Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Sleep Med. 2021 Sep;85:204-210. doi: 10.1016/j.sleep.2021.07.020. Epub 2021 Jul 22.
We compared the prevalence of periodic leg movements during sleep (PLMS) according to two different scoring rules of the American Academy of Sleep Medicine (AASM) 2012 and World Association of Sleep Medicine (WASM) 2016 and determined their association with depressed mood in patients with obstructive sleep apnea (OSA).
PLMS, defined as a periodic leg movements index of >15, were diagnosed on a diagnostic and continuous positive airway pressure (CPAP) titration polysomnography using the AASM 2012 and WASM 2016 rules. The Beck Depression Inventory (BDI) and Epworth Sleepiness Scale (ESS) were used, and multiple regression analyses were performed.
Among 160 OSA patients, the proportion with PLMS scored by the WASM 2016 criteria was significantly higher than that scored by the AASM 2012 criteria in a diagnostic study (20.6% vs. 16.3%, respectively; P = 0.016) but not in CPAP titration study and only in patients with severe OSA. In adjusted models, PLMS were positively associated with BDI scores and a BDI of ≥10 on both diagnostic and CPAP titration studies when scored by the WASM 2016. By contrast, when scored by the AASM 2012, PLMS were associated with BDI scores (but not BDI of ≥10) only in a CPAP titration study.
There are significant differences in the prevalence of PLMS and their association with depressed mood depending on the scoring rules in patients with OSA. The current AASM scoring criteria underestimate the prevalence of PLMS, and PLMS are more likely associated with depressed mood according to the WASM scoring criteria.
我们比较了根据美国睡眠医学学会（AASM）2012 年和世界睡眠医学协会（WASM）2016 年的两种不同评分规则诊断的睡眠周期性肢体运动（PLMS）的患病率，并确定了它们与阻塞性睡眠呼吸暂停（OSA）患者抑郁情绪的关系。
使用 AASM 2012 年和 WASM 2016 年的规则，在诊断性和持续气道正压通气（CPAP）滴定多导睡眠图上诊断 PLMS，定义为周期性肢体运动指数>15。使用贝克抑郁量表（BDI）和爱泼沃斯嗜睡量表（ESS）进行评估，并进行多元回归分析。
在 160 例 OSA 患者中，使用 WASM 2016 标准评分的 PLMS 比例在诊断性研究中明显高于使用 AASM 2012 标准评分的比例（分别为 20.6%和 16.3%；P=0.016），但在 CPAP 滴定研究中并非如此，且仅在重度 OSA 患者中如此。在调整后的模型中，当使用 WASM 2016 评分时，PLMS 与 BDI 评分和 BDI≥10 呈正相关，在诊断性和 CPAP 滴定研究中均如此。相比之下，当使用 AASM 2012 评分时，PLMS 仅与 CPAP 滴定研究中的 BDI 评分（而非 BDI≥10）相关。
在 OSA 患者中，PLMS 的患病率及其与抑郁情绪的关系因评分规则而异，存在显著差异。目前的 AASM 评分标准低估了 PLMS 的患病率，而根据 WASM 评分标准，PLMS 更有可能与抑郁情绪相关。
