Skip to main content

Advertisement

SpringerLink
Log in

Periodic limb movements during sleep are associated with poor health-related quality of life in patients with obstructive sleep apnea

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

Abstract

Purpose

The clinical significance of the comorbidity of periodic limb movements during sleep (PLMS) in sleep-disordered breathing remains unclear. This study aimed to determine whether or not the presence of PLMS is related to depressed mood and poor quality of life in subjects with obstructive sleep apnea (OSA).

Methods

We defined PLMS as a periodic leg movement index of > 15/h. Scores for the Medical Outcomes Study Short Form Health Survey and Beck Depression Inventory were assessed with multiple logistic or linear regression analyses.

Results

Of 1370 subjects with OSA, a prevalence of PLMS was 14.1%. Older age, men, and obesity were positively associated with PLMS. PLMS occurred in 17%, 15%, and 12% of mild, moderate, and severe subjects with OSA, respectively. Severe OSA was less likely to be associated with PLMS than mild OSA. PLMS negatively correlated with physical and mental component summary scores of the health survey but not with Beck Depression Inventory scores after controlling for confounding variables. PLMS were significantly associated with poor sleep architecture on polysomnography. However, the relationship between PLMS and disturbed sleep was no longer significant after adjusting for age.

Conclusions

Health-related quality of life, including physical and mental health but not depressive symptoms, was worse in subjects with OSA and PLMS than in those without PLMS.

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

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not applicable.

References

  1. American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd ed. American Academy of Sleep Medicine, Darien

  2. Scofield H, Roth T, Drake C (2008) Periodic limb movements during sleep: population prevalence, clinical correlates, and racial differences. Sleep 31:1221–1227

    PubMed  PubMed Central  Google Scholar 

  3. Haba-Rubio J, Marti-Soler H, Tobback N et al (2018) Clinical significance of periodic limb movements during sleep: the HypnoLaus study. Sleep Med 41:45–50

    Article  Google Scholar 

  4. Huang TC, Tseng PT, Wu MN, et al (2019) Periodic limb movements during sleep are associated with cardiovascular diseases: a systematic review and meta-analysis. J Sleep Res 28:e12720

  5. Mirza M, Shen WK, Sofi A, Jahangir A, Mori N, Tajik AJ, Jahangir A (2013) Frequent periodic leg movement during sleep is associated with left ventricular hypertrophy and adverse cardiovascular outcomes. J Am Soc Echocardiogr 26:783–790

    Article  Google Scholar 

  6. Giannaki CD, Zigoulis P, Karatzaferi C et al (2013) Periodic limb movements in sleep contribute to further cardiac structure abnormalities in hemodialysis patients with restless legs syndrome. J Clin Sleep Med 9:147–153

    Article  Google Scholar 

  7. Karatas M (2007) Restless legs syndrome and periodic limb movements during sleep: diagnosis and treatment. Neurologist 13:294–301

    Article  Google Scholar 

  8. Budhiraja R, Javaheri S, Pavlova MK, Epstein LJ, Omobomi O, Quan SF (2020) Prevalence and correlates of periodic limb movements in OSA and the effect of CPAP therapy. Neurology 94:e1820–e1827

    Article  CAS  Google Scholar 

  9. Kim HJ, Lee SA (2020) Periodic limb movements during sleep may reduce excessive daytime sleepiness in men with obstructive sleep apnea. Sleep Breath 24:1523–1529

    Article  Google Scholar 

  10. Al-Alawi A, Mulgrew A, Tench E, Ryan CF (2006) 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 2:281–287

    Article  Google Scholar 

  11. Haba-Rubio J, Staner L, Krieger J, Macher JP (2005) Periodic limb movements and sleepiness in obstructive sleep apnea patients. Sleep Med 6:225–229

    Article  Google Scholar 

  12. Chervin RD (2001) Periodic leg movements and sleepiness in patients evaluated for sleep-disordered breathing. Am J Respir Crit Care Med 164(8 Pt 1):1454–1458

    Article  CAS  Google Scholar 

  13. Lee TH, Yen TT, Chiu NY, Chang CC, Hsu WY, Chang YJ, Chang TG (2019) Depression is differently associated with sleep measurement in obstructive sleep apnea, restless leg syndrome and periodic limb movement disorder. Psychiatry Res 273:37–41

    Article  Google Scholar 

  14. Warnes H, Dinner DS, Kotagal P, Burgess RC (1993) Periodic limb movements and sleep apnoea. J Sleep Res 2:38–44

    Article  CAS  Google Scholar 

  15. Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, Zucconi M, Ferri R, Trenkwalder C, Lee HB; International Restless Legs Syndrome Study Group (2014) Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med 15:860–73

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

  17. Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus C, Vaughn BV (2012) The AASM manual for the scoring of sleep and associated events. Rules, Terminology and Technical Specifications, Version 2.0. Darien, Illinois, American Academy of Sleep Medicine

  18. Han CW, Lee EJ, Iwaya T et al (2004) Development of the Korean version of Short-Form 36-Item Health Survey: health related QOL of healthy elderly people and elderly patients in Korea. Tohoku J Exp Med 203:189–194

    Article  Google Scholar 

  19. Lee YH, Song JY (1991) A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. J Korean Neuropsychiatry Assoc 10:93–113

    Google Scholar 

  20. Cho YW, Lee JH, Son HK, Lee SH, Shin C, Johns MW (2011) The reliability and validity of the Korean version of the Epworth sleepiness scale. Sleep Breath 15:377–384

    Article  Google Scholar 

  21. Leary EB, Moore HE IV, Schneider LD, Finn LA, Peppard PE, Mignot E (2018) Periodic limb movements in sleep: prevalence and associated sleepiness in the Wisconsin Sleep Cohort. Clin Neurophysiol 129:2306–2314

    Article  Google Scholar 

  22. Szentkirályi A, Stefani A, Hackner H, et al (2019) Prevalence and associated risk factors of periodic limb movement in sleep in two German population-based studies. Sleep 42:zsy237

  23. Scharf SM, Tubman A, Smale P (2005) Prevalence of concomitant sleep disorders in patients with obstructive sleep apnea. Sleep Breath 9:50–56

    Article  Google Scholar 

  24. Aritake-Okada S, Namba K, Hidano N et al (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 317:13–16

    Article  Google Scholar 

  25. Leng Y, Blackwell T, Stone KL, Hoang TD, Redline S, Yaffe K (2016) Periodic limb movements in sleep are associated with greater cognitive decline in older men without dementia. Sleep 39:1807–1810

    Article  Google Scholar 

  26. Covassin N, Neikrug AB, Liu L et al (2012) Clinical correlates of periodic limb movements in sleep in Parkinson’s disease. J Neurol Sci 316:131–136

    Article  Google Scholar 

  27. Van Herzeele C, Dhondt K, Roels SP, Raes A, Groen LA, Hoebeke P, Vande WJ (2015) Periodic limb movements during sleep are associated with a lower quality of life in children with monosymptomatic nocturnal enuresis. Eur J Pediatr 174:897–902

    Article  Google Scholar 

  28. Hardy De Buisseret FX, Mairesse O, Newell J, Verbanck P, Neu D (2017) While isolated periodic limb movement disorder significantly impacts sleep depth and efficiency, co-morbid restless leg syndrome mainly exacerbates perceived sleep quality. Eur Neurol 77:272–80

  29. Iriarte J, Murie-Fernandez M, Toledo E et al (2009) Sleep structure in patients with periodic limb movements and obstructive sleep apnea syndrome. J Clin Neurophysiol 26:267–271

    Article  Google Scholar 

  30. 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 96:89–91

    Article  CAS  Google Scholar 

  31. 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 26:717–720

    Article  Google Scholar 

  32. Hedli LC, Christos P, Krieger AC (2012) Unmasking of periodic limb movements with the resolution of obstructive sleep apnea during continuous positive airway pressure application. J Clin Neurophysiol 29:339

    Article  Google Scholar 

  33. Chervin RD, Chung S, O’Brien LM et al (2014) Periodic leg movements during sleep in children scheduled for adenotonsillectomy: frequency, persistence, and impact. Sleep Med 15:1362–1369

    Article  Google Scholar 

  34. Yang EH, Hla KM, McHorney CA, Havighurst T, Badr MS, Weber S (2000) Sleep apnea and quality of life. Sleep 23:535–541

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Sang-Ahm Lee, Soo Jeong Kim, So Young Lee & Hyo Jae Kim

Authors
  1. Sang-Ahm Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soo Jeong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. So Young Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyo Jae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Sang-Ahm Lee; methodology: Sang-Ahm Lee; writing— original draft preparation: Sang-Ahm Lee; reviewing and editing, supervision: Sang-Ahm Lee; data curation: Hyo Jae Kim, Soo Jeong Kim, So Young Lee; formal analysis: Hyo Jae Kim.

Corresponding author

Correspondence to Sang-Ahm Lee.

Ethics declarations

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Asan medical center approved this study.

Consent to participate

This was a retrospective study based on records, and formal consent was not required.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, SA., Kim, S.J., Lee, S.Y. et al. Periodic limb movements during sleep are associated with poor health-related quality of life in patients with obstructive sleep apnea. Sleep Breath 26, 1045–1052 (2022). https://doi.org/10.1007/s11325-021-02469-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-021-02469-y

Keywords

Search

Navigation