0794 Effect of Surgical OSA Treatment on Periodic Limb Movements of Sleep in Pediatric Patients

Abstract

Abstract Introduction The relationship between obstructive sleep apnea (OSA) and periodic limb movements of sleep (PLMS) is not completely understood, especially among pediatric patients. Previous research describes varied changes in PLMS following OSA treatment, including increased, decreased, or unchanged PLMS frequency. This study aimed to evaluate the effect of surgical OSA treatment on the periodic limb movement index (PLMI) in pediatric patients with OSA and significant PLMS. Methods Retrospective chart review was performed to identify pediatric patients who had polysomnography demonstrating significant PLMS (PLMI ≥ 5/hour) and OSA (obstructive apnea-hypopnea index (OAHI) ≥ 1.5/hour) that was treated with upper airway surgery. Patients aged 1-18 years were included if significant PLMS was present on either pre-treatment or post-treatment polysomnograms between 1/1/2010 and 7/31/2022. Patients were evaluated for changes in PLMI and OAHI between a pre- and post-treatment polysomnogram, each obtained within 12 months of OSA treatment. Patients with inadequate sleep time (< 2 hours) were excluded. Data are reported as mean ± standard deviation and results from mixed effect linear models. Results Medical record review identified 198 patients. The average age was 5.3±3.8 years (range 1.1-16.9 years) at pre-treatment polysomnogram, including 129 (65.2%) male patients. Adenotonsillectomy was the most common OSA treatment (n=136). For the whole group, the OAHI decreased from 12.3±15.3 to 5.3±8.1/hour and the PLMI increased from 5.5±8.5 to 7.0±8.7/hour after treatment, for an average PLMI increase of 1.5/hour (SE=0.7, p=0.04). Sub-group analysis of patients with decreased OAHI following treatment (n=152) showed an average PLMI increase of 2.3/hour (SE=0.8, p=0.004), while patients with increased OAHI following treatment (n=44) did not show a significant change in PLMI. There were 74 patients (37.4%) who developed significant PLMS following treatment and 36 patients (18.2%) with significant PLMS before and after treatment. Conclusion Effective OSA treatment led to increased PLMI among a majority of children, highlighting the potential for unmasking of PLMS in some pediatric patients with OSA. Furthermore, over one third of patients developed polysomnographic criteria for significant PLMS after OSA management. This may suggest a sub-group of children with OSA who have a PLMD phenotype that may not become apparent until appropriate OSA treatment. Support (if any)