睡眠中周期性肢体运动的临床影响：在睡眠呼吸障碍中的认识不足及与481,857例患者关键临床结局的关联

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中文摘要

研究目的： 在一个大型睡眠障碍队列中评估睡眠中周期性肢体运动（PLMS），并探讨其与睡眠呼吸障碍（SDB）、人口学特征及关键临床合并症的关联。
方法： 一项回顾性分析，纳入481,857名完成整夜多导睡眠监测（PSG）及睡眠/病史问卷的成人。数据收集覆盖美国30个州的240个睡眠中心。周期性肢体运动指数（PLMI）由技术人员评分的PSG计算得出，所有PSG指标均按照美国睡眠医学会指南进行评分。采用多变量线性回归评估与PLMI的关联，自我报告和客观指标分别分析，首先在预测因子特异性模型中，然后在同时纳入所有预测因子的模型中。
结果： 样本中54.1%为男性，平均年龄54.4±14.4岁（范围：18-107），平均PLMI为10.3±22.1次/小时，平均呼吸暂停低通气指数（AHI）为14.7±19.1次/小时。PLMI在白人中最高；在西班牙裔、亚裔和黑人中较低。PLMI与SDB指标呈强烈负相关，即使按CPAP使用分层后仍持续存在。在预测因子特异性和同时多变量模型中，PLMI与确诊的抑郁症、失眠评分、血糖升高和贫血相关。在客观指标上，PLMI与觉醒指数和较低的睡眠效率相关。
结论： 我们的发现强调了PLMS在神经精神、心脏代谢和睡眠领域潜在的临床相关性。种族差异可能反映遗传和社会文化因素。最引人注目的是，在SDB增加的情况下，PLMS可能被低估，可能需要对评分标准进行进一步评估。这些结果支持进一步的遗传和机制研究。

英文摘要

STUDY OBJECTIVES: To evaluate periodic limb movements during sleep (PLMS) in a large sleep disorders cohort and explore associations with sleep-disordered breathing (SDB), demographics and key clinical comorbidities.
METHODS: A retrospective analysis including 481,857 adults who completed overnight polysomnography (PSG) and a sleep/medical history questionnaire. Data collection spanned 240 sleep centers across 30 U.S. states. Periodic limb movement index (PLMI) was calculated from technician-scored PSGs, and all PSG measures were scored in accordance with American Academy of Sleep Medicine guidelines. Associations with PLMI were assessed using multivariable linear regression, with self-reported and objective measures analyzed separately, first in predictor-specific and then in simultaneous models.
RESULTS: The sample included 54.1% males, with a mean age of 54.4 ± 14.4 years (range: 18-107), average PLMI of 10.3 ± 22.1 events/hour and average Apnea Hypopnea Index (AHI) of 14.7 ± 19.1 events/hour. PLMI was highest among White individuals; lower among Hispanic, Asian, and Black individuals. PLMI was strongly negatively associated with SDB measures, persisting even when stratified by CPAP usage.In both predictor-specific and simultaneous multivariable models, PLMI was associated with diagnosed depression, insomnia score, elevated blood sugar and anemia. Objectively, PLMI was associated with arousal index and lower sleep efficiency.
CONCLUSIONS: Our findings highlight the potential clinical relevance of PLMS across neuropsychiatric, cardiometabolic, and sleep domains. Racial disparities may reflect genetic and sociocultural factors. Most strikingly, in the setting of increased SDB, PLMS may be undercounted, potentially warranting further evaluation of scoring criteria. These results support further genetic and mechanistic investigations.