Combined impact of obstructive sleep apnea and periodic limb movements on sleep parameters

Abstract

Study objectives

This study examines the combined effects of Obstructive Sleep Apnea (OSA) and Periodic Limb Movements of Sleep (PLMS) on sleep parameters. Specifically, it aims to determine whether their co-occurrence exacerbates sleep fragmentation, reduces sleep efficiency, and alters restorative sleep stages compared to either condition alone.

Methods

We retrospectively analyzed 581 adults undergoing polysomnography at UCSF Fresno. Subjects were categorized into three groups: OSA, PLMS, and OSA and PLMS. Sleep metrics, including Total Sleep Time (TST), Wake After Sleep Onset (WASO), and sleep stages (N1, N2, N3, REM), were compared across groups using Kruskal-Wallis tests and linear regression, adjusting for age.

Results

The coexistence of OSA and PLMS was associated with a significant reduction in TST and a synergistic effect on deep sleep stages (N3) and REM, indicating amplified sleep disruption beyond additive effects. OSA and PLMS led to a marked increase in WASO and awakenings, although the impact on WASO was additive rather than synergistic.

Conclusions

These findings underscore the need for tailored treatment approaches when OSA and PLMS co-occur. Standard OSA treatments like CPAP may be insufficient, as they don't address PLMS-induced sleep fragmentation. Effective management of both conditions could improve sleep quality and mitigate associated health risks.