Skip to main content
Top

16-04-2024 | Scoliosis | Neurology • Original Article

Elevated periodic limb movement index is associated with hypoxemia in children with early onset scoliosis

Authors: Lourdes M. DelRosso, David Panek, Erin Mackintosh, Klane White, Greg Redding

Published in: Sleep and Breathing

Login to get access

Abstract

Purpose

Patients with early onset scoliosis are at high risk of sleep disordered breathing, sleep disruption, and adverse consequences of poor sleep. In this study, we aim to assess the prevalence of periodic limb movements of sleep in a cohort of children with early onset scoliosis and identify factors that correlate with the presence of periodic limb movements.

Methods

This is a retrospective chart review of 40 patients with EOS (ages 1–17 years) who underwent a PSG from 2003 through 2019. Data collected included age, sex, and polysomnography parameters. Descriptive statistics were used: independent T test and Pearson correlation.

Results

The average age was 9.6 years (SD 5.2); 22 were female. Eleven patients (27.5%) had elevated periodic limb movement index (PLMI) (≥ 5). Those with PLMI ≥ 5 had arousal index of 15.4 (SD 7.2) and those with normal PLMI having an arousal index of 9.4 (SD 4.9); this reached statistical significance (p < 0.05). Those with elevated PLMI spent 4.9 (SD 8.3) minutes with saturations below 88%, while those with normal PLMI spent 1.0 (SD 1.8); this was statistically significant. There was a moderate positive correlation between arousal index, hypoxemia, and PLMI.

Conclusion

The study suggests that children with early onset scoliosis have higher frequency of periodic limb movements during sleep, and these may be correlated with increased arousal and with hypoxemia.
Literature
2.
go back to reference Redding G, Mayer OH, White K, Bompadre V, Emerson J, Krengel W, et al (2017) Maximal respiratory muscle strength and vital capacity in children with early onset scoliosis. Spine (Phila Pa 1976) 42(23):1799–804 Redding G, Mayer OH, White K, Bompadre V, Emerson J, Krengel W, et al (2017) Maximal respiratory muscle strength and vital capacity in children with early onset scoliosis. Spine (Phila Pa 1976) 42(23):1799–804
3.
go back to reference Glotzbecker M, Johnston C, Miller P, Smith J, Perez-Grueso FS, Woon R, et al (2014) Is there a relationship between thoracic dimensions and pulmonary function in early-onset scoliosis? Spine (Phila Pa 1976) 39(19):1590–5 Glotzbecker M, Johnston C, Miller P, Smith J, Perez-Grueso FS, Woon R, et al (2014) Is there a relationship between thoracic dimensions and pulmonary function in early-onset scoliosis? Spine (Phila Pa 1976) 39(19):1590–5
4.
go back to reference McPhail GL, Howells SA, Boesch RP, Wood RE, Ednick M, Chini BA et al (2013) Obstructive lung disease is common in children with syndromic and congenital scoliosis: a preliminary study. J Pediatr Orthop 33(8):781–785CrossRefPubMed McPhail GL, Howells SA, Boesch RP, Wood RE, Ednick M, Chini BA et al (2013) Obstructive lung disease is common in children with syndromic and congenital scoliosis: a preliminary study. J Pediatr Orthop 33(8):781–785CrossRefPubMed
5.
go back to reference Striegl A, Chen ML, Kifle Y, Song K, Redding G (2010) Sleep-disordered breathing in children with thoracic insufficiency syndrome. Pediatr Pulmonol 45(5):469–474CrossRefPubMed Striegl A, Chen ML, Kifle Y, Song K, Redding G (2010) Sleep-disordered breathing in children with thoracic insufficiency syndrome. Pediatr Pulmonol 45(5):469–474CrossRefPubMed
7.
go back to reference Sforza E, Nicolas A, Lavigne G, Gosselin A, Petit D, Montplaisir J (1999) EEG and cardiac activation during periodic leg movements in sleep: support for a hierarchy of arousal responses. Neurology 52(4):786–791CrossRefPubMed Sforza E, Nicolas A, Lavigne G, Gosselin A, Petit D, Montplaisir J (1999) EEG and cardiac activation during periodic leg movements in sleep: support for a hierarchy of arousal responses. Neurology 52(4):786–791CrossRefPubMed
8.
go back to reference American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. Darien, IL: American Academy of Sleep Medicine American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. Darien, IL: American Academy of Sleep Medicine
9.
go back to reference Scofield H, Roth T, Drake C (2008) Periodic limb movements during sleep: population prevalence, clinical correlates, and racial differences. Sleep 31(9):1221–1227PubMedPubMedCentral Scofield H, Roth T, Drake C (2008) Periodic limb movements during sleep: population prevalence, clinical correlates, and racial differences. Sleep 31(9):1221–1227PubMedPubMedCentral
10.
go back to reference Picchietti DL, Rajendran RR, Wilson MP, Picchietti MA (2009) Pediatric restless legs syndrome and periodic limb movement disorder: parent-child pairs. Sleep Med 10(8):925–931CrossRefPubMed Picchietti DL, Rajendran RR, Wilson MP, Picchietti MA (2009) Pediatric restless legs syndrome and periodic limb movement disorder: parent-child pairs. Sleep Med 10(8):925–931CrossRefPubMed
11.
go back to reference Connor JR, Boyer PJ, Menzies SL, Dellinger B, Allen RP, Ondo WG et al (2003) Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome. Neurology 61(3):304–309CrossRefPubMed Connor JR, Boyer PJ, Menzies SL, Dellinger B, Allen RP, Ondo WG et al (2003) Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome. Neurology 61(3):304–309CrossRefPubMed
12.
go back to reference Allen RP, Barker PB, Wehrl FW, Song HK, Earley CJ (2001) MRI measurement of brain iron in patients with restless legs syndrome. Neurology 56(2):263–265CrossRefPubMed Allen RP, Barker PB, Wehrl FW, Song HK, Earley CJ (2001) MRI measurement of brain iron in patients with restless legs syndrome. Neurology 56(2):263–265CrossRefPubMed
13.
go back to reference Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, et al.(2019) AASM Scoring Manual Version 2.6 Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, et al.(2019) AASM Scoring Manual Version 2.6
15.
go back to reference Ferri R, Gschliesser V, Frauscher B, Poewe W, Hogl B (2009) Periodic leg movements during sleep and periodic limb movement disorder in patients presenting with unexplained insomnia. Clin Neurophysiol 120(2):257–263CrossRefPubMed Ferri R, Gschliesser V, Frauscher B, Poewe W, Hogl B (2009) Periodic leg movements during sleep and periodic limb movement disorder in patients presenting with unexplained insomnia. Clin Neurophysiol 120(2):257–263CrossRefPubMed
16.
go back to reference Midgren B, Petersson K, Hansson L, Eriksson L, Airikkala P, Elmqvist D (1988) Nocturnal hypoxaemia in severe scoliosis. Br J Dis Chest 82(3):226–236CrossRefPubMed Midgren B, Petersson K, Hansson L, Eriksson L, Airikkala P, Elmqvist D (1988) Nocturnal hypoxaemia in severe scoliosis. Br J Dis Chest 82(3):226–236CrossRefPubMed
17.
go back to reference Simakajornboon N, Gozal D, Vlasic V, Mack C, Sharon D, McGinley BM (2003) Periodic limb movements in sleep and iron status in children. Sleep 26(6):735–738CrossRefPubMed Simakajornboon N, Gozal D, Vlasic V, Mack C, Sharon D, McGinley BM (2003) Periodic limb movements in sleep and iron status in children. Sleep 26(6):735–738CrossRefPubMed
18.
go back to reference Silva I, Rausch V, Peccerella T, Millonig G, Seitz HK, Mueller S (2018) Hypoxia enhances H(2)O(2)-mediated upregulation of hepcidin: evidence for NOX4-mediated iron regulation. Redox Biol 16:1–10CrossRefPubMedPubMedCentral Silva I, Rausch V, Peccerella T, Millonig G, Seitz HK, Mueller S (2018) Hypoxia enhances H(2)O(2)-mediated upregulation of hepcidin: evidence for NOX4-mediated iron regulation. Redox Biol 16:1–10CrossRefPubMedPubMedCentral
19.
go back to reference Siegert I, Schodel J, Nairz M, Schatz V, Dettmer K, Dick C et al (2015) Ferritin-mediated iron sequestration stabilizes hypoxia-inducible factor-1alpha upon LPS activation in the presence of ample oxygen. Cell Rep 13(10):2048–2055CrossRefPubMed Siegert I, Schodel J, Nairz M, Schatz V, Dettmer K, Dick C et al (2015) Ferritin-mediated iron sequestration stabilizes hypoxia-inducible factor-1alpha upon LPS activation in the presence of ample oxygen. Cell Rep 13(10):2048–2055CrossRefPubMed
20.
go back to reference Pizza F, Biallas M, Wolf M, Valko PO, Bassetti CL (2009) Periodic leg movements during sleep and cerebral hemodynamic changes detected by NIRS. Clin Neurophysiol 120(7):1329–1334CrossRefPubMed Pizza F, Biallas M, Wolf M, Valko PO, Bassetti CL (2009) Periodic leg movements during sleep and cerebral hemodynamic changes detected by NIRS. Clin Neurophysiol 120(7):1329–1334CrossRefPubMed
21.
go back to reference Bara-Jimenez W, Aksu M, Graham B, Sato S, Hallett M (2000) Periodic limb movements in sleep: state-dependent excitability of the spinal flexor reflex. Neurology 54(8):1609–1616CrossRefPubMed Bara-Jimenez W, Aksu M, Graham B, Sato S, Hallett M (2000) Periodic limb movements in sleep: state-dependent excitability of the spinal flexor reflex. Neurology 54(8):1609–1616CrossRefPubMed
22.
go back to reference Ferri R, Proserpio P, Rundo F, Lanza A, Sambusida K, Redaelli T et al (2015) Neurophysiological correlates of sleep leg movements in acute spinal cord injury. Clin Neurophysiol 126(2):333–338CrossRefPubMed Ferri R, Proserpio P, Rundo F, Lanza A, Sambusida K, Redaelli T et al (2015) Neurophysiological correlates of sleep leg movements in acute spinal cord injury. Clin Neurophysiol 126(2):333–338CrossRefPubMed
23.
go back to reference Salminen AV, Manconi M, Rimpila V, Luoto TM, Koskinen E, Ferri R et al (2013) Disconnection between periodic leg movements and cortical arousals in spinal cord injury. J Clin Sleep Med 9(11):1207–1209CrossRefPubMedPubMedCentral Salminen AV, Manconi M, Rimpila V, Luoto TM, Koskinen E, Ferri R et al (2013) Disconnection between periodic leg movements and cortical arousals in spinal cord injury. J Clin Sleep Med 9(11):1207–1209CrossRefPubMedPubMedCentral
24.
go back to reference MacKintosh EW, Ho M, White KK, Krengel W 3rd, Bompadre V, Chen ML et al (2020) Referral indications and prevalence of sleep abnormalities in children with early onset scoliosis. Spine Deform 8(3):523–530CrossRefPubMed MacKintosh EW, Ho M, White KK, Krengel W 3rd, Bompadre V, Chen ML et al (2020) Referral indications and prevalence of sleep abnormalities in children with early onset scoliosis. Spine Deform 8(3):523–530CrossRefPubMed
Metadata
Title
Elevated periodic limb movement index is associated with hypoxemia in children with early onset scoliosis
Authors
Lourdes M. DelRosso
David Panek
Erin Mackintosh
Klane White
Greg Redding
Publication date
16-04-2024
Publisher
Springer International Publishing
Published in
Sleep and Breathing
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-024-03029-w
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.