Prevalence of pediatric periodic leg movements of sleep after initiation of PAP therapy

Pai, Vidya; Khatwa, Umakanth; Ramgopal, Sriram; Singh, Kanwaljit; Fitzgerald, Rebecca; Kothare, Sanjeev V.

doi:10.1002/ppul.22802

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…46 Investigators have hypothesized that to the extent PLMS may be more common after sleep apnea is treated, they could explain persistent neurobehavioral morbidity. 60 However, our findings now suggest that PLMS in this setting are unlikely to have these consequences. At baseline, no outcome measures were worse in association with PLMS or PLMS with arousals.…”

Section: Discussionmentioning

confidence: 56%

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Periodic leg movements during sleep in children scheduled for adenotonsillectomy: frequency, persistence, and impact

et al. 2014

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Objective Assess the frequency and potential clinical impact of periodic leg movements during sleep, with or without arousals, as recorded incidentally from children before and after adenotonsillectomy. Methods Children scheduled for adenotonsillectomy for any clinical indications who participated in the Washtenaw County Adenotonsillectomy Cohort II were studied at enrollment and again 6 months thereafter. Assessments included laboratory-based polysomnography, a Multiple Sleep Latency Test (MSLT), parent-completed behavioral rating scales, neuropsychological testing, and psychiatric evaluation. Results Participants included 144 children (81 boys) aged 3–12 years. Children generally showed mild to moderate obstructive sleep apnea (median respiratory disturbance index 4.5 [Q1=2.0, Q3=9.5]) at baseline, and 15 subjects (10%) had at least 5 periodic leg movements per hour of sleep (PLMI≥5). After surgery, 21 (15%) of n=137 subjects who had follow-up studies showed PLMI≥5 (p=.0067). Improvements were noted after surgery in the respiratory disturbance index; insomnia symptoms; sleepiness symptoms; mean sleep latencies; hyperactive behavior; memory, learning, attention, and executive functioning on NEPSY assessments; and frequency of Attention-Deficit/Hyperactivity Disorder (DSM-IV criteria). However, PLMI≥5 failed to show associations with worse morbidity in these domains at baseline or follow-up. New appearance of PLMI≥5 after surgery failed to predict worsening of these morbidities (all p>.05), with only one exception (NEPSY) where the magnitude of association was nonetheless negligible. Similar findings emerged for periodic leg movements with arousals (PLMAI≥1). Conclusion Periodic leg movements during sleep, with and without arousals, become more common after adenotonsillectomy in children. However, results in this setting did not suggest substantial clinical impact.

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Section: Discussionmentioning

confidence: 56%

“…Others have speculated that CPAP may induce PLMS in children. 60 Although this remains possible, it does not explain why our subjects would have increased PLMS 6 months after adenotonsillectomy.…”

Section: Discussionmentioning

confidence: 82%

Periodic leg movements during sleep in children scheduled for adenotonsillectomy: frequency, persistence, and impact

et al. 2014

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“…Patients who demonstrated an elevated PLMI (or RSWA) were not observed to have an elevated AHI with the exception of patient 7, who also had a normal PLMI, which has previously been associated with PLMD as a possible confounding variable for arousal. 15,16 Similarly, unremarkable AI in multiple domains exclude other nonorganic etiologies to the abnormalities reported.…”

Section: Discussionmentioning

confidence: 66%

Continued Presence of Period Limb Movements During REM Sleep in Patients With Chronic Static Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

Santoro

Frankovich

Bhargava

2018

Journal of Clinical Sleep Medicine

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“…13 Emergence of PLMS was observed in 5.1% of children after initiation of positive airway pressure therapy (PAP) in a large study, including 214 PAP titrations, mostly with continuous PAP pressures >7 cmH 2 O. 16 Asymptomatic PLMS were noted in children scheduled for adenotonsillectomy. The index increased after surgery unrelated to the respiratory improvement, and there was no symptomatic correlation.…”

Section: The Conundrum Of Periodic Limb Movementsmentioning

confidence: 99%

Restless Legs Syndrome and Periodic Limb Movement Disorder in Children

Sharon

Walters

Simakajornboon

2019

JCS

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Introduction Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) have been studied more than any other sleep-related movement disorder in the pediatric population. A common feature to both, periodic limb movements, occurs in many other disorders and also in reportedly healthy children and adolescents. In this review, we discuss the different types of limb movements as it pertains to pediatric RLS and PLMD and provides an update on these disorders. Methods A literature search was performed with the following inclusion criteria: English publication, limb movements, leg movements, periodic limb movements of sleep, periodic limb movements during wake, PLMD, RLS, with each of the modifiers, children, pediatric, and adolescents. Identified publications were reviewed and their reference lists were searched for additional relevant publications. Results A total of 102 references were included in this review. These included epidemiological studies, prospective and retrospective studies, case series, observational data, reviews, and consensus guidelines. A critical summary of these findings is presented. Conclusion The limited evidence-based data support the importance of evaluating limb movements in the context of the clinical symptomatology presented by the child or the adolescent. Further research is needed to (1) better understand the pathophysiological mechanisms resulting in periodic limb movements as encountered in the pediatric PLMD or RLS patient and their impact on the overall health and well-being, (2) develop objective diagnostic criteria for RLS and differentiate it from its “mimics” in the pediatric population, and (3) establish evidence-based guidelines for treatment.

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Prevalence of pediatric periodic leg movements of sleep after initiation of PAP therapy

Abstract: PLMS were seen in 5.1% of children after initiation of PAP. OSA may mask PLMS, which appears as breathing improves. Alternatively, PAP may unmask or induce PLMS. PLMS may potentially be a cause of treatment failure in children on recent-onset PAP therapy.

Cited by 7 publications

References 18 publications

Periodic leg movements during sleep in children scheduled for adenotonsillectomy: frequency, persistence, and impact

Periodic leg movements during sleep in children scheduled for adenotonsillectomy: frequency, persistence, and impact

Continued Presence of Period Limb Movements During REM Sleep in Patients With Chronic Static Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

Restless Legs Syndrome and Periodic Limb Movement Disorder in Children

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