Our Sleep Apnea Blog | I Hate CPAP

A study reported in the January, 2010 Sleep and Breathing discusses effectiveness of oral appliances in treating sleep apnea. The study also showed that periodic leg movements occured in a small subset of patients during oral appliance titration. This problem has been shown previously to occur with CPAP as well. This can be a cause of continued tiredness after treatment with CPAP or an Oral Appliance and is another reason to always have a sleep study to evaluate CPAP OR ORAL APPLIANCE THERAPY SUCCESS.

Frequently low (normal) ferritin levels can cause periodic leg movements and this should be evaluated prior to drug therapy for restless leggs.

I have also had patients see relief of leg movements by taking calcium/magnesium supplements.


(PubMed abstract)
Sleep Breath. 2010 Jan 23. [Epub ahead of print]
Oral appliance titration in patients with obstructive sleep apnea induces the appearance of periodic limb movements.
Guerrero ML, Kim D, Rupp TL, Balkin TJ.

Department of Behavioral Biology, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA, Melanie.guerrero@us.army.mil.
STUDY OBJECTIVES: Oral appliance (OA) therapy is considered a first line choice of therapy for some patients with mild or moderate obstructive sleep apnea (OSA) and an alternative form of treatment in those intolerant of continuous positive airway pressure (CPAP) use. According to several studies, periodic limb movements (PLM) appear during effective treatment of OSA with CPAP, but a similar phenomenon has not been described with the use of oral appliance. Herein, we describe the incidence of PLM in patients with OSA who underwent oral appliance therapy titration. DESIGN: This is a prospective, observational study set in a six-bed sleep center in an academic, military referral hospital. PATIENTS AND METHODS: Patients with OSA (n = 21; 15 men and six women; mean age, 43 years; and age range, 25 to 53 years) treated with OA during a 1-year period were enrolled. Patients were categorized according to the severity of sleep apnea and incidence of PLM on diagnostic polysomnography. Effective treatment of OSA and appearance or disappearance of PLM with arousal on subsequent oral appliance titration polysomnography were recorded and compared. RESULTS: Twenty-one patients were enrolled. During baseline polysomnography, three of 21 (14%) patients had five or more PLM with arousal per hour while 11 of 21 (52%) patients had PLM with arousal during the oral appliance titration trial. CONCLUSION: Oral appliance therapy for obstructive sleep apnea is an effective treatment and ideal for use in military recruits. The appearance of periodic limb movements with arousal during oral appliance use should be considered as a cause of persistent daytime sleepiness despite effective treatment of obstructive sleep apnea in this subset of patients.

Labels: allergy oral appliance, leg movements, military, titration