Periodic limb movements and obstructive sleep apneas before and after continuous positive airway pressure treatment

Abstract

SUMMARY Periodic limb movements during sleep (PLMS) and obstructive sleep apnea syndrome (OSAS) are two common sleep disorders. The similarity in periodicity of periodic limb movements (PLMs) and obstructive sleep apneas (OSAs) led us to hypothesize the existence of a common central generator responsible for the periodicity of both OSAs and PLMs. In order to test this hypothesis, we compared apnea periodicity before continuous positive airway pressure (CPAP) treatment with PLMs periodicity during CPAP treatment in 26 OSA patients, consecutively recorded and treated in our sleep laboratory. The investigation on CPAP was performed twice, once during the initial evaluation and once during a follow-up evaluation after 3 months of home treatment with CPAP. Our results showed that, in this sample, 16 patients out of 26 had an association of OSAS and PLMS, defined as the occurrence of at least 5 PLMs per hour of sleep. The mean apnea interval -measured as the time between the beginning of two successive apneas -was 43.1 s (±15.2, SD) and the mean PLM interval -calculated in the same way -was 29.6 s (±15.2) during the baseline night, 28.5 s (±15.7) during the first CPAP night, and 29.8 s (±14.8) during the second CPAP night. Thus, the periodicity of the two phenomena (apneas and PLMs) was different, both before and after CPAP treatment (P< 0.05). When considering the interval between the end of an event (apnea or PLM) and the beginning of the next one the mean apnea interval was 19.5 s (±11.6), and the mean PLM interval was 28.1 s (±15.3) during the untreated night, 26.6 s (±16) during the first CPAP night and 27.9 s (±15) during the second CPAP night. The shortening of apnea intervals with this method of measuring intervals reflects the longer duration of apneas as compared to PLMs. Again the intervals between PLMs were not different between each other but the intervals between apneas were different from the intervals between PLMs (P< 0.05) These results show that the periodicity of PLMs is different from that of OSAs, suggesting that sleep apneas and PLMs are not generated by a common central generator.

EMG classification in obstructive sleep apnea syndrome and periodic limb movement syndrome patients by using wavelet packet transform and extreme learning machine

“…Unlike some previous studies [1,[14][15][16], in the present study, EMG signals were classified with a simple and effective model in OSAS and PLMS patients. The overall classification accuracy was 96.85% using training and testing sections of 50% and 50%.…”

“…A few studies have looked at OSAS and PLMS together. Garelli et al [14] proved that the periodicity of PLMS is different from that of OSAS, suggesting that sleep apneas and PLMS are not generated by a common central generator. Additionally, Cheliout-Heraut et al [1] showed that PLMS is frequently observed among moderate and mild OSAS patients.…”

Home Sleep-Monitoring Devices: Bridging the Periodic Limb Movement in Sleep Information Gap

“…The prevalence of PLMS is estimated to be >80% in patients with restless legs syndrome (RSL), [4] >34% in the population over 60 years old, [5] and 36% of healthy subjects were reported to have a PLMS index >5 events per hour of sleep [6]. The PLMS incidence increases with age.…”

“…Because PLMS can be comorbid with other sleep disorders (i.e. OSA, [4,5] narcolepsy, [14] rapid eye movement behavior disorder [15] their association to and exclusion from other potential causes of a sleep complaint needs to be determined in conjunction with other simultaneously recorded biological signals. HSMD that record multiple biological signals over consecutive nights might be a better alternative for assessing PLMS clinical significance than a single-night PSG, since consecutive recordings would capture night-to-night variability [10] and time-ofnight PLM patterns [16].…”

Periodic limb movement during sleep and chronic obstructive pulmonary disease

“…Patients suffering from PLMD usually complain of insomnia, daytime fatigue, and daytime sleepiness [1]. PLMD often seems to occur in association with an underlying sleep disorder, including narcolepsy [2], obstructive sleep apnea (OSA) syndrome in both groups receiving treatment or not [3,4], in patients with geriatric insomnia or hypersomnia [5], and lumbosacral spinal disease [6], but PLMD are also observed in aging [7] and caffeine users [8]. Increased PLMD is also observed in healthy individuals as well [9].…”