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Residual periodic limb movement index after CPAP therapy is associated with hypoxemia
Lourdes M DelRosso1, Harshill Modi2, Viraj Jain3
1University of California San Francisco, Fresno, California.
Study Objectives:
Periodic limb movements during sleep frequently coexist with obstructive sleep apnea, yet the impact of continuous positive airway pressure treatment on periodic limb movements during sleep remains unclear. This study investigated factors associated with persistence of periodic limb movement index (PLMI) during continuous positive airway pressure therapy.
Methods:
A retrospective cross-sectional study analyzed data from 107 adult patients who underwent split polysomnographic studies. Participants were classified into 4 groups based on PLMI changes: normal PLMI throughout (group 1), persistent elevated PLMI (group 2), worsened PLMI (group 3), and resolved PLMI (group 4). Predictors of PLMI persistence, including sleep architecture, oxygen desaturation, age, and body mass index, were assessed using logistic regression analysis.
Results:
36.1% of patients experienced resolution of elevated PLMI, 16.4% showed worsening, and 47.5% had persistent PLMI despite continuous positive airway pressure therapy. Logistic regression analysis revealed that male sex (odds ratio = 5.38, 95% confidence interval = 1.64-17.61, P = .005), higher body mass index (odds ratio = 1.09, 95% confidence interval = 1.01-1.17, P = .018), and greater time spent with oxygen saturation ≤ 88% during the diagnostic portion (odds ratio = 1.034, 95% confidence interval = 1.002-1.066, P = .035) were significant predictors of residual PLMI. Sleep architecture variables such as total sleep time, sleep efficiency, and sleep stage distribution were not independently associated with residual PLMI.
Conclusions:
Residual periodic limb movements during continuous positive airway pressure therapy are common and are independently associated with male sex, higher body mass index, and greater hypoxemia during the diagnostic portion of sleep.
Citation:
DelRosso LM, Modi H, Jain V, Vazquez IM, Picchietti DL. Residual periodic limb movement index after CPAP therapy is associated with hypoxemia. J Clin Sleep Med. 2025;21(8):1389-1393.
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