Periodic Limb Movements Without OSA

Q: I have a patient who has no sleep apnea and does not desaturate, but who has 60 periodic limb movements an hour. The sleep physician, a pulmonologist, referred him to an ENT for surgery to help the snoring, but said that since he wasn’t sleepy, we could ignore the limb movements for now. He did have about 30 arousals from limb movements each hour. What do you think of his advice?

Dr. Smith: PLMD often accompanies sleep disordered breathing. However, since his AHI and SpO2 are relatively normal, these movements do not appear to be related to his breathing at all. One movement every minute of the night is very excessive, and since he is also aroused out of normal sleep architecture every 2 minutes, I have to think this is affecting his sleep, even though he does not admit to sleepiness.

I have picked up early Parkinsons in a patient like this, so I am a bit sensitive to the issue, and would discuss a referral to rule this out if he was may patient. As the sleep MD is a pulmonologist, and not a neurologist, he would be less likely to make the connection. However, hopefully, I am just an alarmist, and the patient has little to worry about. Maybe you can make him an appliance for his snoring, then get him retested to see if the PLMD has improved.