Turkiye Klinikleri Archives of Lung

.: ORIGINAL RESEARCH
Frequency and Significance of Periodic Limb Movements in Patients with Obstructive Sleep Apnea: A Retrospective Study
Obstrüktif Uyku Apnesi Olan Hastalarda Periyodik Bacak Hareketlerinin Sıklığı ve Önemi: Retrospektif Bir Çalışma
Berrin Zinnet ERASLANa , Seda BEYHAN SAĞMENa , Sevda ŞENER CÖMERTa
aUniversity of Health Sciences Kartal Dr. Lütfi Kırdar City Hospital, Department of Chest Diseases, İstanbul, Türkiye
Turkiye Klinikleri Arch Lung. 2024;23(1):16-23
doi: 10.5336/archlung.2024-104971
Article Language: EN
Full Text
ABSTRACT
 Objective: The clinical importance of co-occurring periodic limb movements during sleep (PLMS) in the context of sleep-related breathing disorders remains unclear. We aimed to explore the frequency, association, and clinical significance of PLMS in patients with obstructive sleep apnea (OSA) undergoing polysomnography. Material and Methods: Polysomnographies conducted at our clinic were retrospectively reviewed. Patients' demographic characteristics and polysomnographic parameters were recorded. An Apnea-Hypopnea Index (AHI) ≥5 was considered indicative of OSA, and a Periodic Limb Movement Index ≥15 was considered indicative of PLMS. Those with an AHI<5 were classified as the control group. Results: The study involved 331 patients, with an average age of 49 and 202 (61%) being male. Among these, 275 (83.08%) had OSA (AHI≥5), with 45 (16.4%) also presenting PLMS. No significant difference in PLMS positivity was found between OSA patients and the control group (AHI<5) (p=0.47). Patients with OSA and PLMS exhibited significantly higher ages and body mass index (p=0.013 and p=0.006), shorter REM duration, lower sleep efficiency, higher sleep desaturation index, lower average oxygen saturation, and higher heart rate (p=0.013, p=0.01, p<0.001, p=0.01, and p=0.049). Conclusion: In OSA patients with PLMS, sleep efficiency, REM duration, and oxygen saturation levels were lower, while the sleep desaturation index and heart rate were higher. These findings suggest that PLMS negatively impacts sleep quality and may contribute to OSA severity. Considering the potential of inadequate sleep to lead to cardio-cerebrovascular diseases, the presence of PLMS alongside OSA should be carefully evaluated to improve patient outcomes.

Keywords: Obstructive sleep apnea; periodic limb movements in sleep
ÖZET
 Amaç: Uyku ile ilişkili solunum bozukluklarına eşlik eden uykuda periyodik bacak hareketlerinin [periodic limb movements during sleep (PLMS)] klinik önemi net değildir. Bu çalışmada, polisomnografi yapılan hastaların; PLMS sıklığını, obstrüktif uyku apnesi [obstructive sleep apnea (OSA)] ile ilişkisini ve klinik önemini araştırmayı amaçladık. Gereç ve Yöntemler: Kliniğimizde gerçekleştirilen polisomnografi sonuçları retrospektif olarak incelendi. Hastaların demografik özellikleri ve polisomnografik parametreleri kaydedildi. Apne-Hipopne İndeksi (AHİ) ≥5 OSA'yı, Periyodik Bacak Hareketi İndeksi ≥15 ise PLMS'yi işaret edecek şekilde değerlendirildi. AHİ<5 olanlar kontrol grubu olarak sınıflandırıldı. Bulgular: Çalışmaya toplam 331 hasta dâhil edildi. Bunların 202'si (%61) erkek olup, yaş ortalaması 49'dur. Bu hastaların 275'inde (%83,08) OSA (AHİ≥5) saptandı ve bunların 45'inde (%16,4) PLMS eşlik ediyordu. OSA hastaları ile kontrol grubu (AHİ<5) arasında PLMS pozitifliği açısından anlamlı bir fark bulunmadı (p=0,47). PLMS eşlik eden OSA hastalarının yaşı ve beden kitle indeksi anlamlı derecede daha yüksekti (p=0,013 ve p=0,006), REM süresi daha kısaydı, uyku verimliliği düşüktü, uyku desaturasyon indeksi daha yüksekti, ortalama oksijen saturasyonu daha düşüktü ve kalp atım hızı daha yüksekti (p=0,013, p=0,01, p<0,001, p=0,01 ve p=0,049). Sonuç: PLMS'nin eşlik ettiği OSA hastalarında uyku verimliliği, REM süresi ve oksijen saturasyon seviyeleri daha düşük, uyku desaturasyon indeksi ve kalp atım hızı ise daha yüksekti. Bu bulgular, PLMS'nin uyku kalitesini olumsuz etkilediğini ve OSA'nın şiddetini artırabileceğini göstermektedir. Yetersiz uykunun kardiyo-serebrovasküler hastalıklara yol açma potansiyeli göz önünde bulundurulduğunda, OSA ile birlikte PLMS varlığı dikkatle değerlendirilmeli ve hasta sonuçlarını iyileştirmek için ele alınmalıdır.

Anahtar Kelimeler: Obstrüktif uyku apnesi; uykuda periyodik bacak hareketleri
REFERENCES:
  1. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien (IL): American Academy of Sleep Medicine; 2014. Available from: [Link] 
  2. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136-43. [Crossref]  [PubMed]  [PMC] 
  3. Scofield H, Roth T, Drake C. Periodic limb movements during sleep: population prevalence, clinical correlates, and racial differences. Sleep. 2008;31(9):1221-7. [PubMed]  [PMC] 
  4. Hornyak M, Feige B, Riemann D, Voderholzer U. Periodic leg movements in sleep and periodic limb movement disorder: prevalence, clinical significance and treatment. Sleep Med Rev. 2006;10(3):169-77. [Crossref]  [PubMed] 
  5. Montplaisir J, Boucher S, Poirier G, Lavigne G, Lapierre O, Lespérance P. Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria. Mov Disord. 1997;12(1):61-5. [Crossref]  [PubMed] 
  6. Chervin RD. Periodic leg movements and sleepiness in patients evaluated for sleep-disordered breathing. Am J Respir Crit Care Med. 2001;164(8 Pt 1):1454-8. [Crossref]  [PubMed] 
  7. Seifen C, Herrmann M, Pordzik J, Matthias C, Gouveris H. Periodic limb movements in patients with suspected obstructive sleep apnea without comorbid conditions. Front Med (Lausanne). 2024;11:1378410.PMID: 38737757 [Crossref]  [PubMed]  [PMC] 
  8. Wang Q, Li Y, Li J, Wang J, Shen J, Wu H, et al. Low Arousal Threshold: A Potential Bridge Between OSA and Periodic Limb Movements of Sleep. Nat Sci Sleep. 2021;13:229-38. [Crossref]  [PubMed] 
  9. Sforza E, Pichot V, Barthelemy JC, Haba-Rubio J, Roche F. Cardiovascular variability during periodic leg movements: a spectral analysis approach. Clin Neurophysiol. 2005;116(5):1096-104. [Crossref]  [PubMed] 
  10. Allena M, Campus C, Morrone E, De Carli F, Garbarino S, Manfredi C, et al. Periodic limb movements both in non-REM and REM sleep: relationships between cerebral and autonomic activities. Clin Neurophysiol. 2009;120(7):1282-90. [Crossref]  [PubMed] 
  11. Howard ME, O'Donoghue FJ. Periodic leg movements: A marker of cardiovascular risk? Respirology. 2020;25(8):793-4. [Crossref]  [PubMed] 
  12. Zinchuk A, Srivali N, Qin L, Jeon S, Ibrahim A, Sands SA, et al. Association of periodic limb movements and obstructive sleep apnea with risk of cardiovascular disease and mortality. J Am Heart Assoc. 2024;13(3):e031630. [Crossref]  [PubMed]  [PMC] 
  13. Zhou X, Zhou B, Li Z, Lu Q, Li S, Pu Z, et al. Periodic limb movements in patients with obstructive sleep apnea syndrome. Sci Rep. 2021;11(1):15341. [Crossref]  [PubMed]  [PMC] 
  14. Pennestri MH, Whittom S, Adam B, Petit D, Carrier J, Montplaisir J. PLMS and PLMW in healthy subjects as a function of age: prevalence and interval distribution. Sleep. 2006;29(9):1183-7. [Crossref]  [PubMed] 
  15. Al-Alawi A, Mulgrew A, Tench E, Ryan CF. 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(3):281-7. [Crossref]  [PubMed] 
  16. Ren R, Huang G, Zhang J, Zhou J, Li Y, Sun Y, et al. Age and severity matched comparison of gender differences in the prevalence of periodic limb movements during sleep in patients with obstructive sleep apnea. Sleep Breath. 2016;20(2):821-7. [Crossref]  [PubMed] 
  17. Ohayon MM, Roth T. Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res. 2002;53(1):547-54. [Crossref]  [PubMed] 
  18. Leary EB, Moore HE 4th, Schneider LD, Finn LA, Peppard PE, Mignot E. Periodic limb movements in sleep: prevalence and associated sleepiness in the Wisconsin Sleep Cohort. Clin Neurophysiol. 2018;129(11):2306-14. [Crossref]  [PubMed]  [PMC] 
  19. Budhiraja R, Javaheri S, Pavlova MK, Epstein LJ, Omobomi O, Quan SF. Prevalence and correlates of periodic limb movements in OSA and the effect of CPAP therapy. Neurology. 2020;94(17):e1820-e7. [Crossref]  [PubMed]  [PMC] 

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