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Peer-reviewedCC BYSleep science (Sao Paulo, Brazil)

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

  • Hossein Yarmohammadi1
  • Sam Ashtiani2
  • Sina Shahshenas3
  • Masood Soltanipur1,4
  • Amirhossein Bahanesteh5
  • Hamidreza Mirabi6
  • Fereshteh Abbasvandi7,8
  • Ali Montazeri9
  • Zahra Sheikhi1,4
9 affiliations
  1. 1Integrative Oncology Research Group, Motamed Cancer Institute, Tehran Iran
  2. 2Faculty of Medicine, University of Central Lancashire, Preston, Lancashire United Kingdom
  3. 3Student Research Committee, Shahed University Faculty of Medical Sciences, Tehran Iran
  4. 4Department of Quality of Life, Motamed Cancer Institute, Tehran Iran
  5. 5Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran Iran
  6. 6Department of Otorhinolaryngology, Shahid Beheshti University of Medical Sciences, Tehran Iran
  7. 7Department of Advanced Therapy Medicinal Products (ATMPs), Motamed Cancer Institute, Tehran Iran
  8. 8Breast Cancer Research Center, Motamed Cancer Institute, Tehran Iran
  9. 9Academic Center for Education, Culture, and Research (ACECR), Health Metrics Research Center, Tehran Iran
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Abstract

Background: 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.

Materials and Methods: 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).

Results: 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.

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

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Cite

BibTeXRIS
BibTeX
@article{yarmohammadi2026there,
  title = {{Is There a Higher Risk of Obstructive Sleep Apnea among Individuals with Lower-Limb Compared to Those with Upper-Limb Lymphedema?}},
  author = {Hossein Yarmohammadi and Sam Ashtiani and Sina Shahshenas and Masood Soltanipur and Amirhossein Bahanesteh and Hamidreza Mirabi and Fereshteh Abbasvandi and Ali Montazeri and Zahra Sheikhi},
  journal = {Sleep science (Sao Paulo, Brazil)},
  year = {2026},
  month = sep,
  doi = {10.1055/s-0046-1819596},
  url = {https://europepmc.org/article/PMC/PMC13730673},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Is There a Higher Risk of Obstructive Sleep Apnea among Individuals with Lower-Limb Compared to Those with Upper-Limb Lymphedema?
AU  - Hossein Yarmohammadi
AU  - Sam Ashtiani
AU  - Sina Shahshenas
AU  - Masood Soltanipur
AU  - Amirhossein Bahanesteh
AU  - Hamidreza Mirabi
AU  - Fereshteh Abbasvandi
AU  - Ali Montazeri
AU  - Zahra Sheikhi
PY  - 2026
DA  - 2026/09/01
JO  - Sleep science (Sao Paulo, Brazil)
DO  - 10.1055/s-0046-1819596
UR  - https://europepmc.org/article/PMC/PMC13730673
AB  - Background: 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.  Materials and Methods: 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).  Results: 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.  Conclusions: In this study, LLL was associated with a higher risk of OSA and greater sleep disturbances compared to ULL and controls.
SN  - 1984-0659
SN  - 1984-0063
ER  -