Minami Anjyu, Minami Haruna, Matsuoka Harumi, Fukutome Takero
Certified Polysomnographic Technologist of the Japanese Society of Sleep Research, Fukuoka Sleep Clinic, Fukuoka, Japan.
Board Certified Fellow of the Japanese Society of Sleep Research, Fukuoka Sleep Clinic, Fukuoka, Japan.
Medicine (Baltimore). 2025 Jul 25;104(30):e43401. doi: 10.1097/MD.0000000000043401.
Leg movements (LMs) frequently co-occur with obstructive sleep apnea (OSA), and respiratory-related LMs can trigger arrhythmias and cause diagnostic challenges during polysomnography (PSG). While the cardiovascular burden of periodic limb movements in sleep is recognized, little is known about the role of LM suppression during PSG in improving diagnostic accuracy. This case series examines the impact of acuinjection at ST36 on LM suppression during PSG in patients with OSA.
All 3 patients underwent diagnostic PSG due to suspected OSA. PSG was temporarily paused during acuinjection, and the PSG period was divided as follows: Pre-a (before acuinjection), Post-a (from PSG resumption to LM recurrence, defined as multiple LMs within a 5-minute period), and restarted PSG (the remaining PSG time after resumption, excluding any positive airway pressure titration if applicable). In each case, frequent LMs associated with arousals were observed during Pre-a, interfering with sleep quality and complicating the interpretation of respiratory events.
Initial PSG findings were suggestive of moderate to severe OSA with frequent LMs and associated arousals. Respiratory events were often temporally linked to LMs, resulting in substantial sleep fragmentation and diagnostic uncertainty.
Acuinjection was performed bilaterally at ST36 using pentazocine (3.75 mg in 0.5 mL normal saline in 1 case, and 7.5 mg in 1.0 mL in 2 cases). PSG was resumed immediately afterward.
Outcomes were assessed using the apnea-hypopnea index (AHI), hypopnea index (HI), leg movement index (LMI), respiratory-related leg movement index (rLMI), and arousal index (ArI). In the Pre-a period (mean: 76.7 minutes), severe OSA with high LMI and ArI was observed: AHI 72.6, HI 72.3 (obstructive HI: 39.1, central HI: 33.2), LMI 141.6, rLMI 68.4, and ArI 100.0. In the Post-a period (184.8 minutes), these indices markedly improved: AHI 19.9, HI 18.9, LMI 5.9, rLMI 0.7, and ArI 36.7. During the restarted PSG (357.6 minutes), AHI, LMI, and ArI remained low at 23.4, 13.4, and 36.9, respectively. No adverse effects were observed.
This case series suggests that acuinjection at ST36 may effectively suppress LMs and associated arousals during PSG in OSA patients, thereby facilitating more accurate diagnosis and characterization of respiratory events.
腿部运动（LMs）经常与阻塞性睡眠呼吸暂停（OSA）同时出现，与呼吸相关的腿部运动可引发心律失常，并在多导睡眠图（PSG）检查期间带来诊断挑战。虽然睡眠中周期性肢体运动的心血管负担已为人所知，但关于PSG期间抑制腿部运动对提高诊断准确性的作用却知之甚少。本病例系列研究了针刺足三里对OSA患者PSG期间腿部运动抑制的影响。
所有3例患者因疑似OSA接受了诊断性PSG检查。针刺期间PSG暂时暂停，PSG时间段划分如下：针刺前（Pre-a，针刺前）、针刺后（Post-a，从PSG恢复到腿部运动复发，定义为5分钟内多次腿部运动）以及重新开始的PSG（恢复后的剩余PSG时间，如适用，不包括任何气道正压滴定）。在每个病例中，针刺前均观察到频繁的与觉醒相关的腿部运动，干扰睡眠质量并使呼吸事件的解释复杂化。
初始PSG结果提示为中度至重度OSA，伴有频繁的腿部运动和相关觉醒。呼吸事件常与腿部运动在时间上相关联，导致严重的睡眠碎片化和诊断不确定性。
双侧足三里注射喷他佐辛（1例为0.5 mL生理盐水中含3.75 mg，2例为1.0 mL中含7.5 mg）。随后立即恢复PSG检查。
使用呼吸暂停低通气指数（AHI）、低通气指数（HI）、腿部运动指数（LMI）、呼吸相关腿部运动指数（rLMI）和觉醒指数（ArI）评估结果。在针刺前期（平均：76.7分钟），观察到严重OSA，LMI和ArI较高：AHI为72.6，HI为72.3（阻塞性HI：39.1，中枢性HI：33.2），LMI为141.6，rLMI为68.4，ArI为100.0。在针刺后期（184.8分钟），这些指标明显改善：AHI为19.9，HI为18.9，LMI为5.9，rLMI为0.7，ArI为36.7。在重新开始的PSG期间（357.6分钟），AHI、LMI和ArI分别保持在较低水平，为23.4、13.4和36.9。未观察到不良反应。
本病例系列表明，针刺足三里可能有效抑制OSA患者PSG期间的腿部运动及相关觉醒，从而有助于更准确地诊断和鉴别呼吸事件。
