Periodic Limb Movements Before and After Adenotonsillectomy in Children With Obstructive Sleep Apnea.

OBJECTIVES

To determine the prevalence of periodic limb movements (PLMS) in children with obstructive sleep apnea (OSA) and assess the effect of adenotonsillectomy (AT) on PLMS.

METHODS

Charts of children with OSA who underwent AT were reviewed for demographics, obstructive apnea-hypopnea index, and PLMS before and after AT. Prevalence of elevated periodic limb movement index (PLMI), defined as PLMS > 5 events/h, was compared with χ2 test or Fisher's exact. Paired t-test and Wilcoxon signed rank test were used to compare PLMI pre-and post-AT.

RESULTS

Elevated PLMI occurred in 114 (9.8%) of 1159 children (676 male,483 female, median age = 5). The prevalence of elevated PLMI was similar in gender, ethnicity, race, and weight categories. Compared to toddlers, the odds of elevated PLMI increased 22.1 times in preschoolers (p ≤ 0.001), 35.4 times in grade-schoolers (p ≤ 0.001), and 30.8 times in teenagers (p ≤ 0.001). Compared to children with mild OSA, the odds of elevated PLMI increased 2.3 times in children with moderate OSA (p = 0.007) and 1.9 times in those with severe OSA (p = 0.01). Of the 54 children who had a polysomnogram after AT, 46 (85%) resolved and 8 (15%) had persistent elevated PLMI. PLMI after AT decreased from 11.9 ± 7.6 to 2.9 ± 6.5 (p ≤ 0.001).

CONCLUSIONS

Elevated PLMI is common in children with OSA undergoing AT. PLMI resolves after AT in most children with OSA.