Basal sympathetic predominance in periodic limb movements in sleep after continuous positive airway pressure
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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).
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.
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).
Patients with OSA showing PLMS emerging after therapy with CPAP may have a basal sympathetic predominance with potential negative cardiovascular effects.
KeywordsObstructive sleep apnea Sleep-disordered breathing Autonomic nervous system Heart rate variability Parasomnia Continuous positive airway pressure
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.
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.
Compliance with ethical standards
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.
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