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Background <p>Periodic limb movements in sleep (PLMS) have been associated with cardiovascular morbidity, but their relationship with stroke remains incompletely understood. This systematic review and meta-analysis evaluated the association between PLMS and stroke risk.</p> Methods <p>We systematically searched MEDLINE, EMBASE, and Cochrane Library databases through March 2025 for observational studies and clinical trials examining PLMS and stroke. Two independent investigators selected studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Risk ratios were pooled using random-effects meta-analysis with the generic inverse variance method of DerSimonian and Laird.</p> Results <p>Six observational studies comprising 6,557 patients met inclusion criteria. Only two studies employed prospective designs capable of establishing temporality between PLMS and stroke occurrence. Diagnostic methods varied substantially across studies, with PLMS thresholds ranging from &gt; 5/h to &gt; 30/h, and stroke definitions ranging from imaging-confirmed to self-reported events. Meta-analysis revealed that PLMS was associated with increased stroke risk (pooled risk ratio 1.88; 95% CI, 1.00-3.52; <i>P</i> = 0.05), though with substantial heterogeneity (I²=88%). Analysis restricted to prospective studies showed similar associations (RR 2.31; 95% CI, 1.12–4.77; <i>P</i> = 0.02; I²=85%). Egger’s test suggested potential publication bias (<i>P</i> = 0.04).</p> Conclusions <p>Our analysis suggests a possible association between PLMS and stroke risk, but substantial methodological heterogeneity, limited prospective evidence, and potential publication bias severely limit causal inferences. Current evidence does not support routine PLMS screening for stroke prevention. Well-designed prospective studies with standardized PLMS definitions and adequate confounder adjustment are needed to clarify this relationship.</p>

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Periodic limb movements in sleep and stroke risk: A systematic review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年3月3日

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  • Narat Srivali,
  • Charat Thongprayoon,
  • Wisit Cheungpasitporn

摘要

Background

Periodic limb movements in sleep (PLMS) have been associated with cardiovascular morbidity, but their relationship with stroke remains incompletely understood. This systematic review and meta-analysis evaluated the association between PLMS and stroke risk.

Methods

We systematically searched MEDLINE, EMBASE, and Cochrane Library databases through March 2025 for observational studies and clinical trials examining PLMS and stroke. Two independent investigators selected studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Risk ratios were pooled using random-effects meta-analysis with the generic inverse variance method of DerSimonian and Laird.

Results

Six observational studies comprising 6,557 patients met inclusion criteria. Only two studies employed prospective designs capable of establishing temporality between PLMS and stroke occurrence. Diagnostic methods varied substantially across studies, with PLMS thresholds ranging from > 5/h to > 30/h, and stroke definitions ranging from imaging-confirmed to self-reported events. Meta-analysis revealed that PLMS was associated with increased stroke risk (pooled risk ratio 1.88; 95% CI, 1.00-3.52; P = 0.05), though with substantial heterogeneity (I²=88%). Analysis restricted to prospective studies showed similar associations (RR 2.31; 95% CI, 1.12–4.77; P = 0.02; I²=85%). Egger’s test suggested potential publication bias (P = 0.04).

Conclusions

Our analysis suggests a possible association between PLMS and stroke risk, but substantial methodological heterogeneity, limited prospective evidence, and potential publication bias severely limit causal inferences. Current evidence does not support routine PLMS screening for stroke prevention. Well-designed prospective studies with standardized PLMS definitions and adequate confounder adjustment are needed to clarify this relationship.