Oral appliance titration in patients with obstructive sleep apnea induces the appearance of periodic limb movements

Guerrero, Melanie; Kim, Daniel; Rupp, Tracy L.; Balkin, Thomas J.

doi:10.1007/s11325-009-0321-z

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…The physiopathology of PLMS in that setting is incompletely understood and is most likely complex 66 . The treatment of OSA not by CPAP but by mandibular advancement device can also induce PLMS in OSA patients who did not have a diagnosis of PLM at baseline 67 . Clearly, the physiopathology of RLS/PLMS in relation to the treatment of sleep‐disordered breathing is multifactorial and still poorly understood.…”

Section: Rls/plms and Sleep‐related Breathing Disordersmentioning

confidence: 99%

Restless legs syndrome: Impact on sleep‐related breathing disorders

Roux

2013

Respirology

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Section: Rls/plms and Sleep‐related Breathing Disordersmentioning

confidence: 99%

Restless legs syndrome: Impact on sleep‐related breathing disorders

Roux

2013

Respirology

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“…A significant increase in the number of PLMS events has been reported during titration of CPAP therapy in adults and children with OSA and was described as "unmasking" of PLMS associated with respiratory events and arousals (Baran et al, 2003;Hedli et al, 2012). An increase in PLMS with arousals has also been documented during titration of oral appliance therapy in patients with OSA (Guerrero et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Effect of adaptive servo ventilation on central sleep apnea and sleep structure in systolic heart failure patients: polysomnography data from the SERVE‐HF major sub study

Tamisier

Pépin

Cowie

et al. 2022

Journal of Sleep Research

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Summary This SERVE‐HF (Treatment of Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients With Heart Failure) sub study analysis evaluated polysomnography (PSG) data in patients with heart failure with reduced ejection fraction (HFrEF) and predominant central sleep apnea (CSA) randomised to guideline‐based medical therapy, with or without adaptive servo ventilation (ASV). Patients underwent full overnight PSG at baseline and at 12 months. All PSG recordings were analysed by a core laboratory. Only data for patients with baseline and 3‐ or 12‐month values were included. The sub study included 312 patients; the number with available PSG data differed for each variable (94–103 in the control group, 77–99 in the ASV group). After 12 months, baseline‐adjusted respiratory measures were significantly better in the ASV group versus control. Although some between‐group differences in sleep measures were seen at 12 months (e.g., better sleep efficiency in the ASV group), these were unlikely to be clinically significant. The number of periodic leg movements during sleep (PLMS) increased in the ASV group (p = 0.039). At 12 months, the respiratory arousal index was significantly lower in the ASV versus control group (p < 0.001), whilst the PLMS‐related arousal index was significantly higher in the ASV group (p = 0.04 versus control). ASV attenuated the respiratory variables characterising sleep apnea in patients with HFrEF and predominant CSA in SERVE‐HF. Sleep quality improvements during ASV therapy were small and unlikely to be clinically significant. The increase in PLMS and PLMS‐related arousals during ASV warrants further investigation, particularly relating to their potential association with increased cardiovascular risk.

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“…The decrease in PLMS index, however, was positively correlated with the decrease in AHI in patients with vanishing PLMS. There are also some other reports demonstrating that PLMS showed an increment at PAP titration PSG in mild OSAS and decrement in severe OSAS, 17,22,23 demonstrating a complicated mechanism underlying the development of newly emergent PLMS. Periodic limb movements in sleep resulting from residual respiratory events because of undertreated OSAS were not likely to explain all newly emergent PLMS.…”

Section: Discussionmentioning

confidence: 85%

Cyclic Alternating Pattern Analysis in Periodic Leg Movements in Sleep in Patients With Obstructive Sleep Apnea Syndrome Before and After Positive Airway Pressure Treatment

Şenel

Özçeli̇k²,

Karadeniz³

2020

Journal of Clinical Neurophysiology

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Purpose: Cyclic alternating pattern (CAP) is known to increase in many conditions of sleep disruption and sleep disorders, including obstructive sleep apnea syndrome and periodic limb movements in sleep (PLMS). Periodic limb movements in sleep associated with obstructive sleep apnea syndrome may vanish after positive airway pressure treatment, may persist, or emerge at treatment night. Here, the authors aimed to investigate the underlying pathophysiology of nonvanishing, vanishing, or newly emergent PLMS. Methods:The authors designed a prospective study and included 10 patients with nonvanishing PLMS during positive airway pressure therapy, 10 patients with vanishing PLMS, 10 patients with newly emergent PLMS, and 10 patients without PLMS at both nights. The CAP analysis was performed in detail at diagnostic polysomnography recording and at positive airway pressure titration. The changes in CAP parameters were evaluated in regard to nonvanishing, vanishing, or newly emergent PLMS.Results: Periodic limb movements in sleep related to A1 subtype of CAP were observed to decrease under positive airway pressure titration more than PLMS related to A3 subtype of CAP. The A3 subtype of CAP was higher in patients with vanishing PLMS than those with newly emergent PLMS. The newly emergent PLMS were mostly related to A1 subtype of CAP compared with A3 subtype of CAP.Conclusions: This study showed that vanishing, nonvanishing, or newly emerging PLMS may indeed represent different underlying pathophysiology. The authors suggest that organization of sleep and preservation of ultradian rhythms during titration may determine whether PLMS will be vanished or persist. Newly emergent PLMS may probably arise from a separate central generator by the activation of higher cortical areas.

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Oral appliance titration in patients with obstructive sleep apnea induces the appearance of periodic limb movements

Cited by 4 publications

References 18 publications

Restless legs syndrome: Impact on sleep‐related breathing disorders

Restless legs syndrome: Impact on sleep‐related breathing disorders

Effect of adaptive servo ventilation on central sleep apnea and sleep structure in systolic heart failure patients: polysomnography data from the SERVE‐HF major sub study

Cyclic Alternating Pattern Analysis in Periodic Leg Movements in Sleep in Patients With Obstructive Sleep Apnea Syndrome Before and After Positive Airway Pressure Treatment

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