Periodic Limb Movements of Sleep: A Survey on Polysomnographic Characteristics of Patients with Obstructive Sleep Apnea
-
Morteza Saeidi
,
Fariborz Rezaeitalab
,
Saeed Akhlaghi
,
Farnaz Kharaghani
,
Hussein Sharara
,
Mina Abbasi
,
Mahshid Mahyad
Abstract
Background and Objective: Periodic limb movements of sleep (PLMS) and obstructive sleep apnea (OSA) are two common sleep disorders that frequently co-occur in one subject. In this study, we evaluated the polysomnographic (PSG) features of patients with OSA with and without PLMS.
Materials and Methods: Patients with OSA diagnosed by PSG who referred to our sleep clinic over 2 years were
studied for PLMS during a standard diagnostic sleep study. PSG features including apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and sleep quality were evaluated and compared between patients with OSA with and without PLMS.
Results: We evaluated 122 patients with OSA, of whom 17 had comorbid PLMS. Mean sleep quality was significantly lower in patients with PLMS compared to those without PLMS (P < 0.05). There was no significant difference in terms of mean age, gender, arousal index (AI), ODI, and apnea/hypopnea between the two groups.
Conclusion: Patients with OSA with PLMS comorbidity have remarkably lower sleep quality and this finding is independent of the severity of arousals or respiratory events. Proper evaluation, diagnosis, and treatment of PLMS comorbidity in patients with OSA might improve treatment response.
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14. Manconi M, Zavalko I, Fanfulla F, et al. An evidence-based recommendation for a new definition of respiratory-related leg movements. Sleep 2015; 38: 295-304.
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16. Hedli LC, Christos P, Krieger AC. Unmasking of periodic limb movements with the resolution of obstructive sleep apnea during continuous positive airway pressure application. J Clin Neurophysiol 2012; 29: 339-44.
17. Yamashiro Y, Kryger MH. Acute effect of nasal CPAP on periodic limb movements associated with breathing disorders during sleep. Sleep 1994; 17: 172-5.
18. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009; 373: 82-93.
19. Wu MN, Lai CL, Liu CK, et al. Basal sympathetic predominance in periodic limb movements in sleep with obstructive sleep apnea. J Sleep Res 2015; 24: 722-9.
20. Koo BB, Sillau S, Dean DA, et al. Periodic limb movements during sleep and prevalent hypertension in the multi-ethnic study of atherosclerosis. Hypertension 2015; 65: 70-7.
21. Lombardi C, Parati G, Soranna D, et al. Periodic limb movements during sleep and blood pressure J Sleep Sci, Vol. 7, No. 1-2, 2022 21 http://jss.tums.ac.ir changes in sleep apnoea: Data from the European Sleep Apnoea Database. Respirology 2020; 25: 872-9.
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24. Koo BB, Mehra R, Blackwell T, et al. Periodic limb movements during sleep and cardiac arrhythmia in older men (MrOS sleep). J Clin Sleep Med 2014; 10: 7-11.
25. Yumino D, Wang H, Floras JS, et al. Relation of periodic leg movements during sleep and mortality in patients with systolic heart failure. Am J Cardiol 2011; 107: 447-51.
26. Lin CC, Chou CH, Fan YM, et al. Increased risk of dementia among sleep-related movement disorders: A population-based longitudinal study in Taiwan. Medicine (Baltimore) 2015; 94: e2331.
27. Alessandria M, Provini F. Periodic Limb movements during sleep: A new sleep-related cardiovascular risk factor? Front Neurol 2013; 4: 116.
28. Chiaro G, Manconi M. Restless legs syndrome, periodic limb movements during sleep and cardiovascular risk. Auton Neurosci 2019; 220: 102554.
29. Haba-Rubio J, Marti-Soler H, Tobback N, et al. Clinical significance of periodic limb movements during sleep: The HypnoLaus study. Sleep Med 2018; 41: 45-50.
30. Walters AS. Toward a better definition of the rest-less legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 1995; 10: 634-42.
31. Walters AS, LeBrocq C, Dhar A, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003; 4: 121-32.
32. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8: 597-619.
33. Kushida CA, Chediak A, Berry RB, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008; 4: 157-71.
34. Iriarte J, Murie-Fernandez M, Toledo E, et al. Sleep structure in patients with periodic limb movements and obstructive sleep apnea syndrome. J Clin Neurophysiol 2009; 26: 267-71.
35. Shahveisi K, Jalali A, Moloudi MR, et al. Sleep architecture in patients with primary snoring and obstructive sleep apnea. Basic Clin Neurosci 2018; 9: 147-56.
2. Ferri R, Fulda S, Allen RP, et al. World Association of Sleep Medicine (WASM) 2016 standards for recording and scoring leg movements in polysomnograms developed by a joint task force from the International and the European Restless Legs Syndrome Study Groups (IRLSSG and EURLSSG). Sleep Med 2016; 26: 86-95.
3. American Sleep Disorders Association (AASM). The International Classification of Sleep Disorders (ICSD-3). Darien, IL: AASM; 2014.
4. Montplaisir J, Boucher S, Poirier G, et al. Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: A study of 133 patients diagnosed with new standard criteria. Mov Disord 1997; 12: 61-5.
5. Fantini ML, Michaud M, Gosselin N, et al. Periodic leg movements in REM sleep behavior disorder and related autonomic and EEG activation. Neurology 2002; 59: 1889-94.
6. Dauvilliers Y, Pennestri MH, Petit D, et al. Periodic leg movements during sleep and wakefulness in narcolepsy. J Sleep Res 2007; 16: 333-9.
7. Al-Alawi A, Mulgrew A, Tench E, et al. Prevalence, risk factors and impact on daytime sleepiness and hypertension of periodic leg movements with arousals in patients with obstructive sleep apnea. J Clin Sleep Med 2006; 2: 281-7.
8. Ferri R, Koo BB, Picchietti DL, et al. Periodic leg movements during sleep: Phenotype, neurophysiology, and clinical significance. Sleep Med 2017; 31: 29-38.
9. Sateia MJ. International classification of sleep disorders-third edition: Highlights and modifications. Chest 2014; 146: 1387-94.
10. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis. Lancet Respir Med 2019; 7: 687-98.
11. Chervin RD. Periodic leg movements and sleepiness in patients evaluated for sleep-disordered breathing. Am J Respir Crit Care Med 2001; 164: 1454-8.
12. Fulda S, Heinzer R, Haba-Rubio J. Characteristics and determinants of respiratory event-associated leg movements. Sleep 2018; 41: zsx206.
13. Huang CY, Yu CC. Different diagnostic criteria for periodic leg movements in patients with obstructive sleep apnea after continuous positive airway pressure titration. Neuropsychiatr Dis Treat 2019; 15: 2129-36.
14. Manconi M, Zavalko I, Fanfulla F, et al. An evidence-based recommendation for a new definition of respiratory-related leg movements. Sleep 2015; 38: 295-304.
15. Baran AS, Richert AC, Douglass AB, et al. Change in periodic limb movement index during treatment of obstructive sleep apnea with continuous positive air-way pressure. Sleep 2003; 26: 717-20.
16. Hedli LC, Christos P, Krieger AC. Unmasking of periodic limb movements with the resolution of obstructive sleep apnea during continuous positive airway pressure application. J Clin Neurophysiol 2012; 29: 339-44.
17. Yamashiro Y, Kryger MH. Acute effect of nasal CPAP on periodic limb movements associated with breathing disorders during sleep. Sleep 1994; 17: 172-5.
18. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009; 373: 82-93.
19. Wu MN, Lai CL, Liu CK, et al. Basal sympathetic predominance in periodic limb movements in sleep with obstructive sleep apnea. J Sleep Res 2015; 24: 722-9.
20. Koo BB, Sillau S, Dean DA, et al. Periodic limb movements during sleep and prevalent hypertension in the multi-ethnic study of atherosclerosis. Hypertension 2015; 65: 70-7.
21. Lombardi C, Parati G, Soranna D, et al. Periodic limb movements during sleep and blood pressure J Sleep Sci, Vol. 7, No. 1-2, 2022 21 http://jss.tums.ac.ir changes in sleep apnoea: Data from the European Sleep Apnoea Database. Respirology 2020; 25: 872-9.
22. Lin TC, Zeng BY, Chen YW, et al. Cerebrovascular accident risk in a population with periodic limb movements of sleep: A preliminary meta-analysis. Cerebro vasc Dis 2018; 46: 1-9.
23. Kendzerska T, Kamra M, Murray BJ, et al. Incident cardiovascular events and death in individuals with restless legs syndrome or periodic limb movements in sleep: A Systematic Review. Sleep 2017; 40: zsx013.
24. Koo BB, Mehra R, Blackwell T, et al. Periodic limb movements during sleep and cardiac arrhythmia in older men (MrOS sleep). J Clin Sleep Med 2014; 10: 7-11.
25. Yumino D, Wang H, Floras JS, et al. Relation of periodic leg movements during sleep and mortality in patients with systolic heart failure. Am J Cardiol 2011; 107: 447-51.
26. Lin CC, Chou CH, Fan YM, et al. Increased risk of dementia among sleep-related movement disorders: A population-based longitudinal study in Taiwan. Medicine (Baltimore) 2015; 94: e2331.
27. Alessandria M, Provini F. Periodic Limb movements during sleep: A new sleep-related cardiovascular risk factor? Front Neurol 2013; 4: 116.
28. Chiaro G, Manconi M. Restless legs syndrome, periodic limb movements during sleep and cardiovascular risk. Auton Neurosci 2019; 220: 102554.
29. Haba-Rubio J, Marti-Soler H, Tobback N, et al. Clinical significance of periodic limb movements during sleep: The HypnoLaus study. Sleep Med 2018; 41: 45-50.
30. Walters AS. Toward a better definition of the rest-less legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 1995; 10: 634-42.
31. Walters AS, LeBrocq C, Dhar A, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003; 4: 121-32.
32. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8: 597-619.
33. Kushida CA, Chediak A, Berry RB, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008; 4: 157-71.
34. Iriarte J, Murie-Fernandez M, Toledo E, et al. Sleep structure in patients with periodic limb movements and obstructive sleep apnea syndrome. J Clin Neurophysiol 2009; 26: 267-71.
35. Shahveisi K, Jalali A, Moloudi MR, et al. Sleep architecture in patients with primary snoring and obstructive sleep apnea. Basic Clin Neurosci 2018; 9: 147-56.
| Files | ||
| Issue | Vol 7 No 1-2 (2022): Winter-Spring | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jss.v7i(1-2).13210 | |
| Keywords | ||
| Periodic limb movement disorder; Obstructive sleep apnea; Polysomnography; Sleep quality | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Saeidi M, Rezaeitalab F, Akhlaghi S, Kharaghani F, Sharara H, Abbasi M, Mahyad M. Periodic Limb Movements of Sleep: A Survey on Polysomnographic Characteristics of Patients with Obstructive Sleep Apnea. J Sleep Sci. 2023;7(1-2):16-21.
