Near resolution of sleep related rhythmic movement disorder after CPAP for OSA

(A) Rhythmic movements often occurred at the end of apneas, as demonstrated on this 1min epoch recorded during REM sleep. (B) Rhythmic movements appeared to be time-locked with arousals at the termination of obstructive apneas, as demonstrated on this 2min epoch recorded during stage 1 sleep. (C) During the CPAP titration study, at the optimal setting of 12 cm of water, the patient had fewer arousals; many, but not all, now showed no associated rhythmic movements. E2-M1, electro-oculography, right eye; E1-M2, left eye. Chin1–Chin2, surface EMG of the chin. F4-M1, right frontal EEG (international 10–20 EEG electrode placement system); F3-M2, left frontal; C4-M1, right central; C3-M2, left central; O2-M1, right occipital; O1-M2, left occipital. ECG2–ECG1 and ECG2–ECG3, electrocardiographic leads. LAT1–LAT2, left anterior tibialis surface EMG; RAT1–RAT2, right anterior tibialis surface EMG. NPRE, nasal pressure; N/O, oronasal thermocouple. MFLO, mask flow. ORAL, oral leak. THOR and ABD, thoracic and abdominal excursion (piezo-electric belts). SpO2, oxyhemoglobin saturation (%). Pleth, pulse waveform from oximeter.

(A) Rhythmic movements often occurred at the end of apneas, as demonstrated on this 1min epoch recorded during REM sleep. (B) Rhythmic movements appeared to be time-locked with arousals at the termination of obstructive apneas, as demonstrated on this 2min epoch recorded during stage 1 sleep. (C) During the CPAP titration study, at the optimal setting of 12 cm of water, the patient had fewer arousals; many, but not all, now showed no associated rhythmic movements. E2-M1, electro-oculography, right eye; E1-M2, left eye. Chin1–Chin2, surface EMG of the chin. F4-M1, right frontal EEG (international 10–20 EEG electrode placement system); F3-M2, left frontal; C4-M1, right central; C3-M2, left central; O2-M1, right occipital; O1-M2, left occipital. ECG2–ECG1 and ECG2–ECG3, electrocardiographic leads. LAT1–LAT2, left anterior tibialis surface EMG; RAT1–RAT2, right anterior tibialis surface EMG. NPRE, nasal pressure; N/O, oronasal thermocouple. MFLO, mask flow. ORAL, oral leak. THOR and ABD, thoracic and abdominal excursion (piezo-electric belts). SpO2, oxyhemoglobin saturation (%). Pleth, pulse waveform from oximeter.

(A) Rhythmic movements often occurred at the end of apneas, as demonstrated on this 1min epoch recorded during REM sleep. (B) Rhythmic movements appeared to be time-locked with arousals at the termination of obstructive apneas, as demonstrated on this 2min epoch recorded during stage 1 sleep. (C) During the CPAP titration study, at the optimal setting of 12 cm of water, the patient had fewer arousals; many, but not all, now showed no associated rhythmic movements. E2-M1, electro-oculography, right eye; E1-M2, left eye. Chin1–Chin2, surface EMG of the chin. F4-M1, right frontal EEG (international 10–20 EEG electrode placement system); F3-M2, left frontal; C4-M1, right central; C3-M2, left central; O2-M1, right occipital; O1-M2, left occipital. ECG2–ECG1 and ECG2–ECG3, electrocardiographic leads. LAT1–LAT2, left anterior tibialis surface EMG; RAT1–RAT2, right anterior tibialis surface EMG. NPRE, nasal pressure; N/O, oronasal thermocouple. MFLO, mask flow. ORAL, oral leak. THOR and ABD, thoracic and abdominal excursion (piezo-electric belts). SpO2, oxyhemoglobin saturation (%). Pleth, pulse waveform from oximeter.