title: Oral appliance titration in patients with obstructive sleep apnea induces the appearance of periodic limb movements.
abstract: OBJECTIVE
  Oral appliance (OA) therapy is considered a first line choice of therapy for some patients with mild or moderate obstructive sleep apnea (OSA) and an alternative form of treatment in those intolerant of continuous positive airway pressure (CPAP) use. According to several studies, periodic limb movements (PLM) appear during effective treatment of OSA with CPAP, but a similar phenomenon has not been described with the use of oral appliance. Herein, we describe the incidence of PLM in patients with OSA who underwent oral appliance therapy titration.
  
  
  METHODS
  This is a retrospective, [corrected] observational study set in a six-bed sleep center in an academic, military referral hospital.
  
  
  METHODS
  Patients with OSA (n=21; 15 men and six women; mean age, 43 years; and age range, 25 to 53 years) treated with OA during a 1-year period were analyzed. [corrected] Patients were categorized according to the severity of sleep apnea and incidence of PLM on diagnostic polysomnography. Effective treatment of OSA and appearance or disappearance of PLM with arousal on subsequent oral appliance titration polysomnography were recorded and compared.
  
  
  RESULTS
  Twenty-one patients were included in the analysis. [corrected] During baseline polysomnography, three of 21 (14%) patients had five or more PLM with arousal per hour while 11 of 21 (52%) patients had PLM with arousal during the oral appliance titration trial.
  
  
  CONCLUSIONS
  Oral appliance therapy for obstructive sleep apnea is an effective treatment and ideal for use in military recruits. The appearance of periodic limb movements with arousal during oral appliance use should be considered as a cause of persistent daytime sleepiness despite effective treatment of obstructive sleep apnea in this subset of patients.
authors.affiliation: Department of Behavioral Biology, Walter Reed Army Institute of Research, USA. Melanie.guerrero@us.army.mil [corrected]
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Guerrero
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Rupp
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Balkin
mesh_terms: D000328:Adult; D001143:Arousal; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D020189:Nocturnal Myoclonus Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017090:Occlusal Splints; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*