Is There a Higher Risk of Obstructive Sleep Apnea among Individuals with Lower-Limb Compared to Those with Upper-Limb Lymphedema?

Abstract

Lymphedema, a chronic condition caused by impaired lymphatic drainage, can significantly affect patients' quality of life. While its impact on sleep quality is recognized, the association between lymphedema and obstructive sleep apnea (OSA) remains underexplored. This study investigated whether individuals with lower-limb lymphedema (LLL) are at a higher risk of OSA compared to those with upper-limb lymphedema (ULL) and healthy controls.

This cross-sectional study included 91 participants: 32 with ULL, 29 with LLL, and 30 healthy controls. Lymphedema was diagnosed based on excess volume (EV) and EV percentage (EVP) using standardized circumference measurements and the cylinder formula. Sleep quality and OSA risk were assessed using validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey, version 2.0 (SF-12v2), the Epworth Sleepiness Scale (ESS), and the Snoring, Tiredness, Observed Apnea, High Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender (STOP-BANG) Questionnaire (SBQ).

Participants with LLL exhibited significantly higher SBQ (p = 0.022) and ESS (p = 0.044) scores compared to those with ULL, indicating an elevated risk of OSA and daytime sleepiness. Furthermore, LLL patients had significantly lower physical (p = 0.020) and mental (p = 0.009) component scores on the SF-12v2, reflecting poorer health-related quality of life. Although PSQI scores were higher in the LLL group, the difference was not statistically significant. Regression analysis showed a significant association between EV and PSQI scores in the LLL group (adjusted p = 0.029), highlighting the impact of lymphedema severity on sleep quality.

In this study, LLL was associated with a higher risk of OSA and greater sleep disturbances compared to ULL and controls.