0691 High Prevalence of Periodic Limb Movements of Sleep While Using Hypoglossal Nerve Stimulation Therapy

Abstract Introduction Periodic limb movements of Sleep (PLMS) often accompany obstructive sleep apnea (OSA) and significantly impact the quality of sleep and treatment adherence. As a novel treatment for OSA, it is crucial to understand the presence and potential impact of PLMS in patients undergoing hypoglossal nerve stimulation (HNS) therapy. Nevertheless, no study to date has investigated PLMS among those in HNS therapy. Methods Subjects receiving HNS therapy from December 2020 to August 2023 were consecutively included for this retrospective cohort analysis. PLMS diagnosis was based on periodic limb movement index (PLMI) ≥ 15. Prevalence of PLMS was the main outcome measure and then we compared biometric/ demographic data, comorbidities, medications, data from HNS fine-tune polysomnography (PSG), pre- and post-HNS Epworth Sleepiness Scale (ESS), and baseline OSA parameters between two groups: PLMS versus no PLMS. Statistical analyses were performed using STATA. Results One hundred subjects were included for the analysis. The average age was 66.7, with 75% being male, and 82% being non-Hispanic White. Significant PLMS was shown in 52 among 100 subjects receiving HNS treatment. The PLMS group was older (69.0 vs. 64.2 years old, P = 0.008); however, there was no difference observed in terms of sex, race, co-morbidities including depression and anxiety, use of selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors, dopamine agonists, or alpha-2-delta ligands. The PLMS group had lower pre-HNS ESS score (7.3 vs. 9.4, P = 0.018), and higher baseline non-supine apnea-hypopnea index (AHI) (22.5 vs. 12.9, P = 0.030); however, there were no differences of HNS fine-tune PSG parameters including non-supine AHI (6.6 vs 4.2, P = 0.505), maximum tolerated voltage, HNS usage, and subjective benefit. Conclusion The prevalence of PLMS among OSA patients with HNS therapy is notably high at 52%. This high prevalence of PLMS may be attributed to the negative impact of PLMS on CPAP adherence leading to the HNS therapy. Despite the high prevalence of PLMS, PLMS did not result in HNS treatment short-term outcome difference. Further study is needed to investigate the effect of HNS on PLMS and a longer-term impact of PLMS in HNS treatment outcome. Support (if any)