Rhythmic movement disorder associated with respiratory arousals and improved by CPAP titration in a patient with restless legs syndrome and sleep apnea

A 90-s excerpt from a portion of an overnight polysomnography during stage 2 (N2) NREM sleep in a 51-year-old man with upper airway obstructive sleep apnea, restless legs syndrome and rhythmic movement disorder showing two episodes of rhythmic EMG bursts (about 0.75Hz) beginning in the right biceps (Rt Biceps) and right triceps (Rt Triceps) and spreading to other muscles. These bursts were noted following termination of the apneic events and accompanied by arousals and resumption of normal breathing as well as rhythmic body and head-rolling movements (see online video). EEG: top 6 channels (international nomenclature); E1-M1: left electro-oculogram; E2-M1: right electro-oculogram; EKG: electrocardiogram; OralNasal: oronasal thermistor (air flow); PFlow: nasal pressure recording for airflow; Chest: thoracic breathing effort; ABD: abdominal breathing effort; SaO2: oxygen saturation by finger oximetry; Snore: snoring recording; Masseter: right masseter EMG; Chin: submental EMG; RtSterno: right sternocleidomastoideus EMG; LtBiceps: left biceps EMG; LtTriceps: left triceps. EMG; RtBiceps: right biceps EMG; RtTriceps: right triceps EMG; RtQuad: right quadriceps (biceps femoris) EMG; LtQuad: left quadriceps EMG; RtTib: right tibialis EMG; RtGast: right gastrocnemius EMG; LtTib: left tibialis EMG; LtGast: left gastrocnemius EMG.

A 180-s excerpt from a portion of an overnight PSG during stage 2 (N2) NREM sleep in a 51-year-old man with obstructive sleep apnea, RLS and RMD showing three episodes of rhythmic EMG bursts (about 0.75Hz) and a dystonic EMG burst (last episode towards the end of the tracing) beginning in the right biceps (Rt Biceps) and right triceps (Rt Triceps) and spreading to other muscles. These bursts were noted following termination of the apneic events and accompanied by arousals and resumption of normal breathing as well as rhythmic body and head-rolling movements (see online video). The rest of the figure legend is similar to Fig. 1.