Prevalence and correlates of periodic limb movements in OSA and the effect of CPAP therapy
Prevalence and correlates of periodic limb movements in OSA and the effect of CPAP therapy
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DOI：
10.1212/wnl.0000000000008844
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发表时间：
2020-04-28
期刊：
影响因子：
9.9
通讯作者：
Quan, Stuart F.
中科院分区：
文献类型：
--
作者：
Budhiraja, Rohit;Javaheri, Sogol;Quan, Stuart F.
目的通过一项大型前瞻性多中心随机对照试验，评估阻塞性睡眠呼吸暂停（OSA）患者周期性睡眠肢体运动（PLMS）的患病率、相关性和后果，以及持续气道正压通气（CPAP）治疗对PLMS的影响（恶化或改善）。方法我们对来自呼吸暂停正压通气长期疗效研究的数据进行了回顾性分析，这是一项前瞻性多中心随机对照试验。共有1，105名OSA患者参加了本研究，他们在基线时接受了多导睡眠图检查，另一次接受了CPAP滴定，另一次在随机分配至活性CPAP或假CPAP后6个月接受了另一项研究。结果在所有参与者中，19.7%的PLMI>= 10/h，14.8%的PLMI >= 15/h，12.1%的PLMI >= 20/h，9.3%的PLMI >= 25/h，7.5%的PLMI >= 30/h。PLMI ≥ 10的几率在老年参与者中更高（比值比[OR] 1.03，p < 0.001），男性（OR 1.63，p < 0.001）。p = 0.007）、使用抗抑郁药者（OR 1.48. p = 0.048），以及咖啡因使用量较高的人群（OR 1.01，p = 0.04）。在控制了阻塞性睡眠呼吸暂停综合症和抑郁症后，PLMS与睡眠潜伏期增加、睡眠效率降低和总睡眠时间减少有关。PLMS频率与主观嗜睡（埃普沃思嗜睡量表评分）或客观嗜睡（保持清醒测试）之间没有显著关系。治疗6个月后，与假CPAP相比，CPAP对PLMS无差异影响。结论：睡眠呼吸暂停综合征在OSA患者中很常见，与睡眠质量的显著下降有关。CPAP治疗不影响PLMS的严重程度。
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.