Objective: Periodic Limb Movements of Sleep (PLMS) is a poorly understood comorbidity with close association to Obstructive Sleep Apnea (OSA). The mechanistic link between the two is unclear. Recent studies on the latter have uncovered low respiratory arousal threshold as an important non-anatomical cause of the disorder. This study sought to investigate whether periodic limb movements are associated with the low respiratory arousal threshold (ArTH) in OSA.
Methods: Retrospective data on 720 OSA patients (mean age = 47.0) who underwent Polysomnography (PSG) were collected. Using PLMS diagnostic criteria of PLMS index ≥ 15, patients were divided into the OSA-PLMS group (n=95) and the OSA-only group (n=625). Binary logistic regression analysis was used to examine the correlation between PLMS and the presence of low ArTH, classified using a predicted tool (developed by Edward et al) requiring meeting at least two of the three criteria: apnea-hypopnea index (AHI) < 30/h, nadir oxygen saturation (SaO2) > 82.5%, and fraction of hypopneas > 58.3%. The resulting model was validated in the external MrOS database.
Results: The patients in the OSA-PLMS group tend to be older, with a higher prevalence of hypertension, diabetes, and stroke. PLMS was associated with age, diabetes, oxygen desaturation index, and low respiratory arousal threshold (OR=8.78 (4.73– 16.30), p< 0.001). When validated against the MrOS database, low ArTH remained a significant predictor of PLMS with an odds ratio of 1.33 (1.08– 1.64, p = 0.009).
Conclusion: This is the first study that demonstrated a strong correlation between PLMS and low respiratory arousal threshold. This suggests a possible mechanistic link between the physical manifestation of PLMS and the non-anatomical low arousal threshold phenotype in OSA.

Keywords: obstructive sleep apnea, periodic limb movements, low respiratory arousal threshold

A Letter to the Editor has been published for this article.


中文翻译：

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低唤醒阈值：OSA 与睡眠的周期性肢体运动之间的潜在桥梁

目的：睡眠周期性肢体运动 (PLMS) 是一种与阻塞性睡眠呼吸暂停 (OSA) 密切相关的、知之甚少的合并症。两者之间的机制联系尚不清楚。最近对后者的研究发现，低呼吸唤醒阈值是该疾病的重要非解剖学原因。本研究旨在调查周期性肢体运动是否与 OSA 中的低呼吸唤醒阈值 (ArTH) 相关。
方法：收集了 720 名接受多导睡眠图 (PSG) 的 OSA 患者（平均年龄 = 47.0）的回顾性数据。使用PLMS指数≥15的PLMS诊断标准，将患者分为OSA-PLMS组（n=95）和仅OSA组（n=625）。二元逻辑回归分析用于检查 PLMS 与低 ArTH 存在之间的相关性，使用预测工具（由 Edward 等人开发）进行分类，要求满足三个标准中的至少两个：呼吸暂停低通气指数 (AHI) < 30 /h，最低氧饱和度 (SaO2) > 82.5%，低通气分数 > 58.3%。生成的模型在外部 MrOS 数据库中得到验证。
结果：OSA-PLMS 组的患者往往年龄较大，高血压、糖尿病和中风的患病率较高。PLMS 与年龄、糖尿病、氧饱和指数和低呼吸唤醒阈值相关（OR=8.78 (4.73-16.30)，p<0.001）。当针对 MrOS 数据库进行验证时，低 ArTH 仍然是 PLMS 的重要预测指标，优势比为 1.33（1.08-1.64，p = 0.009）。
结论：这是第一项证明 PLMS 与低呼吸唤醒阈值之间存在强相关性的研究。这表明 PLMS 的物理表现与 OSA 中的非解剖学低唤醒阈值表型之间可能存在机制联系。

关键词：阻塞性睡眠呼吸暂停，周期性肢体运动，低呼吸觉醒阈值

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