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Obstructive sleep apnea and periodic limb movement in children: is there really an association?

C González-Merino1, E Martínez-Cayuelas2, A Ladrón-Guevara2

  • 1Autonomous University of Madrid, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040, Madrid, Spain.

Sleep Medicine
|November 26, 2023
PubMed

Insights

The association between Obstructive Sleep Apnea (OSA) and Periodic Limb Movements (PLM) may be overestimated. Updated scoring criteria revealed no significant differences in PLM between children with and without OSA, challenging previous findings.

Area of Science:

  • Sleep Medicine
  • Pediatric Pulmonology
  • Neurology

Background:

  • Periodic limb movements (PLM) are sleep-related movements that can occur independently or alongside other sleep disorders like Obstructive Sleep Apnea (OSA).
  • Previous studies suggested a link between OSA and PLM, but these were based on older diagnostic criteria.
  • Recent modifications to the World Association of Sleep Medicine (WASM) criteria for respiratory-related leg movements (RRLM) may impact the perceived association between OSA and PLM.

Purpose of the Study:

  • To investigate the association between Obstructive Sleep Apnea (OSA) and Periodic Limb Movements (PLM) in children using updated scoring criteria.
  • To determine if the revised definition of respiratory-related leg movements (RRLM) affects the relationship between OSA and PLM.

Main Methods:

  • A study involving 131 children (ages 5-12) suspected of sleep-disordered breathing was conducted.
  • Polysomnography (PSG) data was analyzed, with 65 children diagnosed with OSA and 66 with snoring but no OSA.
  • Leg movements were manually scored using both 2006 and 2016 WASM/IRLSSG criteria.

Main Results:

  • Using 2006 WASM rules, significant differences in PLM index were found between OSA and non-OSA groups.
  • However, applying the 2016 WASM rules, no statistical differences were observed for PLM index, non-REM PLM index, REM PLM index, or PLM with arousal index.
  • The percentage of children with PLM>5/h decreased from 38.93% with older criteria to 19.08% with updated criteria.

Conclusions:

  • The updated WASM/IRLSSG scoring rules suggest that the association between OSA and PLM may be overestimated.
  • The lack of a clear association under new criteria, coupled with unclear pathophysiology, indicates the relationship might not be as significant as previously thought.
  • Further research is needed to fully understand the complex interplay between OSA and PLM.
Abstract

Keywords:
Obstructive sleep apneaPeriodic limb movements

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