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Prevalence of pediatric periodic leg movements of sleep after initiation of PAP therapy
Author(s) -
Pai Vidya,
Khatwa Umakanth,
Ramgopal Sriram,
Singh Kanwaljit,
Fitzgerald Rebecca,
Kothare Sanjeev V.
Publication year - 2014
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.22802
Subject(s) - medicine , positive airway pressure , continuous positive airway pressure , obstructive sleep apnea , polysomnography , apnea–hypopnea index , apnea , anesthesia
Positive‐airway‐pressure (PAP) is a treatment for obstructive‐sleep‐apnea (OSA). In adults, initiation of PAP‐therapy may unmask periodic‐limb movements‐of‐sleep (PLMS). We present a series of children in whom PLMS was aggravated or induced following initiation of PAP therapy. Methods Retrospective analysis was performed on children who had PAP‐studies performed over a 3‐year period. Children with OSA without significant PLMS on baseline studies and who then showed a periodic‐limb‐movement‐index (PLMI) (>5/hr) during titration with PAP‐therapy were identified. Charts were reviewed for demographics, OSA severity based on apnea hypopnea index (AHI), PLMI, PLM‐arousal‐index (PLMAI) and pressures titrated. Results Two hundred fourteen PAP‐titration studies (151 on continuous positive airway pressure [CPAP] and 63 on bilevel positive airway pressure [BiPAP]) were done. Eleven (10 on CPAP, 1 on BiPAP) met study criteria. Eight patients were boys. The median age was 12 years (range 6 months–18 years). On baseline studies, median AHI was 5/hr (range 1.5–32/hr), median PLMI was 1/hr (range 0–4/hr) and median PLMAI 0.3/Hr (range 0–2/hr). On titration studies, pressures ranged from 4 to 14 cm of water, median AHI was 0.5/hr (range 0–1), median PLMI was 12/hr (range 5–55/hr) and median PLMAI 9/hr (range 0–25). PLMS were seen predominantly during N1, N2 sleep and on PAP of >7 cm of water. One patient had resolution of PLMS at 1‐year follow‐up. Conclusion PLMS were seen in 5.1% of children after initiation of PAP. OSA may mask PLMS, which appears as breathing improves. Alternatively, PAP may unmask or induce PLMS. PLMS may potentially be a cause of treatment failure in children on recent‐onset PAP therapy. Pediatr Pulmonol. 2014; 49:252–256. © 2013 Wiley Periodicals, Inc.