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Abstract
Objective We sought to assess the prevalence, correlates, and consequences of periodic limb movements of sleep (PLMS) in persons with obstructive sleep apnea (OSA) and the effect (worsening or improvement) of continuous positive airway pressure (CPAP) therapy on PLMS in a large prospective multicenter randomized controlled trial.
Methods We performed retrospective analyses of data from the Apnea Positive Pressure Long-term Efficacy Study, a prospective multicenter randomized controlled trial. A total of 1,105 persons with OSA enrolled in this study underwent a polysomnographic investigation at baseline, another one for CPAP titration, and another study 6 months after randomization to either active CPAP or sham CPAP.
Results Of all participants, 19.7% had PLM index (PLMI) ≥10/hour, 14.8% had PLMI ≥15/hour, 12.1% had PLMI ≥20/hour, 9.3% had PLMI ≥25/hour, and 7.5% had PLMI ≥30/hour. The odds of having a PLMI ≥10 were higher in older participants (odds ratio [OR] 1.03, p < 0.001), men (OR 1.63. p = 0.007), those using antidepressants (OR 1.48. p = 0.048), and those with higher caffeine use (OR 1.01, p = 0.04). After controlling for OSA and depression, PLMS were associated with increased sleep latency, reduced sleep efficiency, and reduced total sleep time. No significant relationships were noted between PLMS frequency and subjective sleepiness (Epworth Sleepiness Scale score) or objective sleepiness (Maintenance of Wakefulness Test). There was no differential effect of CPAP in comparison to sham CPAP on PLMS after 6 months of therapy.
Conclusions PLMS are common in patients with OSA and are associated with a significant reduction in sleep quality over and above that conferred by OSA. Treatment with CPAP does not affect the severity of PLMS.
Glossary
- AASM=
- American Academy of Sleep Medicine;
- AHI=
- apnea-hypopnea index;
- APPLES=
- Apnea Positive Pressure Long-term Efficacy Study;
- CPAP=
- continuous positive airway pressure;
- ESS=
- Epworth Sleepiness Scale;
- HAM-D=
- Hamilton Rating Scale for Depression;
- MWT=
- maintenance of wakefulness test;
- OR=
- odds ratio;
- OSA=
- obstructive sleep apnea;
- PAP=
- positive airway pressure;
- PLMI=
- PLM index;
- PLMS=
- periodic limb movements of sleep;
- RLS=
- restless legs syndrome;
- SOL=
- sleep onset latency;
- TST=
- total sleep time
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received May 18, 2019.
- Accepted in final form November 11, 2019.
- © 2019 American Academy of Neurology
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