1
|
Xu S, Faust O, Seoni S, Chakraborty S, Barua PD, Loh HW, Elphick H, Molinari F, Acharya UR. A review of automated sleep disorder detection. Comput Biol Med 2022; 150:106100. [PMID: 36182761 DOI: 10.1016/j.compbiomed.2022.106100] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 12/22/2022]
Abstract
Automated sleep disorder detection is challenging because physiological symptoms can vary widely. These variations make it difficult to create effective sleep disorder detection models which support hu-man experts during diagnosis and treatment monitoring. From 2010 to 2021, authors of 95 scientific papers have taken up the challenge of automating sleep disorder detection. This paper provides an expert review of this work. We investigated whether digital technology and Artificial Intelligence (AI) can provide automated diagnosis support for sleep disorders. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines during the content discovery phase. We compared the performance of proposed sleep disorder detection methods, involving differ-ent datasets or signals. During the review, we found eight sleep disorders, of which sleep apnea and insomnia were the most studied. These disorders can be diagnosed using several kinds of biomedical signals, such as Electrocardiogram (ECG), Polysomnography (PSG), Electroencephalogram (EEG), Electromyogram (EMG), and snore sound. Subsequently, we established areas of commonality and distinctiveness. Common to all reviewed papers was that AI models were trained and tested with labelled physiological signals. Looking deeper, we discovered that 24 distinct algorithms were used for the detection task. The nature of these algorithms evolved, before 2017 only traditional Machine Learning (ML) was used. From 2018 onward, both ML and Deep Learning (DL) methods were used for sleep disorder detection. The strong emergence of DL algorithms has considerable implications for future detection systems because these algorithms demand significantly more data for training and testing when compared with ML. Based on our review results, we suggest that both type and amount of labelled data is crucial for the design of future sleep disorder detection systems because this will steer the choice of AI algorithm which establishes the desired decision support. As a guiding principle, more labelled data will help to represent the variations in symptoms. DL algorithms can extract information from these larger data quantities more effectively, therefore; we predict that the role of these algorithms will continue to expand.
Collapse
Affiliation(s)
- Shuting Xu
- Cogninet Brain Team, Sydney, NSW, 2010, Australia
| | - Oliver Faust
- Anglia Ruskin University, East Rd, Cambridge CB1 1PT, UK.
| | - Silvia Seoni
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Subrata Chakraborty
- School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia; Centre for Advanced Modelling and Geospatial Lnformation Systems (CAMGIS), Faculty of Engineer and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Prabal Datta Barua
- Cogninet Brain Team, Sydney, NSW, 2010, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia; School of Business (Information System), University of Southern Queensland, Australia
| | - Hui Wen Loh
- School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, 599494, Singapore
| | | | - Filippo Molinari
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - U Rajendra Acharya
- School of Business (Information System), University of Southern Queensland, Australia; School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, 599494, Singapore; Department of Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
| |
Collapse
|
2
|
Drakatos P, Olaithe M, Verma D, Ilic K, Cash D, Fatima Y, Higgins S, Young AH, Chaudhuri KR, Steier J, Skinner T, Bucks R, Rosenzweig I. Periodic limb movements during sleep: a narrative review. J Thorac Dis 2022; 13:6476-6494. [PMID: 34992826 PMCID: PMC8662505 DOI: 10.21037/jtd-21-1353] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 10/20/2021] [Indexed: 01/02/2023]
Abstract
Objective Using narrative review techniques, this paper evaluates the evidence for separable underlying patho-mechanisms of periodic limb movements (PLMs) to separable PLM motor patterns and phenotypes, in order to elucidate potential new treatment modalities. Background Periodic limb movement disorder (PLMD) is estimated to occur in 5–8% of the paediatric population and 4–11% of the general adult population. Due to significant sleep fragmentation, PLMD can lead to functional impairment, including hyperactivity and delayed language development in children, and poor concentration and work performance in adults. Longitudinal data demonstrate that those with PLMD are at greater risk of depression and anxiety, and a 4-fold greater risk of developing dementia. PLMD has been extensively studied over the past two decades, and several key insights into the genetic, pathophysiological, and neural correlates have been proposed. Amongst these proposals is the concept of separable PLM phenotypes, proposed on the basis of nocturnal features such as the ratio of limb movements and distribution throughout the night. PLM phenotype and presentation, however, varies significantly depending on the scoring utilized and the nocturnal features examined, across age, and co-morbid clinical conditions. Furthermore, associations between these phenotypes with major neurologic and psychiatric disorders remain controversial. Methods In order to elucidate potential divergent biological pathways that may help clarify important new treatment modalities, this paper utilizes narrative review and evaluates the evidence linking PLM motor patterns and phenotypes with hypothesised underlying patho-mechanisms. Distinctive, underlying patho-mechanisms include: a pure motor mechanism originating in the spinal cord, iron deficiency, dopamine system dysfunction, thalamic glutamatergic hyperactivity, and a more cortical-subcortical interplay. In support of the latter hypothesis, PLM rhythmicity appears tightly linked to the microarchitecture of sleep, not dissimilarly to the apnoeic/hypopneic events seen in obstructive sleep apnea (OSA). Conclusions This review closes with a proposal for greater investigation into the identification of potential, divergent biological pathways. To do so would require prospective, multimodal imaging clinical studies which may delineate differential responses to treatment in restless legs syndrome (RLS) without PLMS and PLMS without RLS. This could pave the way toward important new treatment modalities.
Collapse
Affiliation(s)
- Panagis Drakatos
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK.,Faculty of Life and Sciences Medicine, King's College London, London, UK
| | - Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Dhun Verma
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK
| | - Katarina Ilic
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,BRAIN, Imaging Centre, CNS, King's College London, London, UK
| | - Diana Cash
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,BRAIN, Imaging Centre, CNS, King's College London, London, UK
| | - Yaqoot Fatima
- Institute for Social Science Research, University of Queensland, Brisbane, Australia.,Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK
| | - Allan H Young
- School of Academic Psychiatry, King's College London, London, UK
| | - K Ray Chaudhuri
- King's College London and Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Joerg Steier
- Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK.,Faculty of Life and Sciences Medicine, King's College London, London, UK
| | - Timothy Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark.,La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Romola Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia.,The Raine Study, University of Western Australia, Perth, Australia
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK
| |
Collapse
|
3
|
Schütz L, Sixel-Döring F, Hermann W. Management of Sleep Disturbances in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2029-2058. [PMID: 35938257 PMCID: PMC9661340 DOI: 10.3233/jpd-212749] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 06/07/2023]
Abstract
Parkinson's disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.
Collapse
Affiliation(s)
- Lukas Schütz
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
| |
Collapse
|
4
|
Spektor ED, Poluektov MG. [Periodic limb movements in sleep and clinicomorphological features of cerebral small vessel disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:75-79. [PMID: 34078864 DOI: 10.17116/jnevro202112104275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To search for the association between white matter deterioration extend as well as related cognitive dysfunction and periodic limb movements in sleep (PLMS) in patients with cerebral small vessel disease (cSVD). MATERIAL AND METHODS Thirty-four subjects with cSVD were enrolled (12 men, 22 women, average age 66.9 y.o.). The study protocol includes nocturnal actigraphy, cardiorespiratory monitoring, cognitive assessment and brain MRI. Two groups were formed depending on PLMS index. The patients of the main group had PLMS index equal or more than 15 movements per hour, and the controls had PLMS index less than 15. RESULTS AND CONCLUSION The significant differences between groups are shown in the executive functioning (p=0.0025 for the Frontal Assessment battery, p=0.036 for TMT-B, p=0.009 for TMT-A) and in the volume of juxtacortical white matter hyperintensities (WMH) (p=0.009). The positive correlation of PLMS features with total and periventricular volume of WMH and the negative correlation of PLMS features with cognitive performance are found as well.
Collapse
Affiliation(s)
- E D Spektor
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M G Poluektov
- Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
5
|
Chen JM, Chiu PF, Chang YJ, Hsu PC, Chang CC, Lo LC. Effect of electroacupuncture on restless legs syndrome (RLS) in hemodialysis patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23629. [PMID: 33327340 PMCID: PMC7738042 DOI: 10.1097/md.0000000000023629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Restless legs syndrome (RLS) is frequent in dialysis patients and occurs predominantly in its most severe forms. The aim of the present study was to evaluate the effects of electroacupuncture (EA) in hemodialysis patients with RLS by heart rate variability (HRV) monitor. METHODS One hundred twelve subjects who were hemodialysis patients with RLS will be divided into 2 groups: experimental and control. Each subject will receive the treatment relevant to their group 2 times a week for 4 weeks. After 4 weeks of treatment the subject will enter a 2-week washout period, after which the subjects will switch groups. Measurements will include HRV recordings, International Restless Legs Syndrome Rating Scale (IRLSRS) and Insomnia Severity Index (ISI). RESULT The results of this study will systematically evaluate the effectiveness and safety of electoracupuncture intervention for hemodialysis patients with RLS. DISCUSSION This study is the first investigation to analyze the relationship between EA and the change of HRV by an objective monitor. If the findings of the current trial are positive, this study will also help support an effective, safe and cheap approach to clinical treatment of this challenging disorder, help foster improved understanding the relationship between autonomic nervous system and RLS, and ultimately contribute to elucidate the mechanisms of EA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04356794; registration date: April 22, 2020.
Collapse
Affiliation(s)
- Jia-Ming Chen
- Graduate Institute of Chinese Medicine, China Medical University, Taichung
- Department of Traditional Chinese Medicine, Changhua Christian Hospital, Changhua
| | - Ping-Fang Chiu
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua
| | - Po-Chi Hsu
- School of Chinese Medicine, China Medical University, Taichung
| | - Chia-Chu Chang
- Division of Nephrology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung
| | - Lun-Chien Lo
- School of Chinese Medicine, China Medical University, Taichung
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
6
|
Residual excessive sleepiness in patients with obstructive sleep apnea on treatment with continuous positive airway pressure. Curr Opin Pulm Med 2018; 22:589-94. [PMID: 27583668 DOI: 10.1097/mcp.0000000000000324] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW One of the most common causes of excessive daytime sleepiness in clinical practice is obstructive sleep apnea syndrome (OSAS). So far, continuous positive airway pressure (CPAP) is the most effective treatment for OSA. Some of the patients do not improve on CPAP and remain sleepy despite using CPAP.This review provides updated information about the possible causes of residual sleepiness whilst using the CPAP in patients with OSAS. RECENT FINDINGS Prevalence of OSAS has increased recently to 23.4% in women and 49.7% in men. Periodic limb movement, behaviorally induced insufficient sleep syndrome and depression are the most common causes of persistent sleepiness on CPAP. Residual sleepiness after exclusion of all possible causes is 6%. SUMMARY There is still lack of sufficient evidence about the accurate characteristics and possible causes of this residual sleepiness and how to address this in large prospective studies.
Collapse
|
7
|
|
8
|
Sleep in ambulatory patients with stable cirrhosis of the liver. Sleep Med 2018; 41:15-19. [DOI: 10.1016/j.sleep.2017.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
|
9
|
Sergeeva V, Viczko J, Ray LB, Owen AM, Fogel SM. Sleep-dependent motor sequence memory consolidation in individuals with periodic limb movements. Sleep Med 2017; 40:23-32. [DOI: 10.1016/j.sleep.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
|
10
|
|
11
|
Choi JW, Song JS, Lee YJ, Jeong DU. Periodic Limb Movements in Sleep is Associated with Increased Mortality. Psychiatry Investig 2017; 14:669-673. [PMID: 29042893 PMCID: PMC5639136 DOI: 10.4306/pi.2017.14.5.669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/18/2016] [Accepted: 11/19/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To elucidate the association between periodic limb movements in sleep (PLMS) and mortality. METHODS Nocturnal polysomnographic recordings of 1,344 subjects obtained from 1995 to 2008 were reviewed. The subjects were divided into four groups based on PLMS and insomnia: reference group (PLMS≤5), insomnia group (PLMS≤5 with insomnia symptoms), 5<PLMS≤15 group, and the PLMS>15 group. We searched each subject's Identification Number in the death records from the Statistics of Korea, the national bureau of statistics, to determine deaths in the cohort that occurred prior to December, 2013. Cox-proportional hazard regression and Kaplan-Meier survival curve analyses were used to compare mortality among the four groups. RESULTS Hazard ratios (HRs) in the 5<PLMS≤15 and PLMS>15 groups were significantly higher than that in the reference group before adjusting for age and gender [HR, 3.37; 95% confidence interval (CI), 1.73-6.55; p<0.001; HR, 5.77; 95% CI, 3.24-10.29; p<0.001]. Only the PLMS>15 group had a higher mortality rate than that in the reference group after adjusting for age, gender, and sleep efficiency (HR, 1.99; 95% CI, 1.06-2.21; p=0.033). CONCLUSION These results suggest that PLMS may be associated with increased mortality.
Collapse
Affiliation(s)
- Jae-Won Choi
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Ji Soo Song
- Department of Biological Basis of Behavior, University of Pennsylvania, PA, USA
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Do-Un Jeong
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| |
Collapse
|
12
|
Abstract
OPINION STATEMENT Periodic leg movements during sleep (PLMS) are commonly found in patients with restless leg syndrome (RLS), but they may occur in other sleep disorders and several medical conditions. Their prevalence increases with age, but they can also be observed in children. During the last decades, very active research has been devoted to determine and understand the pathophysiology, associated events, and clinical significance of PLMS. This chapter tries to sum up the most relevant PLMS-related findings, focusing on the relationship between PLMS and the cardiovascular system, in order to understand the clinical implication of this complex motor phenomenon. PLMS have been associated with sympathetic overactivity, namely surges in nocturnal blood pressure and heart rate, without modification in global autonomic balance. Also, PLMS have been related to inflammatory cellular pathways, with elevated level of inflammatory markers, which are associated with cardiovascular risk. The PLMS-related modulation of the autonomic system and of inflammation may increase cardiovascular and cerebrovascular risk in subjects with frequent PLMS. Moreover, also, comorbidities associated with PLMS may play a synergic role in worsening the cardiovascular risk and the consequent mortality and morbidity. Furthermore, little is known about pathophysiological correlates in children with PLMS and their chronic implication on the cardiovascular and cerebrovascular systems. A few studies have suggested that treating PLMS with dopaminergic drugs may reduce their associated sympathetic overactivity and modify disease progression. Definitely, further research is needed to assess the clinical impact of PLMS, associated or not with RLS, and above all the long-term impact of treating PLMS on cardiovascular risk, morbidity, and mortality.
Collapse
|
13
|
Haba-Rubio J, Marti-Soler H, Marques-Vidal P, Tobback N, Andries D, Preisig M, Waeber G, Vollenweider P, Kutalik Z, Tafti M, Heinzer R. Prevalence and determinants of periodic limb movements in the general population. Ann Neurol 2016; 79:464-74. [PMID: 26703954 DOI: 10.1002/ana.24593] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Periodic limb movements during sleep (PLMS) are sleep phenomena characterized by periodic episodes of repetitive stereotyped limb movements. The aim of this study was to describe the prevalence and determinants of PLMS in a middle to older aged general population. METHODS Data from 2,162 subjects (51.2% women, mean age = 58.4 ± 11.1 years) participating in a population-based study (HypnoLaus, Lausanne, Switzerland) were collected. Assessments included laboratory tests, sociodemographic data, personal and treatment history, and full polysomnography at home. PLMS index (PLMSI) was determined, and PLMSI > 15/h was considered as significant. RESULTS Prevalence of PLMSI > 15/h was 28.6% (31.3% in men, 26% in women). Compared to subjects with PLMSI ≤ 15/h, subjects with PLMSI > 15/h were older (p < 0.001), were predominantly males (p = 0.007), had a higher proportion of restless legs syndrome (RLS; p < 0.001), had a higher body mass index (p = 0.001), and had a lower mean glomerular filtration rate (p < 0.001). Subjects with PLMSI > 15/h also had a higher prevalence of diabetes, hypertension, and beta-blocker or hypnotic treatments. The prevalence of antidepressant use was higher, but not statistically significant (p = 0.07). Single nucleotide polymorphisms (SNPs) within BTBD9 (rs3923809), TOX3 (rs3104788), and MEIS1 (rs2300478) genes were significantly associated with PLSMI > 15/h. Conversely, mean hemoglobin and ferritin levels were similar in both groups. In the multivariate analysis, age, male gender, antidepressant intake, RLS, and rs3923809, rs3104788, and rs2300478 SNPs were independently associated with PLMSI > 15/h. INTERPRETATION PLMS are highly prevalent in our middle-aged European population. Age, male gender, RLS, antidepressant treatment, and specific BTBD9, TOX3, and MEIS1 SNP distribution are independent predictors of PLMSI > 15/h.
Collapse
Affiliation(s)
- José Haba-Rubio
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Helena Marti-Soler
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, and Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Nadia Tobback
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniela Andries
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Gérard Waeber
- Department of Medicine, Internal Medicine, and Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, and Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Zoltán Kutalik
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne University, Lausanne, Switzerland
| | - Mehdi Tafti
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland.,Center for Integrative Genomics, Lausanne University, Lausanne, Switzerland
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland.,Pulmonary Department, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
14
|
Moro M, Goparaju B, Castillo J, Alameddine Y, Bianchi MT. Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring. Nat Sci Sleep 2016; 8:277-89. [PMID: 27540316 PMCID: PMC4982487 DOI: 10.2147/nss.s101753] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Periodic limb movements of sleep (PLMS) may increase cardiovascular and cerebrovascular morbidity. However, most people with PLMS are either asymptomatic or have nonspecific symptoms. Therefore, predicting elevated PLMS in the absence of restless legs syndrome remains an important clinical challenge. METHODS We undertook a retrospective analysis of demographic data, subjective symptoms, and objective polysomnography (PSG) findings in a clinical cohort with or without obstructive sleep apnea (OSA) from our laboratory (n=443 with OSA, n=209 without OSA). Correlation analysis and regression modeling were performed to determine predictors of periodic limb movement index (PLMI). Markov decision analysis with TreeAge software compared strategies to detect PLMS: in-laboratory PSG, at-home testing, and a clinical prediction tool based on the regression analysis. RESULTS Elevated PLMI values (>15 per hour) were observed in >25% of patients. PLMI values in No-OSA patients correlated with age, sex, self-reported nocturnal leg jerks, restless legs syndrome symptoms, and hypertension. In OSA patients, PLMI correlated only with age and self-reported psychiatric medications. Regression models indicated only a modest predictive value of demographics, symptoms, and clinical history. Decision modeling suggests that at-home testing is favored as the pretest probability of PLMS increases, given plausible assumptions regarding PLMS morbidity, costs, and assumed benefits of pharmacological therapy. CONCLUSION Although elevated PLMI values were commonly observed, routinely acquired clinical information had only weak predictive utility. As the clinical importance of elevated PLMI continues to evolve, it is likely that objective measures such as PSG or at-home PLMS monitors will prove increasingly important for clinical and research endeavors.
Collapse
Affiliation(s)
- Marilyn Moro
- Neurology Department, Massachusetts General Hospital
| | | | | | | | - Matt T Bianchi
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Abstract
Aging is associated with numerous changes, including changes in sleep timing, duration, and quality. The circadian timing system interacts with a sleep-wake homeostatic system to regulate human sleep, including sleep timing and structure. This article reviews key features of the human circadian timing system, age-related changes in the circadian timing system, and how those changes may contribute to the observed alterations in sleep.
Collapse
Affiliation(s)
- Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, BLI438, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
| | - Kirsi-Marja Zitting
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, BLI438, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Evan D Chinoy
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, BLI438, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
16
|
Sleep fragmentation and periodic limb movements in children with monosymptomatic nocturnal enuresis and polyuria. Pediatr Nephrol 2015; 30:1157-62. [PMID: 25669760 DOI: 10.1007/s00467-015-3044-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/23/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with nocturnal enuresis (NE) have been found to have sleep fragmentation and a high incidence of periodic limb movements in sleep (PLMS). This study explored the association of monosymptomatic NE and polyuria in relation to fluid intake, bladder volume, number of wet nights, and number of nights with polyuria to the frequency of PLMS and cortical arousals during sleep. MATERIALS AND METHODS Thirty children with monosymptomatic NE and polyuria were enrolled in the study. Enuretic parameters were determined by diaries, forced drinking, uroflow, and ultrasound examination. All subjects participated in one polysomnographic study. The number of cortical arousals and PLMS were compared with those recorded in a former pilot study which included only children with refractory NE. RESULTS Of the 30 children who participated in the study, the mean age was 10.43 ± 3.08 (range 6-16) years, and 23 were boys. The PLMS index was positively associated with the arousal index and the awakening index (p < 0.001). No significant association between the sleep and the enuretic parameters was found. Children with refractory NE showed a significantly higher PLMS index (p < 0.001). CONCLUSIONS We found that PLMS and cortical arousals in sleep were increased in children with monosymptomatic NE and polyuria, without a significant association with the enuretic parameters. These observations suggest the presence of a comorbid mechanism driven by a common, independent pacemaker. We hypothesize the autonomic system, its sympathetic branch, and the dopaminergic system as candidates for this pacemaker.
Collapse
|
17
|
Actigraph evaluation of acupuncture for treating restless legs syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:343201. [PMID: 25763089 PMCID: PMC4339862 DOI: 10.1155/2015/343201] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/26/2014] [Indexed: 01/01/2023]
Abstract
We evaluated the effects of acupuncture in patients with restless legs syndrome (RLS) by actigraph recordings. Among the 38 patients with RLS enrolled, 31 (M = 12, F = 19; mean age, 47.2 ± 9.7 years old) completed the study. Patients were treated with either standard acupuncture (n = 15) or randomized acupuncture (n = 16) in a single-blind manner for 6 weeks. Changes in nocturnal activity (NA) and early sleep activity (ESA) between week 0 (baseline), week 2, week 4, and week 6 were assessed using leg actigraph recordings, the International Restless Legs Syndrome Rating Scale (IRLSRS), and Epworth Sleepiness Scale (ESS). Standard but not randomized acupuncture reduced the abnormal leg activity of NA and ESA significantly in week 2, week 4, and week 6 based on the changes in the clinical scores for IRLSRS and ESS in week 4 and week 6 compared with the baseline. No side effects were observed. The results indicate that standard acupuncture might improve the abnormal leg activity in RLS patients and thus is a potentially suitable integrative treatment for long-term use.
Collapse
|
18
|
Veauthier C, Gaede G, Radbruch H, Sieb JP, Wernecke KD, Paul F. Periodic limb movements during REM sleep in multiple sclerosis: a previously undescribed entity. Neuropsychiatr Dis Treat 2015; 11:2323-9. [PMID: 26396516 PMCID: PMC4574879 DOI: 10.2147/ndt.s83350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are few studies describing periodic limb movement syndrome (PLMS) in rapid eye movement (REM) sleep in patients with narcolepsy, restless legs syndrome, REM sleep behavior disorder, and spinal cord injury, and to a lesser extent, in insomnia patients and healthy controls, but no published cases in multiple sclerosis (MS). The aim of this study was to investigate PLMS in REM sleep in MS and to analyze whether it is associated with age, sex, disability, and laboratory findings. METHODS From a study of MS patients originally published in 2011, we retrospectively analyzed periodic limb movements (PLMs) during REM sleep by classifying patients into two subgroups: PLM during REM sleep greater than or equal to ten per hour of REM sleep (n=7) vs less than ten per hour of REM sleep (n=59). A univariate analysis between PLM and disability, age, sex, laboratory findings, and polysomnographic data was performed. RESULTS MS patients with more than ten PLMs per hour of REM sleep showed a significantly higher disability measured by the Kurtzke expanded disability status scale (EDSS) (P=0.023). The presence of more than ten PLMs per hour of REM sleep was associated with a greater likelihood of disability (odds ratio 22.1; 95% confidence interval 3.5-139.7; P<0.0001), whereas there were no differences in laboratory and other polysomnographic findings. CONCLUSION PLMs during REM sleep were not described in MS earlier, and they are associated with disability measured by the EDSS.
Collapse
Affiliation(s)
- Christian Veauthier
- Interdisciplinary Center of Sleep Medicine, Charité University Medicine Berlin, Germany
| | - Gunnar Gaede
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Germany ; Department of Neurology, St Joseph Hospital Berlin-Weissensee, Berlin, Germany
| | - Helena Radbruch
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Germany
| | - Joern-Peter Sieb
- Department of Neurology, HELIOS Hanseklinikum Stralsund, Stralsund, Germany ; Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Klaus-Dieter Wernecke
- CRO SOSTANA GmbH, Berlin, Germany ; Institute of Medical Biometry, Charité University Medicine Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Germany ; Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| |
Collapse
|
19
|
Lapointe E, Frenette É. Periodic or Rhythmic Movements During Sleep. Sleep Med Clin 2014. [DOI: 10.1016/j.jsmc.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
20
|
Nannapaneni S, Ramar K. Periodic limb movements during sleep and their effect on the cardiovascular system: is there a final answer? Sleep Med 2014; 15:379-84. [PMID: 24656911 DOI: 10.1016/j.sleep.2013.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/04/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
Abstract
Periodic limb movements during sleep (PLMS) is a sleep-related movement disorder characterized by repetitive limb movements during sleep, seen predominantly in the legs but also occasionally involving the arms. These movements may be associated with arousals that can lead to increases in sympathetic tone, resulting in tachycardia and elevated systolic blood pressure. Chronic sustained tachycardia and elevated systolic blood pressure are known to be associated with the development of arrhythmias, hypertension, left ventricular hypertrophy, and congestive heart failure. However, the data are not entirely clear on whether untreated PLMS is associated with these cardiovascular risks. This review examines the current evidence on whether PLMS has any effect on the cardiovascular system.
Collapse
Affiliation(s)
- Srikant Nannapaneni
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Kannan Ramar
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
21
|
Li Y, Li Z, Lei F, Zhou J, Tang X. Daytime leg pain after overnight continuous positive airway pressure titration. J Neurol Sci 2014; 336:281-3. [PMID: 24210774 DOI: 10.1016/j.jns.2013.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/07/2013] [Accepted: 10/21/2013] [Indexed: 02/05/2023]
Abstract
We report a case that showed transitional, severe emergent periodic limb movements during sleep (PLMS) in the first continuous positive airway pressure (CPAP) titration night and mild PLMS in the 3rd and 20th nights of CPAP titration in a 56-year-old woman after she was found to have severe obstructive sleep apnea (OSA). Severe PLMS in the initial CPAP night unexpectedly resulted in acute leg muscle soreness in the second morning. The case suggests that CPAP therapy in patients who suffer from severe OSA may provide a unique opportunity to look into the pathological mechanism of PLMS.
Collapse
Affiliation(s)
- Yun Li
- Sleep Medicine Center, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhe Li
- Sleep Medicine Center, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Lei
- Sleep Medicine Center, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Junying Zhou
- Sleep Medicine Center, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- Sleep Medicine Center, Translational Neuroscience Center, Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
22
|
Pennestri MH, Montplaisir J, Fradette L, Lavigne G, Colombo R, Lanfranchi PA. Blood pressure changes associated with periodic leg movements during sleep in healthy subjects. Sleep Med 2013; 14:555-61. [DOI: 10.1016/j.sleep.2013.02.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/17/2013] [Accepted: 02/08/2013] [Indexed: 10/26/2022]
|
23
|
Covassin N, Neikrug AB, Liu L, Corey-Bloom J, Loredo JS, Palmer BW, Maglione J, Ancoli-Israel S. Clinical correlates of periodic limb movements in sleep in Parkinson's disease. J Neurol Sci 2012; 316:131-6. [PMID: 22277375 PMCID: PMC3321115 DOI: 10.1016/j.jns.2012.01.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 11/21/2011] [Accepted: 01/04/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of the current study was to investigate the frequency of periodic limb movements in sleep (PLMS) in Parkinson's disease (PD) and their impact on nocturnal sleep and daytime functioning. METHODS Forty-five PD patients (mean age 68.5 ± 8.7 years; 32 males) underwent one night of polysomnography (PSG). Clinical assessment and questionnaires evaluating sleep disturbance and quality of life (QoL) were completed. Patients were divided into two groups based on their PLMS index (PLMSI): PLMSI ≥ 15 (PLMS+) and PLMSI <15 (PLMS-). RESULTS There were 26 (57.8%) PD patients in the PLMS+group and 19 (42.2%) patients in the PLMS-group. Subjective assessment revealed an association between PLMS+status and greater PD symptom severity, more subjective sleep disturbance, and decreased QoL. All patients showed poor sleep, and no significant group differences were detected on PSG measures. CONCLUSION We observed that PLMS occurred frequently in PD and increased with more severe PD. Although PLMS did not affect objective sleep, it was associated with increased sleep complaints and reduced QoL. Overall, our findings support the association between PLMS and PD as well as the clinical relevance of sleep disturbances in PD.
Collapse
Affiliation(s)
| | | | - Lianqi Liu
- Department of Psychiatry, University of California San Diego
| | | | - Jose S. Loredo
- Department of Medicine, University of California San Diego
| | | | - Jeanne Maglione
- Department of Psychiatry, University of California San Diego
| | - Sonia Ancoli-Israel
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California San Diego
- Department of Medicine, University of California San Diego
| |
Collapse
|
24
|
SAKUTA K, KOMADA Y, KAGIMURA T, OKAJIMA I, NAKAMURA M, INOUE Y. Factors associated with severity of daytime sleepiness and indications for initiating treatment in patients with periodic limb movements during sleep. Sleep Biol Rhythms 2012. [DOI: 10.1111/j.1479-8425.2012.00560.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
25
|
Recognition and diagnosis of sleep disorders in Parkinson's disease. J Neurol 2012; 259:2031-40. [PMID: 22535255 PMCID: PMC3464375 DOI: 10.1007/s00415-012-6505-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 03/29/2012] [Indexed: 11/26/2022]
Abstract
Sleep disturbances are among the most frequent and incapacitating non-motor symptoms of Parkinson’s disease (PD), and are increasingly recognized as an important determinant of impaired quality of life. Here we review several recent developments regarding the recognition and diagnosis of sleep disorders in PD. In addition, we provide a practical and easily applicable approach to the diagnostic process as a basis for tailored therapeutic interventions. This includes a stepwise scheme that guides the clinical interview and subsequent ancillary investigations. In this scheme, the various possible sleep disorders are arranged not in order of prevalence, but in a ‘differential diagnostic’ order. We also provide recommendations for the use of sleep registrations such as polysomnography. Furthermore, we point out when a sleep specialist could be consulted to provide additional diagnostic and therapeutic input. This structured approach facilitates early detection of sleep disturbances in PD, so treatment can be initiated promptly.
Collapse
|
26
|
Ferri R. The time structure of leg movement activity during sleep: The theory behind the practice. Sleep Med 2012; 13:433-41. [DOI: 10.1016/j.sleep.2011.10.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 10/07/2011] [Accepted: 10/31/2011] [Indexed: 10/14/2022]
|
27
|
Benbir G, Karadeniz D. Periodic leg movements in sleep in patients with supratentorial cerebral infarction. Acta Neurol Belg 2012; 112:27-32. [PMID: 22427286 DOI: 10.1007/s13760-011-0002-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 09/19/2011] [Indexed: 11/28/2022]
Abstract
The pathophysiology of periodic leg movements in sleep (PLMS) is complex, and still lacks a consensus. Consecutive 35 patients with the diagnosis of acute supratentorial ischemic stroke and 35 age- and sex-matched control subjects were prospectively investigated. Clinical and sociodemographic evaluation and a whole-night polysomnographic recording were performed. In patients with supratentorial ischemic stroke, 27 patients (77.2%) had PLMS-index more than 5/h, and 19 out of 35 patients (54.3%) had PLMS-index more than 15/h; while only 10 participants (28.5%) in control group had PLMS-index more than 5/h, and 6 participants (17.1%) had PLMS-index more than 15/h (p < 0.05). None of the demographic variables showed statistically significant relationship with PLMS, such as gender (p = 0.952) and age (p = 0.435). Territorial localization of ischemic lesions showed no relation with the presence of PLMS (p = 0.867), PLMS-index (p = 0.432), or restless legs syndrome (p = 0.833). All patients demonstrated PLMS contralateral to ischemic lesion except eight patients with bilateral PLMS; these were also more prominent contralaterally. Our study supports the hypothesis that destructive lesions causing the loss of cortical or subcortical inhibition exerting on the reticular formation on spinal pathways could lead to the development of PLMS.
Collapse
Affiliation(s)
- Gulcin Benbir
- Sleep Disorders Unit, Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
| | | |
Collapse
|
28
|
Huynh NT, Morton PD, Rompré PH, Papadakis A, Remise C. Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations. Am J Orthod Dentofacial Orthop 2011; 140:762-70. [PMID: 22133940 DOI: 10.1016/j.ajodo.2011.03.023] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 03/01/2011] [Accepted: 03/01/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Nelly T Huynh
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Québec, Canada.
| | | | | | | | | |
Collapse
|
29
|
Rizzi M, Barrella M, Kotzalidis GD, Bevilacqua M. Periodic Limbic Movement Disorder during Sleep as Diabetes-Related Syndrome? A Polysomnographic Study. ISRN ENDOCRINOLOGY 2011; 2011:246157. [PMID: 22363869 PMCID: PMC3262626 DOI: 10.5402/2011/246157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 06/20/2011] [Indexed: 11/23/2022]
Abstract
Introduction. Periodic limb movements during sleep (PLMs) is common in the elderly. When quality-of-life drops due to sleep disturbances, we speak about periodic limb movement disorder during sleep (PLMD). Another similar disorder, restless legs syndrome (RLS), is considered to be related to diabetes; RLS and PLMDs are genetically related. Our aim was to detect PLMDs in a population of diabetic patients and identify them as possible hallmarks of these autonomic disorders. Material and Methods. We selected 41 type-2 diabetics with no sleep comorbidity, and compared them with 38 healthy matched volunteers. All participants underwent the Epworth Sleepiness Scale (ESS) and polysomnography (PSG). A periodic limb movement (PLM) index >5, that is, the higher number of PLMs/sleep hour for the entire night, was considered as abnormal. Results. Diabetics showed lower sleep efficiency than controls on the ESS, lower proportions of REM and non-REM sleep, and higher arousal and PLM indexes, as assessed through PSG. PLMDs were diagnosed in 13 of 41 diabetic patients (31%); the latter showed lower sleep efficiency, lower non-REM slow-wave sleep, and increased arousal and PLM indexes. Conclusion. The relationship between PLMs-related sleep fragmentation and endocrine carbohydrate metabolism regulation might be casual or genetically determined. This deserves further investigations.
Collapse
Affiliation(s)
- M Rizzi
- Institute of Pneumology, Luigi Sacco Hospital, Giovanni Battista Grassi Street 74, 20157 Milan, Italy
| | | | | | | |
Collapse
|
30
|
Effects of acute dopamine-agonist treatment in restless legs syndrome on heart rate variability during sleep. Sleep Med 2011; 12:47-55. [DOI: 10.1016/j.sleep.2010.03.019] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/15/2010] [Accepted: 03/23/2010] [Indexed: 11/20/2022]
|
31
|
Earley CJ, Allen RP, Hening W. Restless legs syndrome and periodic leg movements in sleep. HANDBOOK OF CLINICAL NEUROLOGY 2011; 99:913-48. [PMID: 21056236 DOI: 10.1016/b978-0-444-52007-4.00015-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
32
|
Deak MC, Winkelman JW. The Pharmacologic Management of Restless Legs Syndrome and Periodic Leg Movement Disorder. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2010.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Rummel C, Gast H, Schindler K, Müller M, Amor F, Hess CW, Mathis J. Assessing periodicity of periodic leg movements during sleep. Front Neurosci 2010; 4:58. [PMID: 20948585 PMCID: PMC2953451 DOI: 10.3389/fnins.2010.00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 07/16/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Periodic leg movements (PLM) during sleep consist of involuntary periodic movements of the lower extremities. The debated functional relevance of PLM during sleep is based on correlation of clinical parameters with the PLM index (PLMI). However, periodicity in movements may not be reflected best by the PLMI. Here, an approach novel to the field of sleep research is used to reveal intrinsic periodicity in inter movement intervals (IMI) in patients with PLM. METHODS Three patient groups of 10 patients showing PLM with OSA (group 1), PLM without OSA or RLS (group 2) and PLM with RLS (group 3) are considered. Applying the "unfolding" procedure, a method developed in statistical physics, enhances or even reveals intrinsic periodicity of PLM. The degree of periodicity of PLM is assessed by fitting one-parameter distributions to the unfolded IMI distributions. Finally, it is investigated whether the shape of the IMI distributions allows to separate patients into different groups. RESULTS Despite applying the unfolding procedure, periodicity is neither homogeneous within nor considerably different between the three clinically defined groups. Data-driven clustering reveals more homogeneous and better separated clusters. However, they consist of patients with heterogeneous demographic data and comorbidities, including RLS and OSA. CONCLUSIONS The unfolding procedure may be necessary to enhance or reveal periodicity. Thus this method is proposed as a pre-processing step before analyzing PLM statistically. Data-driven clustering yields much more reasonable results when applied to the unfolded IMI distributions than to the original data. Despite this effort no correlation between the degree of periodicity and demographic data or comorbidities is found. However, there are indications that the nature of the periodicity might be determined by long-range interactions between LM of patients with PLM and OSA.
Collapse
Affiliation(s)
- Christian Rummel
- Department of Neurology, Inselspital, Bern University Hospital and University of BernBern, Switzerland
| | - Heidemarie Gast
- Department of Neurology, Inselspital, Bern University Hospital and University of BernBern, Switzerland
| | - Kaspar Schindler
- Department of Neurology, Inselspital, Bern University Hospital and University of BernBern, Switzerland
| | - Markus Müller
- Facultad de Ciencias, Universidad Autónoma del Estado de MorelosCuernavaca, Morelos, Mexico
- Centro Internacional de Ciencias AC, Universidad Nacional Autónoma de MéxicoCuernavaca, Mexico
| | - Frédérique Amor
- Department of Neurology, Inselspital, Bern University Hospital and University of BernBern, Switzerland
| | - Christian W. Hess
- Department of Neurology, Inselspital, Bern University Hospital and University of BernBern, Switzerland
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital and University of BernBern, Switzerland
| |
Collapse
|
34
|
Wing YK, Zhang J, Ho CKW, Au CT, Li AM. Periodic limb movement during sleep is associated with nocturnal hypertension in children. Sleep 2010; 33:759-65. [PMID: 20550016 PMCID: PMC2881712 DOI: 10.1093/sleep/33.6.759] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that blood pressure (BP) is significantly influenced by sleep problems in children, but the association between periodic limb movement during sleep (PLMS) and BP is still unclear. This study aims to compare ambulatory blood pressure (ABP) in children with and without PLMS. METHODS AND RESULTS A cross-sectional study involving 314 children (mean (SD) age of 10.4 (1.7) years, boys 62.4%). Participants underwent an overnight polysomnographic study and ABP monitoring. Subjects were hypertensive if mean SBP or DBP > 95th percentile and prehypertensive if mean SBP or DBP > 90th percentile of reference. Children with PLMS (n = 17) were at significantly higher risk for nocturnal systolic (adjusted OR (95%CI) = 6.25 [1.87-20.88]) and diastolic (OR (95%CI) = 4.83 [1.66-14.07]) hypertension. However, mean nocturnal BP did not differ between children with and without PLMS. There was a trend for higher daytime BP in patients with PLMS than those children without PLMS (P = 0.084 for systolic BP z score; P = 0.051 for diastolic BP z score; P = 0.067 for systolic prehypertension). There were significant associations between log transformed PLM index and daytime systolic and mean BP z scores (P = 0.03 and 0.033 respectively) as well as that between log transformed PLM related arousal index (PLMSArI) and nocturnal diastolic and mean BP (P = 0.008 and 0.038 respectively). CONCLUSIONS PLMS was independently associated with a wide range of BP elevations, especially nocturnal indices. Future studies should examine the underlying pathophysiologic mechanisms and effects of PLMS treatment on BP.
Collapse
Affiliation(s)
- Yun Kwok Wing
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin Hospital, Shatin, Hong Kong SAR, China.
| | | | | | | | | |
Collapse
|
35
|
Ferri R, Manconi M, Aricò D, Sagrada C, Zucconi M, Bruni O, Oldani A, Ferini-Strambi L. Acute dopamine-agonist treatment in restless legs syndrome: effects on sleep architecture and NREM sleep instability. Sleep 2010; 33:793-800. [PMID: 20550020 PMCID: PMC2881713 DOI: 10.1093/sleep/33.6.793] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To analyze cyclic alternating pattern (CAP) in restless legs syndrome (RLS) and the eventual changes induced by the acute administration of pramipexole. SETTING Sleep clinic in a scientific research institute. INTERVENTIONS Placebo or pramipexole 0.25 mg. METHODS Thirty-four patients were included: 19 patients received 0.25 mg of pramipexole and 15 were given placebo. The control group included 13 normal subjects. Nocturnal polysomnography was carried out in all subjects, and a second night was recorded after pramipexole or placebo was administered to patients with RLS. Sleep stages, CAP, and leg movement activity were scored following standard criteria. MEASUREMENTS AND RESULTS At baseline, rapid eye movement sleep latency was significantly longer in patients with RLS than in normal control subjects, and the periodic leg movement during sleep index (PLMS) was also significantly higher. On the contrary, many CAP parameters appeared to be significantly different, with a general increase in CAP rate in patients with RLS. Acute administration of pramipexole induced moderate changes in sleep architecture (increased number of stage shifts/h, sleep efficiency, and percentage of stage 2 sleep; decreased wakefulness after sleep onset; and a lower PLMS index. No effects of treatment on CAP were observed. CONCLUSION Patients with RLS show significant abnormalities in sleep microstructure, represented by an excessive sleep instability/discontinuity. Acute pramipexole administration seems to exert no action on these abnormalities; the moderate effects seen on sleep architecture might be interpreted as the beneficial consequence of the removal of presleep RLS symptoms and PLMS.
Collapse
Affiliation(s)
- Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
O’Donnell D, Silva EJ, Munch M, Ronda JM, Wang W, Duffy JF. Comparison of subjective and objective assessments of sleep in healthy older subjects without sleep complaints. J Sleep Res 2009; 18:254-63. [PMID: 19645969 PMCID: PMC2975570 DOI: 10.1111/j.1365-2869.2008.00719.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Older adults have reduced sleep quality compared with younger adults when sleeping at habitual times and greater sleep disruption when their sleep is at adverse times. The purpose of this analysis was to investigate how subjective measures of sleep relate to objectively recorded sleep in older subjects scheduled to sleep at all times of day. We analyzed data from 24 healthy older (55-74 years) subjects who took part in a 32-day inpatient study where polysomnography was recorded each night and subjective sleep was assessed after each scheduled wake time. The study included baseline nights and a forced desynchrony (FD) protocol when the subjects lived on a 20-h rest activity schedule. Our postsleep questionnaire both included quantitative and qualitative questions about the prior sleep. Under baseline and FD conditions, objective and subjective sleep latency were correlated, subjective sleep duration was related to slow-wave sleep and wake after sleep onset, subjective sleep quality was related to stage 1 and 2 sleep, and sleepiness and refreshment at wake time were related to duration of premature awakening. During FD, most measures of objective and subjective sleep varied with circadian phase and many additional correlations between objective and subjective sleep were present. Our findings show that when sleeping at habitual times, these healthy older subjects did not perceive their generally poor sleep quality, but under FD conditions where sleep quality changed from day-to-day their subjective sleep ratings were more associated with their objective sleep.
Collapse
Affiliation(s)
- Deirdre O’Donnell
- Division of Sleep Medicine, Brigham & Women’s Hospital, Boston, MA 02115 USA
| | - Edward J. Silva
- Division of Sleep Medicine, Brigham & Women’s Hospital, Boston, MA 02115 USA
| | - Mirjam Munch
- Division of Sleep Medicine, Brigham & Women’s Hospital, Boston, MA 02115 USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA
| | - Joseph M. Ronda
- Division of Sleep Medicine, Brigham & Women’s Hospital, Boston, MA 02115 USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA
| | - Wei Wang
- Division of Sleep Medicine, Brigham & Women’s Hospital, Boston, MA 02115 USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA
| | - Jeanne F. Duffy
- Division of Sleep Medicine, Brigham & Women’s Hospital, Boston, MA 02115 USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115 USA
| |
Collapse
|
37
|
Periodic leg movements in RLS patients as compared to controls: Are there differences beyond the PLM index? Sleep Med 2009; 10:566-71. [DOI: 10.1016/j.sleep.2008.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 04/07/2008] [Accepted: 04/09/2008] [Indexed: 11/22/2022]
|
38
|
Merlino G, Serafini A, Robiony F, Valente M, Gigli GL. Restless legs syndrome: differential diagnosis and management with rotigotine. Neuropsychiatr Dis Treat 2009; 5:67-80. [PMID: 19557102 PMCID: PMC2695234 DOI: 10.2147/ndt.s3675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
RLS is a common sleep disorder with distinctive clinical features. The prevalence of RLS in Caucasians and North Americans ranges from 5% to 10%. However, only some of these subjects (almost the 3% of the general population) report being affected by a frequent and severe form of the sleep disorder. RLS is diagnosed clinically by means of four internationally recognized criteria that summarize the main characteristics of the sleep disorder. Besides the essential criteria, supportive and associated features of RLS have been established by experts in order to help physicians treat patients with doubtful symptoms. Several clinical conditions may mimic this sleep disorder. In order to increase the sensibility and specificity of RLS diagnosis, doctors should perform a meticulous patient history and then an accurate physical and neurological examination. Dopamine agonists are recognized as the preferred first-line treatment for RLS. Rotigotine is a non-ergoline dopamine agonist with selectivity for D1, D2 and D3 receptors. The drug is administered via transdermal patches which release rotigotine for 24 hours. Four clinical trials demonstrated that this compound is able to improve RLS symptomatology with few and moderate adverse events. Head to head trials are required to compare the efficacy and tolerability of rotigotine with other dopamine agonists administered via oral intake. Rotigotine has been approved by the FDA and EMEA for Parkinson's disease. For the treatment of moderate to severe idiopathic RLS, rotigotine has been recommended for approval by the EMEA and is under review by the FDA.
Collapse
Affiliation(s)
- Giovanni Merlino
- Sleep Disorder Center, Neurology and Clinical Neurophysiology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | | | | | | | | |
Collapse
|
39
|
Rauhala E, Virkkala J, Himanen SL. Periodic limb movement screening as an additional feature of Emfit sensor in sleep-disordered breathing studies. J Neurosci Methods 2008; 178:157-61. [PMID: 19100767 DOI: 10.1016/j.jneumeth.2008.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 11/20/2008] [Accepted: 11/22/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND The standard method for recording periodic limb movements is anterior tibialis electromyography (EMG) but other methods are also used. A new movement sensor Emfit (ElectroMechanical Film) provides information about sleep-disordered breathing but also shows movements in bed. The aim of the study was to investigate the usability of a small Emfit sensor in revealing periodic movements. METHODS Twenty seven consecutive patients were studied. Periodic movements in EMG and Emfit were scored blindly and periodic leg movement index (PLMI) for EMG and periodic movement index (PMI) for Emfit were counted. Spearman's correlation coefficient was used to assess the relationship between Emfit data and EMG results. Sensitivities and specificities were computed for PLMI and PMI levels of 5 and 15 movements/h. Additionally, receiver operating characteristic (ROC) curves were derived and the area under the curve (AUC) was calculated. RESULTS The Spearman's correlation coefficient between the PMI of Emfit and the PLMI of EMG was 0.87. The sensitivity of the Emfit sensor to detect periodic limb movements was 0.91 at the level of 5 movements/h and 0.73 when the cut-off level was 15 movements/h. The specificities were 0.75 and 1.00, respectively. AUC in ROC analysis was 0.96 and 0.98 in the levels of 5 and 15 movements/h. CONCLUSIONS The results suggest that the Emfit sensor might be suitable for screening of periodic limb movements even if the sensor is placed under the thoracic area of the patient in sleep-disordered breathing studies.
Collapse
Affiliation(s)
- Esa Rauhala
- Department of Clinical Neurophysiology, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland.
| | | | | |
Collapse
|
40
|
Placidi F, Izzi F, Romigi A, Stanzione P, Marciani MG, Brusa L, Sperli F, Galati S, Pasqualetti P, Pierantozzi M. Sleep-wake cycle and effects of cabergoline monotherapy in de novo Parkinson's disease patients. An ambulatory polysomnographic study. J Neurol 2008; 255:1032-7. [PMID: 18500498 DOI: 10.1007/s00415-008-0836-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 11/15/2007] [Accepted: 12/05/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the sleep-wake cycle and the effects of cabergoline monotherapy in a homogenous group of de novo Parkinson's Disease (PD) patients without confounding comorbid factors. DESIGN AND PARTICIPANTS Twelve de novo patients affected by idiopathic PD underwent two ambulatory polysomnographic (APSG)monitoring sessions. The first was performed at baseline, and the second recording one-month after stable treatment with cabergoline monotherapy. Subjective daytime sleepiness was evaluated by means of the Epworth Sleepiness Scale.Data obtained in PD patients at baseline were compared with those obtained in 12 age- and sex-matched healthy subjects. RESULTS Diurnal sleep parameters did not show significant differences between controls and PD patients at baseline. In PD patients, no significant changes in diurnal sleep were observed between baseline and cabergoline treatment. Regarding nocturnal sleep, patients at baseline showed a significantly lower sleep efficiency and a significantly higher Wakefulness After Sleep Onset than controls. With respect to baseline, a significant increase in REM latency and a significant reduction in REM sleep were observed during cabergoline treatment. CONCLUSIONS In the early stage of PD, the neurodegenerative process does not seem to be directly responsible for daytime somnolence, but it may be directly involved in the alteration of nocturnal sleep. Cabergoline monotherapy does not affect daytime sleep propensity and, despite clinical improvement, it may have negative effects on REM sleep.
Collapse
Affiliation(s)
- Fabio Placidi
- Neurology Clinic, Dept. of Neuroscience, University of Rome,Tor Vergata Policlinico Tor Vergata, Servizio di Neurofisiopatologia, Centro di Medicina del Sonno, V.le Oxford 81, 00133 Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
Restless legs syndrome (RLS) is a common neurological disorder characterized by an urge to move the legs. The symptoms show a strong circadian rhythmicity, with onset or increase in the evening or at night; thus, sleep disturbances are the most frequent reason for patients seeking medical aid. The prevalence of the disorder increases strongly with age, with an estimated 9% to 20% of sufferers being among the elderly. Dopaminergic drugs are the first-line treatment option in RLS; opioids and anticonvulsants can also be used either as add-on or stand alone therapy options. Secondary forms of RLS and possible interaction with other medications require particular consideration in the elderly.
Collapse
|
42
|
Dauvilliers Y, Pennestri MH, Petit D, Dang-Vu T, Lavigne G, Montplaisir J. Periodic leg movements during sleep and wakefulness in narcolepsy. J Sleep Res 2007; 16:333-9. [PMID: 17716283 DOI: 10.1111/j.1365-2869.2007.00601.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objectives of the study were to measure the prevalence of periodic leg movements during NREM and REM sleep (PLMS) and while awake (PLMW) and to assess the impact of PLMS on nocturnal sleep and daytime functioning in patients with narcolepsy. One hundred and sixty-nine patients with narcolepsy and 116 normal controls matched for age and gender were included. Narcoleptics with high and low PLMS indices were compared to assess the impact of PLMS on sleep and Multiple Sleep Latency Test (MSLT) variables. More narcoleptics than controls had a PLMS index greater than 5 per hour of sleep (67% versus 37%) and an index greater than 10 (53% versus 21%). PLMS indices were higher both in NREM and REM sleep in narcoleptic patients, but the between-group difference was greater for REM sleep. A significant increase of PLMS index was also found with aging in both narcoleptic patients and controls. PLMW indices were also significantly higher in narcoleptic patients. Patients with an elevated index of PLMS had a higher percentage of stage 1 sleep, a lower percentage of REM sleep, a lower REM efficiency and a shorter MSLT latency. The present study demonstrates a high frequency of PLMS and PLMW in narcolepsy, an association between the presence of PLMS and measures of REM sleep and daytime functioning disruption. These results suggest that PLMS represent an intrinsic feature of narcolepsy.
Collapse
Affiliation(s)
- Yves Dauvilliers
- Department of Neurology, Hôpital Gui de Chauliac, INSERM U888, Université de Montpellier, Montpellier, France
| | | | | | | | | | | |
Collapse
|
43
|
Guggisberg AG, Hess CW, Mathis J. The significance of the sympathetic nervous system in the pathophysiology of periodic leg movements in sleep. Sleep 2007; 30:755-66. [PMID: 17580597 PMCID: PMC1978348 DOI: 10.1093/sleep/30.6.755] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Periodic leg movements in sleep (PLMS) are frequently accompanied by arousals and autonomic activation, but the pathophysiologic significance of these manifestations is unclear. DESIGN Changes in heart rate variability (HRV), HRV spectra, and electroencephalogram (EEG) spectra associated with idiopathic PLMS were compared with changes associated with isolated leg movements and respiratory-related leg movements during sleep. Furthermore, correlations between electromyographic activity, HRV changes, and EEG changes were assessed. SETTING Sleep laboratory. PATIENTS Whole-night polysomnographic studies of 24 subjects fulfilling the criteria of either periodic leg movements disorder (n = 8), obstructive sleep apnea syndrome (n = 7), or normal polysomnography (n = 9) were used. MEASUREMENTS AND RESULTS Spectral HRV changes started before all EEG changes and up to 6 seconds before the onset of all types of leg movements. An initial weak autonomic activation was followed by a sympathetic activation, an increase of EEG delta activity, and finally a progression to increased higher-frequency EEG rhythms. After movement onset, HRV indicated a vagal activation, and, the EEG, a decrease in spindle activity. Sympathetic activation, as measured by HRV spectra, was greater for PLMS than for all other movement types. In EEG, gamma synchronization began 1 to 2 seconds earlier for isolated leg movements and respiratory-related leg movements than for PLMS. Significant correlations were found between autonomic activations and electromyographic activity, as well as between autonomic activations and EEG delta activity, but not between higher-frequency EEG rhythms and EMG activity or HRV changes. CONCLUSIONS These results suggest a primary role of the sympathetic nervous system in the generation of PLMS.
Collapse
Affiliation(s)
- Adrian G Guggisberg
- Center of Sleep Medicine, Department of Neurology, University of Berne, Inselspital, Bern, Switzerland.
| | | | | |
Collapse
|
44
|
Ferri R, Zucconi M, Rundo F, Spruyt K, Manconi M, Ferini-Strambi L. Heart rate and spectral EEG changes accompanying periodic and non-periodic leg movements during sleep. Clin Neurophysiol 2007; 118:438-48. [PMID: 17140849 DOI: 10.1016/j.clinph.2006.10.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 09/18/2006] [Accepted: 10/08/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the changes in heart rate (HR) and EEG spectra accompanying periodic (PLM) and non-periodic leg movements (NPLM) during sleep in patients with restless legs syndrome (RLS). METHODS Sixteen patients with RLS underwent one polysomnographic night recording; leg movements (LMs) during sleep were detected and classified as PLM or NPLM; up to 10 PLM and NPLM were chosen from NREM and REM sleep, for each patient and for each type (mono- or bilateral). EEG spectral analysis and HR were evaluated for 20s preceding and 30s following the onset of each LM. RESULTS EEG activation preceded LMs, particularly in the delta band which increased before the other frequency bands, in NREM sleep but not in REM sleep for PLM, and in both stages for NPLM. A similar difference was seen between mono- and bilateral LMs. CONCLUSIONS Sleep EEG, HR, and leg motor activity seems to be modulated by a complex dynamically interacting system of cortical and subcortical mechanisms, which influence each other. SIGNIFICANCE Future studies on the clinical significance of leg motor events during sleep need to take into account events classifiable as "isolated" and to integrate the autonomic and EEG changes accompanying them.
Collapse
Affiliation(s)
- Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute (IRCCS), 94018 Troina, Italy.
| | | | | | | | | | | |
Collapse
|
45
|
Hornyak M, Feige B, Riemann D, Voderholzer U. Periodic leg movements in sleep and periodic limb movement disorder: prevalence, clinical significance and treatment. Sleep Med Rev 2006; 10:169-77. [PMID: 16762807 DOI: 10.1016/j.smrv.2005.12.003] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Periodic leg movements in sleep (PLMS) are a frequent finding in polysomnography. The prevalence of PLMS is estimated to be 4-11% in adults. In childhood, PLMS rarely occur although medical conditions like sleep apnea syndrome or neuropsychiatric disorders can lead to high rates of PLMS. In the elderly, PLMS are also common in subjects without sleep disturbances. In sleep studies, PLMS are found most frequently in restless legs syndrome (RLS) and often occur in narcolepsy, sleep apnea syndrome and REM sleep behavior disorder. Some patients with otherwise unexplained insomnia or hypersomnia reveal an elevated number of PLMS, a condition defined as periodic limb movement disorder (PLMD). PLMS were found also in various medical and neurological disorders that do not primarily affect sleep. A summary of these is presented. In sleep disorders related to dopaminergic dysfunction such as RLS, PLMS are considered to be a symptom of the disease. In other disorders like primary insomnia, the clinical relevance of PLMS is still being controversially discussed. Studies with findings both pro and contra are referred. To date, only a few studies have evaluated the efficacy of therapeutic substances in reducing PLMS in PLMD patients. Their results need to be confirmed in controlled randomized trials.
Collapse
Affiliation(s)
- Magdolna Hornyak
- Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Hauptstrasse 5, D-79104 Freiburg, Germany.
| | | | | | | |
Collapse
|
46
|
Montplaisir J, Michaud M, Petit D. New trends in restless legs syndrome research. Sleep Med Rev 2006; 10:147-51. [PMID: 16762805 DOI: 10.1016/j.smrv.2006.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
47
|
Bliwise DL. Periodic Leg Movements in Sleep and Restless Legs Syndrome: Considerations in Geriatrics. Sleep Med Clin 2006; 1:263-271. [PMID: 19881897 DOI: 10.1016/j.jsmc.2006.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Donald L Bliwise
- Program in Sleep, Aging and Chronobiology Department of Neurology Emory University Medical School Atlanta, Georgia
| |
Collapse
|
48
|
Mahowald MW. Does size or frequency really matter? Sleep Med 2006; 7:205-7. [PMID: 16564208 DOI: 10.1016/j.sleep.2006.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 01/16/2006] [Accepted: 01/16/2006] [Indexed: 12/01/2022]
|
49
|
Allen RP. The resurrection of periodic limb movements (PLM): Leg activity monitoring and the restless legs syndrome (RLS). Sleep Med 2005; 6:385-7. [PMID: 16103010 DOI: 10.1016/j.sleep.2005.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 05/31/2005] [Indexed: 10/25/2022]
|