Periodic limb movements in sleep

KW - Polysomnography

KW - Sickle cell disease

KW - Transcranial doppler

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U2 - 10.5664/jcsm.7884

DO - 10.5664/jcsm.7884

M3 - Article

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JO - Journal of Clinical Sleep Medicine

JF - Journal of Clinical Sleep Medicine

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