OSA and PLMD

Aug 8, 2025

In this discussion, Dr. Gulcin Benbir, a neurology professor from Turkey specializing in sleep disorders, and Dr. Lourdes Del Rosso, a UCSF sleep physician and RLS guidelines task force member, shine a light on periodic limb movement disorder (PLMD). They reveal that 30% of patients with obstructive sleep apnea still experience significant limb movements even after treatment. The duo explores the relationship between PLMD and restless legs syndrome, iron levels' role in treatment, and whether PLMs are merely symptoms or contributors to more serious health issues.

Ask episode

AI Snips

Chapters

Transcript

Episode notes

INSIGHT

Treating OSA Doesn’t Always Remove PLMs

Treating OSA can reveal or fail to resolve PLMs: 47% persisted and 16% worsened in one cohort.
Time spent with saturation below 88% in diagnostic studies correlated with residual PLMs.

ADVICE

Screen For PLMS In OSA Patients

Assess PLMS in OSA patients because PLMS associate with arousals and sympathetic activation.
Gulcin Benbir recommends screening to reduce cardiovascular and sleep-related risks.

INSIGHT

Arousal-Linked PLMs Raise Cardiac Risk

PLMs linked to arousal-associated sympathetic activation carry cardiovascular risk, not all PLMs are equal.
Movements tied to arousals predict risk, while spontaneous non-arousal PLMs may not.

Get the Snipd Podcast app to discover more snips from this episode

Get the app

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Gulcin Benbir, professor of neurology and sleep researcher from Turkey, and Dr. Lourdes Del Rosso, sleep physician and professor at UCSF who served on the task force for updated AASM RLS guidelines, to discuss groundbreaking research on periodic limb movements in sleep (PLMS) that persist after successful sleep apnea treatment.

Following the recent updates to RLS guidelines, this conversation addresses the often-overlooked condition of periodic limb movement disorder (PLMD). The guests reveal surprising findings that challenge traditional teaching: while sleep medicine practitioners have long been taught that PLMD improves with PAP therapy, their research shows that 30% of patients continue to experience significant periodic limb movements even after successful OSA treatment.

The discussion explores critical clinical questions: Are PLMs innocent bystanders or pathological processes requiring treatment? When do PLMs become PLMD? How should we evaluate residual hypersomnolence in well-treated OSA patients—should we screen for persistent PLMs before prescribing wake-promoting agents? The experts also delve into the complex relationship between RLS and PLMs, examining whether they represent interconnected sensory and motor phenomena or distinct processes.

Practical treatment strategies are covered extensively, including the role of iron supplementation, appropriate diagnostic testing, IV iron protocols, and evidence-based pharmacological interventions. The conversation also addresses how the shift toward home sleep testing may impact our ability to detect and treat this important cause of continued sleep disruption.

Whether you're treating OSA patients with persistent daytime sleepiness or managing complex sleep disorders, this episode provides essential insights into recognizing and treating PLMD as a potential contributor to ongoing symptoms.

Join us for this clinically relevant discussion that may change how you approach residual hypersomnolence in your practice.