Skip to main content
SpringerLink
Log in

Possible effect of periodic limb movements during sleep on the sleepiness of patients with sleep disordered breathing

  • Original Article
  • Published:
Sleep and Biological Rhythms Aims and scope Submit manuscript

Abstract

We aimed to conduct a cross-sectional study in order to investigate the effect of periodic limb movements during sleep (PLMS) on daytime sleepiness in patients with sleep disordered breathing especially those with obstructive sleep apnea syndrome (OSAS), diagnosed by polysomnography (PSG). Our subjects included 233 male patients who visited our institute during the 25-month period between June 2012 and June 2013. We scored the number of Periodic Limb Movements per hour as the Periodic Limb Movements Index (PLMI) on standard PSG, and considered that periodic limb movements during sleep was present in the patients with PLMI >15/h. Non-PLMS group included those patients with PLMI ≤15/h. To assess the sleepiness of participants, we used Japanese version of the Epworth Sleepiness Scale (JESS) and Japanese version of the Pittsburgh Sleep Quality Index. We compared the sleep parameters and sleepiness indicators between patients with PLMS and age, apnea–hypopnea index (AHI), and body mass index-matched non-PLMS control groups. JESS scores were higher in patients with PLMS than in non-PLMS in both low AHI (<15/h) and high AHI (≥15/h) strata. However, the difference was statistically significant only in high AHI stratum (P = 0.399 and 0.001, respectively). In conclusion, PLMS was associated with increased JESS especially in patients with moderate-to-severe OSAS. Although the magnitude of the difference in those with AHI <15/h was smaller and statistically insignificant in the present study, this issue warrants further investigation by enrolling more patients with AHI <15/h.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Iber C, American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications. Westchester: American Academy of Sleep Medicine; 2007.

    Google Scholar 

  2. American Academy of Sleep Medicine. International classification of sleep disorders. Diagnostic and coding manual. American Academy of Sleep Medicine: Darian; 2014.

    Google Scholar 

  3. Natarajan R. Review of periodic limb movement and restless leg syndrome. J Postgrad Med. 2010;56:157–62.

    Article  CAS  PubMed  Google Scholar 

  4. Bixler EO, Kales A, Vela-Bueno A, Jacoby JA, Scarone S, Soldatos CR. Nocturnal myoclonus and nocturnal myoclonic activity in the normal population. Res Commun Chem Pathol Pharmacol. 1982;36:129–40.

    CAS  PubMed  Google Scholar 

  5. Coleman RM, Bliwise DL, Sajben N, Boomkamp A, de Bruyn LM, Dement WC. Daytime sleepiness in patients with periodic movements in sleep. Sleep. 1982;5(Suppl 2):S191–202.

    PubMed  Google Scholar 

  6. Mendelson WB. Are periodic leg movements associated with clinical sleep disturbance? Sleep. 1996;19:219–23.

    CAS  PubMed  Google Scholar 

  7. Chervin RD. Periodic leg movements and sleepiness in patients evaluated for sleep-disturbed breathing. Am J Respir Crit Care Med. 2001;164:1454–8.

    Article  CAS  PubMed  Google Scholar 

  8. Montplaisir J, Michaud M, Denesle R, Gosselin A. Periodic leg movements are not more prevalent in insomnia or hypersomnia but are specifically associated with sleep disorders involving a dopaminergic impairment. Sleep Med. 2000;1:163–7.

    Article  PubMed  Google Scholar 

  9. Takegami M, Suzukamo Y, Wakita T, et al. Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on item response theory. Sleep Med. 2009;10:556–65.

    Article  PubMed  Google Scholar 

  10. Doi Y, Minowa M, Uchiyama M, et al. Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects. Psychiatry Res. 2000;97:165–72.

    Article  CAS  PubMed  Google Scholar 

  11. 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;2:281–7.

    PubMed  Google Scholar 

  12. Kapur VK, Baldwin CM, Resnick HE, Gottlieb DJ, Nieto FJ. Sleepiness in patients with moderate to severe sleep-disordered breathing. Sleep. 2005;28:472–7.

    PubMed  Google Scholar 

  13. Vernet C, Redolfi S, Attali V, et al. Residual sleepiness in obstructive sleep apnoea: phenotype and related symptoms. Eur Respir J. 2011;38:98–105.

    Article  CAS  PubMed  Google Scholar 

  14. Scofield H, Roth T, Drake C. Periodic limb movements during sleep: population prevalence, clinical correlates, and racial differences. Sleep. 2008;31:1221–7.

    PubMed  PubMed Central  Google Scholar 

  15. Aritake-Okada S, Namba K, Hidano N, et al. Change in frequency of periodic limb movements during sleep with usage of continuous positive airway pressure in obstructive sleep apnea syndrome. J Neurol Sci. 2012;317:13–6.

    Article  PubMed  Google Scholar 

  16. Ferri R, Fulda S, Manconi M, et al. Night-to-night variability of periodic leg movements during sleep in restless legs syndrome and periodic limb movement disorder: comparison between the periodicity index and the PLMS index. Sleep Med. 2013;14:293–6.

    Article  PubMed  Google Scholar 

  17. Trotti LM, Bliwise DL, Greer SA, et al. Correlates of PLMs variability over multiple nights and impact upon RLS diagnosis. Sleep Med. 2009;10:668–71.

    Article  PubMed  Google Scholar 

  18. Agnew HW Jr, Webb WB, Williams RL. The first night effect: an EEG study of sleep. Psychophysiology. 1966;2:263–6.

    Article  PubMed  Google Scholar 

  19. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Publishers; 1988.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Laboratory, Second Affiliated Hospital, Fujita Health University, Nagoya, Japan

    Masatoshi Hirata, Miyoko Nishiura & Yoshihiro Imaeda

  2. Fujita Health University, Second Hospital, Otolaryngology, Nagoya, Japan

    Seiichi Nakata, Mahmood A. Hamed, Noboru Iwata & Yoichi Nishimura

  3. Department of Internal Medicine, National Hospital Orgaization Suzuka Hospital, Suzuka, Japan

    Fumihiko Yasuma

  4. Department of Public Health, Fujita Health University, Toyoake, Japan

    Masaaki Matsunaga & Hiroshi Yatsuya

Authors
  1. Masatoshi Hirata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seiichi Nakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahmood A. Hamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noboru Iwata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoichi Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Miyoko Nishiura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoshihiro Imaeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fumihiko Yasuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masaaki Matsunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroshi Yatsuya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seiichi Nakata.

Ethics declarations

Conflict of interest

All the authors have no conflicts of interests to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirata, M., Nakata, S., A. Hamed, M. et al. Possible effect of periodic limb movements during sleep on the sleepiness of patients with sleep disordered breathing. Sleep Biol. Rhythms 14, 205–210 (2016). https://doi.org/10.1007/s41105-015-0043-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41105-015-0043-5

Keywords

Search

Navigation