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Your arousals are a learned defense to your sleep related breathng disorder. This is your body's way of fixing the problem. Your arousals could be worse due to a neurologic reverberation that happens from the sleep/arousal loop of OSA or any sleep related breathing problem.
Some good studies on the subject.
http://www.journalsleep.org/ViewAbstract.aspx?pid=25869
http://www.journalsleep.org/ViewAbstract.aspx?pid=24678
View the Full Text to get some more detailed information.
Study Objectives: The following hypotheses were investigated: 1) severe obstructive sleep apnea (OSA) can mask concurrent periodic limb movement (PLM) disorder (PLMD), which becomes evident or worsens after treatment with continuous positive airway pressure (CPAP); 2) in patients with mild OSA, PLMs are not masked but may be triggered by subclinical hypopneas or respiratory effort-related arousals and improve after CPAP.
Design: Retrospective analysis was performed on 2 polysomnographic studies per patient—1 baseline, the second with CPAP titration. The apnea-hypopnea index (AHI) and PLM index (PLMI) under the 2 conditions were statistically analyzed.
Setting: University hospital sleep disorders center.
Patients: Patients were selected if they had a baseline AHI of 5 or greater and CPAP titration resulted in reduced AHI. Also, each needed to have either a PLMI of 5 or greater on baseline PSG or during CPAP titration. Patients who started or discontinued a medication that could affect PLMs after the baseline PSG were excluded. Interventions: As clinically indicated, CPAP for OSA.
Measurements and Results: Eighty-six patients qualified and were divided into 3 groups based on OSA severity. Significant correlations (P<0.05) were found between AHI and PLMI on the baseline PSG (-0.50), between AHI on baseline PSG and PLMI on CPAP titration (0.49), and between PLMI on baseline PSG and on CPAP titration (-0.21). The increase in PLMI during CPAP titration in patients with severe OSA was statistically significant (P<0.001). The PLMI decreased with CPAP in 20 of 86 patients, mostly in the mild OSA subgroup. Regression of post-CPAP reduction of AHI and change in PLMI yielded a significant logarithmic relationship (R2=0.3042).
Conclusions: Severity of OSA may determine the effect of CPAP on PLMs. The PLMs may increase in moderate to severe OSA due mainly to “unmasking” of underlying PLMD. The PLMs may decrease in mild OSA post-CPAP due to resolution of PLMs associated with respiratory effort-related arousals. This suggests that PLMs may have more than 1 etiology and may be categorized as spontaneous (as in PLMD) and induced (when secondary to respiratory effort-related arousals).
Citation: Baran AS; Richert AC; Douglass AB et al. Change in periodic limb movement index during treatment of obstructive sleep apnea with continuous positive airway pressure. SLEEP 2003;26(6):717-20.
Ok this is my understanding of it. A periodic limb movement (PLM) is different from an isolated leg movement or RERAs. PLM is a completely different disorder with no common generator to apnea.
http://www.ncbi.nlm.nih.gov/pubmed/10476008?dopt=Abstract.
A leg movement is classified as .5 to 10 second movement that leads to an amplitude increase in the leg signal.
A leg movement by itself is just a leg movement.
A PLM is 4 leg movements within 90 seconds. PLMs are usually seen as trains of limb movements seen throughout NREM sleep. Leg movements such as these are usually seen in people with Kidney, neurological problems, or an iron defficiency.
A leg movement or arousal connected to any type of flow limitation is an event with an arousal ie OSA with arousal, Central with arousal, hypopnea with arousal or a RERA. These events are very well defined and easy to pick out on a psg. These types of event typically have o2 desats. Arousals connected to these types of sleep related breathing events are a learned behavoir.
RERAs are a little different. A RERA is a sequence of breaths lasting 10 seconds in duration that results in a decrease of oral nasal breathing with an increase in lung effort that ends or leads to an arousal(LM). The arousals involved with RERAs are a learned reaction in keeping you breathing. Without them your RERAs would probably be apneas.
If You have a severe breathing disorder with arousels over a mild to moderate one this can greatly influence how long it takes your mind to stop doing it. Severe apnea in a great many cases will cover a PLM disorder. Arousals related to your sleep relateed breathing disorder will clear up with PAP therapy. Periodic Limb Movement disorder is not related to a breathing problem so it may or may not.
I hope that was not to much info, and that I explained it right.
Isn't there a specific xPAP device that best treats UARS? Since I don't have UARS I haven't followed in the info on it closely and most of what I did read passed out the other ear since it wasn't info I was using and I needed room to hold on to the info pertinent to my situation.
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