Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 26, 2015; 3(3): 181-187
Published online Jun 26, 2015. doi: 10.13105/wjma.v3.i3.181
Sleep-associated movement disorders and the risk of cardiovascular disease: A systematic review and meta-analysis
Zhen Fang, Yao-Wu Liu, Li-Yan Zhao, Yan Xu, Feng-Xiang Zhang
Zhen Fang, Yao-Wu Liu, Li-Yan Zhao, Yan Xu, Feng-Xiang Zhang, Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Fang Z, Liu YW and Zhang FX designed the review; Fang Z, Zhao LY and Xu Y collected the data; Fang Z and Liu YW analyzed the data and wrote the paper.
Supported by The National Natural Science Foundation of China, Nos. 81470456 and 81170160; The priority Academic Program Development of Jiangsu Higher Education Institutions.
Conflict-of-interest: No conflict of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Feng-Xiang Zhang, MD, PhD, Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, Jiangsu Province, China. njzfx6@njmu.edu.cn
Telephone: +86-25-68136056 Fax: +86-25-83717168
Received: January 25, 2015
Peer-review started: January 27, 2015
First decision: February 7, 2015
Revised: April 9, 2015
Accepted: April 16, 2015
Article in press: April 20, 2015
Published online: June 26, 2015
Abstract

AIM: To investigate whether an association exists between sleep-associated movement disorders and cardiovascular disease (CVD).

METHODS: Several studies have observed the relationship of sleep-associated movement disorders such as restless legs syndrome (RLS) and periodic limb movements during sleep with CVD, but the results were still contradictory. We performed an extensive literature search on PubMed, Medline and Web of Science published from inception to December 2014. Additional studies were manually searched from bibliographies of retrieved studies. Meta-analyses were conducted with Stata version 12.0 (Stata Corp, College Station, Texas). Pooled odds ratios (ORs) and 95%CIs were calculated to assess the strength of association using the random effects model. Sensitivity and subgroup analyses were performed to explore the underlying sources of heterogeneity. The publication bias was detected using Egger’s test and Begg’s test.

RESULTS: A total of 781 unique citations were indentified from electronic databases and 13 articles in English were finally selected. Among these studies, nine are cohort studies; two are case-control studies; and two are cross-sectional studies. The results showed that the summary OR of CVD associated with sleep-associated movement was 1.51 (95%CI: 1.29-1.77) in a random-effects model. There was significant heterogeneity between individual studies (P for heterogeneity = 0.005, I2 = 57.6%). Further analysis revealed that a large-scale cohort study may account for this heterogeneity. A significant association was also found between RLS and CVD (OR = 1.54, 95%CI: 1.24-1.92). In a fixed-effects model, we determined a significant relationship between sleep-associated movement disorders and coronary artery disease (CAD) (OR = 1.34, 95%CI: 1.16-1.54; P for heterogeneity = 0.210; I2 = 30.0%). Our meta-analysis suggests that sleep-associated movement disorders are associated with prevalence of CVD and CAD.

CONCLUSION: This finding indicates that sleep-associated movement disorders may prove to be predictive of underlying CVD.

Keywords: Sleep-associated movement disorders, Restless legs syndrome, Cardiovascular disease, Meta-analysis, Periodic limb movements during sleep

Core tip: We conducted a meta-analysis of 13 relevant studies to investigate the association between sleep-associated movement disorders and cardiovascular disease (CVD). The present study suggested that sleep-associated movement disorders are associated with prevalence of CVD. This finding indicates that sleep-associated movement disorders may prove to be predictive of underlying CVD.