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Sleep. 2017 Mar 1;40(3). doi: 10.1093/sleep/zsw080.

Periodic Limb Movements and White Matter Hyperintensities in First-Ever Minor Stroke or High-Risk Transient Ischemic Attack.

Boulos MI1,2,3,4,2, Murray BJ1,2,3,4, Muir RT1,2, Gao F1,2, Szilagyi GM1, Huroy M1, Kiss A4,5, Walters AS6, Black SE1,2,3,4,2, Lim AS1,2,3,4, Swartz RH1,2,3,4,2.

Author information

L.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.
Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.
Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN.


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.


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.


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.


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.


Restless Legs Syndrome.; magnetic resonance imaging; periodic limb movements of sleep; stroke; transient ischemic attack; white matter hyperintensities

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