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A high periodic limb movement index (PLMI) and high arousal index OSA phenotype is associated with increased cardiovascular risk in patients undergoing coronary artery bypass grafting.

In a case-comparison study, patients with coronary artery disease (CAD) undergoing CABG had significantly higher rates of abnormal PLMI, arousal index, and AHI compared to non-CAD controls (p=0.0002, p=0.002, p=0.015, respectively). Multivariable regression identified high PLMI and arousal index as the strongest associations with CAD, suggesting that this OSA phenotype may increase cardiovascular risk.

Last updated: Aug 21, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Polysomnographic arousal index and periodic limb movement index in patients undergoing coronary artery bypass grafting: an exploratory case-comparison study.

observational

Mekky J, Dardir HW, Malek K, Elsayed AAR, Ayad SW, Ramadan I, Saadallah H, Basson MD · Sleep & breathing = Schlaf & Atmung (2026)

Participants: N/A
Duration: Not reported in abstract
Intervention: Observational comparison of polysomnographic parameters (PLMI, arousal index, AHI) between CAD patients and controls
Outcome: Presence of CAD (as indicated by need for CABG), and polysomnographic measures (PLMI, arousal index, AHI)
Effect Size: N/A (only p-values reported: p=0.0002 for PLMI, p=0.002 for arousal index, p=0.015 for AHI)
Population: Adults undergoing preprocedural polysomnography before CABG (CAD group) compared to age- and gender-matched adults undergoing polysomnography for employment screening (non-CAD group)

Result:

PubMed: 42563023DOI: 10.1007/s11325-026-03779-9

Mechanism Graph

High PLMI and arousal index are associated with increased sympathetic nervous system activity and sleep fragmentation.
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Sleep fragmentation and sympathetic activation may contribute to endothelial dysfunction and inflammation.
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These processes may promote atherosclerosis and coronary artery disease.
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Result: High PLMI/high arousal index phenotype is associated with increased cardiovascular risk.

Limitations

  • ⚠Exploratory case-comparison design with retrospective control group, which may introduce selection bias.
  • ⚠Small sample size and lack of adjustment for all potential confounders (e.g., BMI, comorbidities) in the abstract.
  • ⚠Causal relationship cannot be established due to observational design.

Frequently Asked Questions

What is the high PLMI/high arousal index OSA phenotype?▼

It is a subtype of obstructive sleep apnea characterized by elevated periodic limb movement index (PLMI) and high arousal index, which may indicate increased sleep fragmentation and autonomic activation.

How was the association between this phenotype and CAD measured?▼

The study compared polysomnographic parameters (PLMI, arousal index, AHI) between patients with CAD (undergoing CABG) and non-CAD controls, using chi-square tests and multivariable logistic regression.

What were the main findings?▼

CAD patients had significantly higher rates of abnormal PLMI, arousal index, and AHI compared to controls. High PLMI and arousal index were the strongest associations with CAD.

What are the clinical implications?▼

Identifying high-risk OSA phenotypes like high PLMI/high arousal index could improve early screening and intervention strategies for coronary artery disease.

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References

  1. 1.Mekky J, Dardir HW, Malek K, Elsayed AAR, Ayad SW, Ramadan I, Saadallah H, Basson MD. "Polysomnographic arousal index and periodic limb movement index in patients undergoing coronary artery bypass grafting: an exploratory case-comparison study.." Sleep & breathing = Schlaf & Atmung, 2026. PMID: 42563023 DOI: 10.1007/s11325-026-03779-9
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.