Aritake Sayaka, Blackwell Terri, Peters Katherine W, Rueschman Michael, Mobley Daniel, Morrical Michael G, Platt Samuel F, Dam Thuy-Tien L, Redline Susan, Winkelman John W
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Japan Society for the Promotion of Science (JSPS), Tokyo, Japan.
California Pacific Medical Center Research Institute, San Francisco Coordinating Center, San Francisco, CA, USA.
Sleep Med. 2015 Oct;16(10):1236-44. doi: 10.1016/j.sleep.2015.06.012. Epub 2015 Jun 30.
Obstructive respiratory events often terminate with an associated respiratory-related leg movement (RRLM). Such leg movements are not scored as periodic leg movements (periodic limb movements during sleep, PLMS), although the criteria for distinguishing RRLM from PLMS differ between the American Academy of Sleep Medicine (AASM) and the World Association of Sleep Medicine (WASM)/ International Restless Legs Syndrome Study Group (IRLSSG) scoring manuals. Such LMs may be clinically significant in patients with obstructive sleep apnea (OSA). The prevalence and correlation of RRLM in men with OSA were examined.
A case-control sample of 575 men was selected from all men with an apnea-hypopnea index (AHI, ≥3% desaturation criteria) ≥ 10 and good data from piezoelectric leg movement sensors at the first in-home sleep study in the MrOS cohort (mean age = 76.8 years). Sleep studies were rescored for RRLMs using five different RRLM definitions varying in both latency of leg movement onset from respiratory event termination and duration of the leg movement. The quartile of RRLM% (the number of RRLM/the number of hypopneas + apneas) was derived.
The nonparametric densities of RRLM% were most influenced by alterations in the latency rather than the duration of the LM. The most liberal RRLM definition (latency 0-5 s, duration 0.5-10 s) led to a median RRLM% of 23.4 (interquartile range 12.41, 37.12) in this sample. The average AHI and arousal index increased as the quartile of RRLM% increased, as well as the prevalence of chronic obstructive pulmonary disease (COPD). The prevalence of those with a history of hypertension decreased as RRLM% increased. The non-Caucasian race was associated with lower RRLM%.
Within an elderly sample with moderate to severe OSA, piezoelectric-defined RRLM% is associated with a number of sleep-related and demographic factors. Further study of the optimal definition, predictors, and consequences of RRLM is warranted.
阻塞性呼吸事件通常会伴随着相关的呼吸相关性腿部运动（RRLM）而终止。尽管美国睡眠医学学会（AASM）与世界睡眠医学协会（WASM）/国际不宁腿综合征研究组（IRLSSG）的评分手册中区分RRLM与睡眠期周期性腿部运动（PLMS）的标准有所不同，但此类腿部运动并不被计为PLMS。此类腿部运动在阻塞性睡眠呼吸暂停（OSA）患者中可能具有临床意义。本研究对男性OSA患者中RRLM的患病率及相关性进行了调查。
从MrOS队列中首次在家中进行睡眠研究时呼吸暂停低通气指数（AHI，采用≥3%血氧饱和度下降标准）≥10且压电式腿部运动传感器数据良好的所有男性中选取了一个包含575名男性的病例对照样本（平均年龄=76.8岁）。使用五种不同的RRLM定义对睡眠研究中的RRLM进行重新评分，这些定义在腿部运动起始相对于呼吸事件终止的潜伏期以及腿部运动持续时间方面各不相同。计算出RRLM%（RRLM数量/呼吸暂停+低通气数量）的四分位数。
RRLM%的非参数密度受腿部运动潜伏期变化的影响大于持续时间变化的影响。在本样本中，最宽松的RRLM定义（潜伏期0 - 5秒，持续时间0.5 - 10秒）导致RRLM%的中位数为23.4（四分位间距12.41，37.12）。随着RRLM%四分位数增加，平均AHI和觉醒指数升高，慢性阻塞性肺疾病（COPD）患病率也升高。有高血压病史者的患病率随RRLM%增加而降低。非白种人与较低的RRLM%相关。
在患有中度至重度OSA的老年样本中，压电式定义的RRLM%与一些睡眠相关因素及人口统计学因素相关。有必要进一步研究RRLM的最佳定义、预测因素及后果。
