Change in frequency of periodic limb movements during sleep with usage of continuous positive airway pressure in obstructive sleep apnea syndrome

Aritake-Okada, Sayaka; Namba, Kazuyoshi; Hidano, Natsuki; Asaoka, Shoichi; Komada, Yoko; Usui, Akira; Inoue, Yuichi

doi:10.1016/j.jns.2012.03.013

Cited by 24 publications

(19 citation statements)

References 11 publications

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“…In our study, PLMS prevalence in patients with a PLMI of ≥15 was 4.5% lower than the values reported by Ren et al However, we could not clearly elucidate the reason for this relatively low PLMS prevalence. In a Japanese study, among patients with PLMI ≥15, women had a higher PLMS prevalence than men 23. Our study had a higher men/women ratio (4.9/1) than did the study of Ren et al (men/women =1/1).…”

Section: Discussioncontrasting

confidence: 58%

<p>Different diagnostic criteria for periodic leg movements in patients with obstructive sleep apnea after continuous positive airway pressure titration</p>

Huang

2019

NDT

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Objective Periodic leg movement in sleep (PLMS) is common among patients with obstructive sleep apnea (OSA). The PLMS frequency changes after continuous positive airway pressure (CPAP) titration. This study investigated the effects of two PLMS diagnostic criteria on PLMS prevalence and the restless leg syndrome (RLS) detection rate in patients with OSA before and after CPAP titration. Methods This retrospective study included patients with OSA who received polysomnography (PSG) and successful CPAP titration from December 2012 to December 2014. Their clinical variables and sleep parameters were evaluated using the PLMS diagnostic criteria: PLMS index (PLMI) ≥5 and ≥15. PLMS prevalence and the RLS detection rate were analyzed according to the PLMI before and after CPAP. Results In patients with OSA with a PLMI of ≥5 and ≥15 after PSG with CPAP titration, the PLMS prevalence was 20.1% (76/378) and 4.5% (17/378), respectively, which revealed CPAP titration increased PLMI. Moreover, in terms of PLMI ≥5 and ≥15, PSG with CPAP titration led to significantly higher PLMS prevalence than PSG alone (20.1% vs 7.1% and 4.5% vs 0.8%, respectively; both P <0.001). PLMI ≥5 also demonstrated a higher RLS detection rate than PLMI ≥15 did (69.2% vs 15.4%; P =0.016). Conclusion In patients with OSA, CPAP titration increases PLMS prevalence and the PLMI regardless of whether PLMI is ≥5 or ≥15. The use of the current diagnostic criteria, PLMI ≥15, for PLMS may lead to underestimation of PLMS prevalence and the RLS detection rate in patients with OSA.

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Section: Discussioncontrasting

confidence: 58%

<p>Different diagnostic criteria for periodic leg movements in patients with obstructive sleep apnea after continuous positive airway pressure titration</p>

Huang

2019

NDT

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“…One study demonstrated a decreased PLM after CPAP therapy in mild OSA, suggesting the development of PLM as one of the consequences of OSA 37 . However, PLM sometimes newly appears after the initiation of positive airway pressure therapy 38 and therefore the direct causal relationship between PLMS and OSA is poorly understood…”

Section: Discussionmentioning

confidence: 99%

Polysomnographic phenotyping of obstructive sleep apnea and its implications in mortality in Korea

Kim

Won

Rhee

et al. 2020

Sci Rep

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Conventionally, apnea–hypopnea index (AHI) is used to define and categorize the severity of obstructive sleep apnea. However, routine polysomnography (PSG) includes multiple parameters for assessing the severity of obstructive sleep apnea. The goal of this study is to identify and categorize obstructive sleep apnea phenotypes using unsupervised learning methods from routine PSG data. We identified four clusters from 4,603 patients by using 29 PSG variable and arranged according to their mean AHI. Cluster 1, spontaneous arousal (mean AHI = 8.52/h); cluster 2, poor sleep and periodic limb movements (mean AHI = 12.16/h); cluster 3, hypopnea (mean AHI = 38.60/h); and cluster 4, hypoxia (mean AHI = 69.66/h). Conventional obstructive sleep apnea classification based on apnea–hypopnea index severity showed no significant difference in cardiovascular or cerebrovascular mortality (Log rank P = 0.331), while 4 clusters showed an overall significant difference (Log rank P = 0.009). The risk of cardiovascular or cerebrovascular mortality was significantly increased in cluster 2 (hazard ratio = 6.460, 95% confidence interval 1.734–24.073) and cluster 4 (hazard ratio = 4.844, 95% confidence interval 1.300–18.047) compared to cluster 1, which demonstrated the lowest mortality. After adjustment for age, sex, body mass index, and underlying medical condition, only cluster 4 showed significantly increased risk of mortality compared to cluster 1 (hazard ratio = 7.580, 95% confidence interval 2.104–34.620). Phenotyping based on numerous PSG parameters gives additional information on patients’ risk evaluation. Physicians should be aware of PSG features for further understanding the pathophysiology and personalized treatment.

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“…Whether this result correlates to the smaller pupil diameter in the examined age group or other age-related changes can not be distinguished by our data. PLMS are a common finding in patients with sleep apnea and tend decrease with successful treatment of the apneas [30], although treatment might also unmask PLMS. Since treatment effects of sleep apnea were not registered in our study, we did not make a distinction between sleep apnea patients with and without PLMS.…”

Section: Discussionmentioning

confidence: 99%

Pupillographic Sleepiness Test and Polysomnography in Nondemented Patients with Ischemic White Matter Lesions

Landwehr¹,

Liszka

2015

Journal of Geriatrics

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Background. Patients with ischemic white matter lesions (WML) frequently report nonrestorative sleep or daytime sleepiness. However, subjective estimations of sleep and sleepiness can differ considerably from objective measures. The pupillographic sleepiness test (PST) could identify patients with sleep disorders requiring polysomnography (PSG) and further treatment.Methods. We performed a PST and a PSG of 35 nondemented patients with WML, who reported nonrestorative sleep or daytime sleepiness, and assessed the diagnostic value of the pupillary unrest index (PUI). Sleep parameters were compared to normative data.Results. The mean PUI of WML patients was normal (5.89 mm/min) and comparable to PUIs of patients with other neurological disorders. All 9 of the 35 WML patients (25.7%) who had a PUI above normal also had clinically relevant sleep disorders (5: sleep apnea, 7: periodic leg movements, and 4: insomnia). Six patients with a normal PUI had mild to moderate primary insomnia.Conclusion. PST and PSG parameters were physiological in most patients with WML. Age-related changes and affective and neuropsychological disorders might account for their sleep-related complaints. An elevated PUI in patients with WML seems to indicate comorbid sleep disorders that require further diagnostic evaluation and treatment (sleep apnea, insomnia with periodic leg movements, but not primary insomnia).

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Change in frequency of periodic limb movements during sleep with usage of continuous positive airway pressure in obstructive sleep apnea syndrome

Cited by 24 publications

References 11 publications

<p>Different diagnostic criteria for periodic leg movements in patients with obstructive sleep apnea after continuous positive airway pressure titration</p>

<p>Different diagnostic criteria for periodic leg movements in patients with obstructive sleep apnea after continuous positive airway pressure titration</p>

Polysomnographic phenotyping of obstructive sleep apnea and its implications in mortality in Korea

Pupillographic Sleepiness Test and Polysomnography in Nondemented Patients with Ischemic White Matter Lesions

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