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

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.

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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.

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Correspondence to Chung-Yao Hsu.

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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.

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Wu, M., Lai, C., Liu, C. 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

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Keywords

  • Obstructive sleep apnea
  • Sleep-disordered breathing
  • Autonomic nervous system
  • Heart rate variability
  • Parasomnia
  • Continuous positive airway pressure