title: Basal sympathetic predominance in periodic limb movements in sleep with obstructive sleep apnea.
abstract: Because the impact of periodic limb movements in sleep (PLMS) is controversial, no consensus has been reached on the therapeutic strategy for PLMS in obstructive sleep apnea (OSA). To verify the hypothesis that PLMS is related to a negative impact on the cardiovascular system in OSA patients, this study investigated the basal autonomic regulation by heart rate variability (HRV) analysis. Sixty patients with mild-to-moderate OSA who underwent polysomnography (PSG) and completed sleep questionnaires were analysed retrospectively and divided into the PLMS group (n = 30) and the non-PLMS group (n = 30). Epochs without any sleep events or continuous effects were evaluated using HRV analysis. No significant difference was observed in the demographic data, PSG parameters or sleep questionnaires between the PLMS and non-PLMS groups, except for age. Patients in the PLMS group had significantly lower normalized high frequency (n-HF), high frequency (HF), square root of the mean of the sum of the squares of difference between adjacent NN intervals (RMSSD) and standard deviation of all normal to normal intervals index (SDNN-I), but had a higher normalized low frequency (n-LF) and LF/HF ratio. There was no significant difference in the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the Short-Form 36 and the Hospital Anxiety and Depression Scale between the two groups. After adjustment for confounding variables, PLMS remained an independent predictor of n-LF (β = 0.0901, P = 0.0081), LF/HF ratio (β = 0.5351, P = 0.0361), RMSSD (β = -20.1620, P = 0.0455) and n-HF (β = -0.0886, P = 0.0134). In conclusion, PLMS is related independently to basal sympathetic predominance and has a potentially negative impact on the cardiovascular system of OSA patients.
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Meng-Ni
authors.initials: MN
authors.lastname: Wu
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chiou-Lian
authors.initials: CL
authors.lastname: Lai
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Ching-Kuan
authors.initials: CK
authors.lastname: Liu
authors.affiliation: Department of Mechanical and Electro-mechanical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.
authors.forename: Chen-Wen
authors.initials: CW
authors.lastname: Yen
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Liou
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Cheng-Fang
authors.initials: CF
authors.lastname: Hsieh
authors.affiliation: Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Tsai
authors.affiliation: Department of Medical Imaging and Radiation Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Sharon C-J
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chung-Yao
authors.initials: CY
authors.lastname: Hsu
mesh_terms: D002319:Cardiovascular System / Q000503:physiopathology; D005260:Female; D006339:Heart Rate; D006801:Humans; D007866:Leg / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009068:Movement; D020189:Nocturnal Myoclonus Syndrome / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D017286:Polysomnography; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013564:Sympathetic Nervous System / Q000502:physiology*
keywords: autonomic nervous system; parasomnia; sleep-disordered breathing