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 chi(2) 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.