Skip to main content
SpringerLink
Log in

Basal sympathetic predominance in periodic limb movements in sleep after continuous positive airway pressure

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

This study investigated the basal autonomic regulation in patients with obstructive sleep apnea (OSA) showing periodic limb movements in sleep (PLMS) emerging after therapy with continuous positive airway pressure (CPAP).

Methods

Data of patients with OSA undergoing a first polysomnography for diagnosis and a second polysomnography for therapy with CPAP were reviewed. Patients with OSA showing PLMS on the first polysomnography were excluded. By using heart rate variability analysis, epochs without any sleep events and continuous effects from the second polysomnography were retrospectively analyzed.

Results

Of 125 eligible patients, 30 with PLMS after therapy with CPAP (PLMS group) and 30 not showing PLMS on both polysomnography (non-PLMS group) were randomly selected for the analysis. No significant differences in the demographic characteristics and variables of polysomnographies were identified between the groups. Although one trend of low root mean square of successive differences (RMSSD) between intervals of adjacent normal heart beats (NN intervals) in the PLMS group was observed, patients in the PLMS group had significantly low normalized high-frequency (n-HF) and high-frequency (HF) values, but high normalized low frequency (n-LF) and high ratio of LF to HF (LF/HF ratio). After adjustment for confounding variables, PLMS on the second polysomnography was significantly associated with RMSSD (β = − 6.7587, p = 0.0338), n-LF (β = 0.0907, p = 0.0148), n-HF (β = − 0.0895, p = 0.0163), log LF/HF ratio (β = 0.4923, p = 0.0090), and log HF (β = − 0.6134, p = 0.0199).

Conclusions

Patients with OSA showing PLMS emerging after therapy with CPAP may have a basal sympathetic predominance with potential negative cardiovascular effects.

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. Hornyak M, Feige B, Riemann D, Voderholzer U (2006) Periodic leg movements in sleep and periodic limb movement disorder: prevalence, clinical significance and treatment. Sleep Med Rev 10(3):169–177. https://doi.org/10.1016/j.smrv.2005.12.003

    Article  PubMed  Google Scholar 

  2. Warnes H, Dinner DS, Kotagal P, Burgess RC (1993) Periodic limb movements and sleep apnoea. J Sleep Res 2(1):38–44. https://doi.org/10.1111/j.1365-2869.1993.tb00059.x

    Article  CAS  PubMed  Google Scholar 

  3. Baran AS, Richert AC, Douglass AB, May W, Ansarin K (2003) Change in periodic limb movement index during treatment of obstructive sleep apnea with continuous positive airway pressure. Sleep 26(6):717–720

    Article  Google Scholar 

  4. Aritake-Okada S, Namba K, Hidano N, Asaoka S, Komada Y, Usui A, Matsuura M, Inoue Y (2012) Change in frequency of periodic limb movements during sleep with usage of continuous positive airway pressure in obstructive sleep apnea syndrome. J Neurol Sci 317(1-2):13–16. https://doi.org/10.1016/j.jns.2012.03.013

    Article  PubMed  Google Scholar 

  5. Shamsuzzaman AS, Gersh BJ, Somers VK (2003) Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 290(14):1906–1914. https://doi.org/10.1001/jama.290.14.1906

    Article  CAS  PubMed  Google Scholar 

  6. Koo BB, Blackwell T, Ancoli-Israel S, Stone KL, Stefanick ML, Redline S, Osteoporotic Fractures in Men Study G (2011) Association of incident cardiovascular disease with periodic limb movements during sleep in older men: outcomes of sleep disorders in older men (MrOS) study. Circulation 124(11):1223–1231. https://doi.org/10.1161/CIRCULATIONAHA.111.038968

    Article  PubMed  PubMed Central  Google Scholar 

  7. Walters AS, Rye DB (2009) Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke. Sleep 32(5):589–597. https://doi.org/10.1093/sleep/32.5.589

    Article  PubMed  PubMed Central  Google Scholar 

  8. Boulos MI, Murray BJ, Muir RT, Gao F, Szilagyi GM, Huroy M, Kiss A, Walters AS, Black SE, Lim AS, Swartz RH (2017) Periodic limb movements and white matter hyperintensities in first-ever minor stroke or high-risk transient ischemic attack. Sleep 40(3). https://doi.org/10.1093/sleep/zsw080

  9. Aurora RN, Kristo DA, Bista SR, Rowley JA, Zak RS, Casey KR, Lamm CI, Tracy SL, Rosenberg RS, American Academy of Sleep M (2012) The treatment of restless legs syndrome and periodic limb movement disorder in adults—an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine clinical practice guideline. Sleep 35:1039–1062. https://doi.org/10.5665/sleep.1988

    Article  PubMed  PubMed Central  Google Scholar 

  10. Murase K, Hitomi T, Hamada S, Azuma M, Toyama Y, Harada Y, Tanizawa K, Handa T, Yoshimura C, Oga T, Mishima M, Chin K (2014) The additive impact of periodic limb movements during sleep on inflammation in patients with obstructive sleep apnea. Ann Am Thorac Soc 11(3):375–382. https://doi.org/10.1513/AnnalsATS.201306-144OC

    Article  CAS  PubMed  Google Scholar 

  11. MN W, Lai CL, Liu CK, Yen CW, Liou LM, Hsieh CF, Tsai MJ, Chen SC, Hsu CY (2015) Basal sympathetic predominance in periodic limb movements in sleep with obstructive sleep apnea. J Sleep Res 24(6):722–729. https://doi.org/10.1111/jsr.12314

    Article  Google Scholar 

  12. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). Circulation 93:1043–1065

  13. Dekker JM, Crow RS, Folsom AR, Hannan PJ, Liao D, Swenne CA, Schouten EG (2000) Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC study. Atherosclerosis Risk In Communities. Circulation 102(11):1239–1244. https://doi.org/10.1161/01.CIR.102.11.1239

    Article  CAS  PubMed  Google Scholar 

  14. Liao D, Cai J, Rosamond WD, Barnes RW, Hutchinson RG, Whitsel EA, Rautaharju P, Heiss G (1997) Cardiac autonomic function and incident coronary heart disease: a population-based case-cohort study. The ARIC study. Atherosclerosis Risk in Communities Study. Am J Epidemiol 145(8):696–706. https://doi.org/10.1093/aje/145.8.696

    Article  CAS  PubMed  Google Scholar 

  15. Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, Feldman CL, Levy D (1996) Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 94(11):2850–2855. https://doi.org/10.1161/01.CIR.94.11.2850

    Article  CAS  PubMed  Google Scholar 

  16. Aydin M, Altin R, Ozeren A, Kart L, Bilge M, Unalacak M (2004) Cardiac autonomic activity in obstructive sleep apnea: time-dependent and spectral analysis of heart rate variability using 24-hour Holter electrocardiograms. Tex Heart Inst J 31(2):132–136

    PubMed  PubMed Central  Google Scholar 

  17. Gula LJ, Krahn AD, Skanes A, Ferguson KA, George C, Yee R, Klein GJ (2003) Heart rate variability in obstructive sleep apnea: a prospective study and frequency domain analysis. Ann Noninvasive Electrocardiol 8(2):144–149. https://doi.org/10.1046/j.1542-474X.2003.08209.x

    Article  PubMed  Google Scholar 

  18. Ferrillo F, Beelke M, Canovaro P, Watanabe T, Arico D, Rizzo P, Garbarino S, Nobili L, De Carli F (2004) Changes in cerebral and autonomic activity heralding periodic limb movements in sleep. Sleep Med 5(4):407–412. https://doi.org/10.1016/j.sleep.2004.01.008

    Article  PubMed  Google Scholar 

  19. Guggisberg AG, Hess CW, Mathis J (2007) The significance of the sympathetic nervous system in the pathophysiology of periodic leg movements in sleep. Sleep 30(6):755–766. https://doi.org/10.1093/sleep/30.6.755

    Article  PubMed  PubMed Central  Google Scholar 

  20. Manconi M, Ferri R, Zucconi M, Clemens S, Rundo F, Oldani A, Ferini-Strambi L (2011) Effects of acute dopamine-agonist treatment in restless legs syndrome on heart rate variability during sleep. Sleep Med 12(1):47–55. https://doi.org/10.1016/j.sleep.2010.03.019

    Article  PubMed  Google Scholar 

  21. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force (1999). Sleep 22:667–689

  22. Manconi M, Zavalko I, Fanfulla F, Winkelman JW, Fulda S (2015) An evidence-based recommendation for a new definition of respiratory-related leg movements. Sleep 38:295–304. https://doi.org/10.5665/sleep.4418

    Article  PubMed  PubMed Central  Google Scholar 

  23. McCall WV, Haponik E (1993) Relationship of nasal continuous positive airway pressure to periodic limb movement disorder in a patient without sleep apnea. Chest 103(5):1609–1611. https://doi.org/10.1378/chest.103.5.1609

    Article  CAS  PubMed  Google Scholar 

  24. Guerrero ML, Kim D, Rupp TL, Balkin TJ (2010) Oral appliance titration in patients with obstructive sleep apnea induces the appearance of periodic limb movements. Sleep Breath 14(4):359–363. https://doi.org/10.1007/s11325-009-0321-z

    Article  PubMed  Google Scholar 

  25. Fry JM, DiPhillipo MA, Pressman MR (1989) Periodic leg movements in sleep following treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Chest 96(1):89–91. https://doi.org/10.1378/chest.96.1.89

    Article  CAS  PubMed  Google Scholar 

  26. Exar EN, Collop NA (2001) The association of upper airway resistance with periodic limb movements. Sleep 24(2):188–192. https://doi.org/10.1093/sleep/24.2.188

    Article  CAS  PubMed  Google Scholar 

  27. Siddiqui F, Strus J, Ming X, Lee IA, Chokroverty S, Walters AS (2007) Rise of blood pressure with periodic limb movements in sleep and wakefulness. Clin Neurophysiol 118(9):1923–1930. https://doi.org/10.1016/j.clinph.2007.05.006

    Article  PubMed  Google Scholar 

  28. Ross AJ, Yang H, Larson RA, Carter JR (2014) Sleep efficiency and nocturnal hemodynamic dipping in young, normotensive adults. Am J Physiol Regul Integr Comp Physiol 307(7):R888–R892. https://doi.org/10.1152/ajpregu.00211.2014

    Article  CAS  PubMed  Google Scholar 

  29. Hornyak M, Kopasz M, Feige B, Riemann D, Voderholzer U (2005) Variability of periodic leg movements in various sleep disorders: implications for clinical and pathophysiologic studies. Sleep 28(3):331–335

    PubMed  Google Scholar 

  30. Ferri R, Fulda S, Manconi M, Hogl B, Ehrmann L, Ferini-Strambi L, Zucconi M (2013) 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 14(3):293–296. https://doi.org/10.1016/j.sleep.2012.08.014

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Miss Yen-Ju Chuang, Miss Fu-Huei Tsai, Miss Huei-En Cheng, and Mr. Ming-Hung Sun in the Sleep Center of Kaohsiung Medical University Hospital for their assistance in data collection.

Funding

This study was supported by a grant from the Kaohsiung Medical University Hospital (grant number: KMUH-101-1M49), but this funding source had no involvement of the study design or interpretation of results.

Author information

Authors and Affiliations

  1. Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung City, 80754, Taiwan

    Meng-Ni Wu, Chiou-Lian Lai, Ching-Kuan Liu, Li-Min Liou, Cheng-Fang Hsieh & Chung-Yao Hsu

  2. Department of Master’s Program in Neurology, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80754, Taiwan

    Meng-Ni Wu, Chiou-Lian Lai, Ching-Kuan Liu, Li-Min Liou & Chung-Yao Hsu

  3. Department of Mechanical and Electro-mechanical Engineering, National Sun Yat-Sen University, 70 Lienhai Rd., Kaohsiung, 80424, Taiwan

    Chen-Wen Yen

  4. Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung City, 80754, Taiwan

    Cheng-Fang Hsieh

  5. Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80754, Taiwan

    Cheng-Fang Hsieh & Ming-Ju Tsai

  6. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung City, 80754, Taiwan

    Ming-Ju Tsai

  7. Department of Medical Imaging and Radiation Sciences, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80754, Taiwan

    Sharon Chia-Ju Chen

Authors
  1. Meng-Ni Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiou-Lian Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ching-Kuan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chen-Wen Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Li-Min Liou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cheng-Fang Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ming-Ju Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sharon Chia-Ju Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chung-Yao Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chung-Yao Hsu.

Ethics declarations

Ethical statement

This study was approved by the Institutional Review Board (KMUH-IRB-20110421) and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required because of the retrospective design of this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

ESM 1

(PDF 684 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, MN., Lai, CL., Liu, CK. et al. Basal sympathetic predominance in periodic limb movements in sleep after continuous positive airway pressure. Sleep Breath 22, 1005–1012 (2018). https://doi.org/10.1007/s11325-018-1620-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-018-1620-z

Keywords

Search

Navigation