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Mogavero MP, Antelmi E, Lanza G, Marelli S, Castelnuovo A, Tinazzi M, DelRosso LM, Silvestri R, Ferri R, Ferini Strambi L. Sex-based disparities in dopamine agonist response in patients with restless legs syndrome. J Sleep Res 2024:e14311. [PMID: 39160111 DOI: 10.1111/jsr.14311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/15/2024] [Accepted: 07/26/2024] [Indexed: 08/21/2024]
Abstract
This study aimed to investigate sex-related differences in the response to ropinirole and pramipexole in patients with restless legs syndrome (RLS). By analysing clinical parameters and polysomnographic (PSG) findings, we sought to elucidate the potential factors related to sex disparities modulating treatment responses and sleep quality in RLS. A total of 41 drug-free patients with RLS, aged ≥18 years, underwent two consecutive nocturnal PSG recordings, without medication at baseline; before the second night, 26 patients received an oral dose of 0.25 mg pramipexole whereas 15 received 0.5 mg ropinirole. After each PSG recording, patients self-evaluated the severity of their previous night symptoms by means of an ad hoc visual analogue scale (VAS). At baseline, sleep efficiency and percentage of Stage N2 tended to be higher in females while wakefulness after sleep onset was significantly higher in males. After treatment, total leg movements during sleep (LMS), periodic LMS (PLMS), and periodicity indexes were significantly lower in females than in males. The VAS score was lower after treatment in all patients, without differences between the two sexes. This study demonstrates a higher acute responsiveness of PLMS to dopamine agonists (pramipexole and ropinirole) in females than in males with RLS. These findings might be explained by differential sex-related expression of dopamine receptors, especially D3, within the central nervous system. In addition, our findings provide translational hints toward a better tailored and sex-specific approach to the treatment of RLS associated with PLMS, with dopamine agonist possibly associated with a better outcome in females than in males.
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Affiliation(s)
- Maria P Mogavero
- Vita-Salute San Raffaele University, Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Antelmi
- Neurology Unit, Parkinson Disease and Movement Disorders Division, AOUI, Verona, Italy
- DIMI Department of Engineering and Medicine of Innovation, University of Verona, Verona, Italy
| | - Giuseppe Lanza
- Clinical Neurophysiology Research Unit and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Sara Marelli
- Vita-Salute San Raffaele University, Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Castelnuovo
- Vita-Salute San Raffaele University, Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Michele Tinazzi
- Neurology Unit, Parkinson Disease and Movement Disorders Division, AOUI, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Rosalia Silvestri
- Sleep Medicine Center, UOSD of Neurophysiopathology and Movement Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Luigi Ferini Strambi
- Vita-Salute San Raffaele University, Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
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DelRosso LM, Picchietti DL, Sharon D, Spruyt K, Owens JA, Walters AS, Zucconi M, Ferri R. Periodic limb movement disorder in children: A systematic review. Sleep Med Rev 2024; 76:101935. [PMID: 38652932 DOI: 10.1016/j.smrv.2024.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/09/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
This systematic review evaluates the scientific literature on pediatric periodic limb movement disorder (PLMD), adhering to PRISMA guidelines and utilizing PICOS criteria. The search across PubMed, EMBASE, and Scopus yielded 331 articles, with 17 meeting inclusion criteria. Diagnostic criteria evolved, with polysomnography and PLMS index ≥5 required since 2003. Also, PLMD diagnosis mandates clinical consequences like insomnia, hypersomnia, and fatigue, excluding comorbidities causing sleep disruption. Prevalence in children is low (0.3%), emphasizing the need for meticulous investigation. Comorbidities, particularly the bidirectional relationship with ADHD, were explored. Challenges in diagnosis and understanding arise from overlapping conditions such as sleep disordered breathing, psychotropic medication, and criteria non-adherence. Despite generally good study quality, weaknesses include sample size justification and biases. The periodic leg movement index shows high sensitivity but low specificity, underscoring strict diagnostic criteria adherence. Diverse metrics for symptoms necessitate standardized approaches. Family history of RLS in children with PLMD suggests unexplored aspects. Treatment, mainly iron supplementation, lacks standardized assessment metrics. The review emphasizes diagnostic and treatment challenges, recommending unbiased studies with precise techniques. Comprehensive research, quantifying PLMS and objectively assessing sleep parameters, is crucial for advancing understanding in pediatric PLMD. PROSPERO REGISTRATION NUMBER: CRD42021251406.
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Affiliation(s)
| | - Daniel L Picchietti
- University of Illinois School of Medicine, Carle Illinois College of Medicine, and Carle Health, Urbana, IL, USA.
| | - Denise Sharon
- Pomona Valley Hospital and Medical Center, Claremont, CA, USA.
| | - Karen Spruyt
- Université de Paris, NeuroDiderot, INSERM, Paris, 75019, France.
| | - Judith A Owens
- Division of Neurology, Boston Children's Hospital, Harvard Medical School, Waltham, MA, USA.
| | - Arthur S Walters
- Division of Sleep Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Marco Zucconi
- Sleep Disorders Center, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Institute and Ospedale San Raffaele, Milan, Italy.
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy.
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Mogavero MP, Congiu P, Lanza G, Marelli S, Castelnuovo A, Puligheddu M, DelRosso LM, Ferini Strambi L, Ferri R. Large muscle group movements during sleep in restless leg syndrome: neurophysiological and clinical implications. Sleep 2024; 47:zsae113. [PMID: 38761118 PMCID: PMC11236943 DOI: 10.1093/sleep/zsae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/05/2024] [Indexed: 05/20/2024] Open
Abstract
STUDY OBJECTIVES Recently, criteria have been drawn up for large muscle group movements during sleep (LMM), defined as movements lasting for 3-45 seconds in adults, which are often accompanied by changes in sleep stage, arousals, and increases in heart rate. The aim of this study was to characterize LMM in restless legs syndrome (RLS) in order to better evaluate their impact on the neurophysiology of the disorder and, therefore, the possible clinical implications. METHODS Consecutive, drug-free patients diagnosed with RLS and controls, aged 18 years or more, were retrospectively enrolled. Leg movement activity-short-interval (SILMS), periodic (PLMS), and isolated (ISOLMS) leg movements during sleep-and LMM were detected and scored. RESULTS In total, 100 patients and 67 controls were recruited. All movement measures were significantly higher in RLS. A significant positive correlation was found between LMM and ISOLMS index but not PLMS index in both groups. LMM index showed a significant negative correlation with total sleep time, sleep efficiency, and percentage of sleep stages N3 and R, as well as a significant positive correlation with the number of awakenings, and percentage of sleep stages N1 and N2 only in patients with RLS. No significant correlation was found between either LMM or PLMS index and RLS severity. CONCLUSIONS Different types of movements, including SILMS, ISOLMS, and LMM, play somewhat distinct roles in sleep neurophysiology in RLS. Notably, LMM, a newly recognized category of movements, demonstrates associations with sleep architecture instability and fragmentation, arousals, and awakenings, suggesting potential clinical implications.
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Affiliation(s)
- Maria P Mogavero
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Congiu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Giuseppe Lanza
- Clinical Neurophysiology Research Unit and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Sara Marelli
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Castelnuovo
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, Sleep Disorder Research Center, University of Cagliari, Cagliari, Italy
| | - Lourdes M DelRosso
- Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA
| | - Luigi Ferini Strambi
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
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Mogavero MP, DelRosso LM, Lanza G, Bruni O, Ferini Strambi L, Ferri R. The dynamics of cyclic-periodic phenomena during non-rapid and rapid eye movement sleep. J Sleep Res 2024:e14265. [PMID: 38853262 DOI: 10.1111/jsr.14265] [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: 04/26/2024] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
Sleep is a complex physiological state characterized by distinct stages, each exhibiting unique electroencephalographic patterns and physiological phenomena. Sleep research has unveiled the presence of intricate cyclic-periodic phenomena during both non-rapid eye movement and rapid eye movement sleep stages. These phenomena encompass a spectrum of rhythmic oscillations and periodic events, including cyclic alternating pattern, periodic leg movements during sleep, respiratory-related events such as apneas, and heart rate variability. This narrative review synthesizes empirical findings and theoretical frameworks to elucidate the dynamics, interplay and implications of cyclic-periodic phenomena within the context of sleep physiology. Furthermore, it invokes the clinical relevance of these phenomena in the diagnosis and management of sleep disorders.
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Affiliation(s)
- Maria P Mogavero
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy
| | | | - Giuseppe Lanza
- Oasi Research Institute-IRCCS, Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Luigi Ferini Strambi
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy
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Mogavero MP, Ferri R, Marelli S, Lanza G, Terzaghi M, Castelnuovo A, DelRosso LM, Schenck CH, Ferini‐Strambi L. Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches? CNS Neurosci Ther 2024; 30:e14569. [PMID: 38421131 PMCID: PMC10850928 DOI: 10.1111/cns.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/06/2023] [Accepted: 12/02/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS Although clonazepam (CLO) and melatonin (MLT) are the most frequently used treatments for REM sleep behavior disorder, the polysomnographic features associated with their use are little known. The aim of this study was to evaluate polysomnographic and clinical parameters of patients with idiopathic/isolated REM sleep behavior disorder (iRBD) treated chronically with CLO, sustained-release MLT, alone or in combination, and in a group of drug-free iRBD patients. METHODS A total of 96 patients were enrolled: 43 drug-free, 21 with CLO (0.5-2 mg), 20 with sustained-release MLT (1-4 mg), and 12 taking a combination of them (same doses). Clinical variables and polysomnography were collected. RESULTS Although clinical improvement was reported in all groups, MLT impacted sleep architecture more than the other treatments, with significant and large increase in N3 stage, moderate reduction in N2 and REM sleep, and moderate increase in REM latency. CLO moderately increased the percentage of both REM sleep and especially N2, while reducing N1 and wakefulness. Patients treated with both CLO and MLT did not show major changes in sleep architecture. CONCLUSION These results suggest that the administration of MLT or CLO impacts (positively) on sleep parameters of iRBD patients. However, there is a need to better stratify patients, in order to treat them in a targeted manner, depending on the patient's individual sleep architecture and expected differential effects of these agents.
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Affiliation(s)
- Maria P. Mogavero
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| | - Raffaele Ferri
- Sleep Research Centre and Clinical Neurophysiology Research UnitOasi Research Institute – IRCCSTroinaItaly
| | - Sara Marelli
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| | - Giuseppe Lanza
- Sleep Research Centre and Clinical Neurophysiology Research UnitOasi Research Institute – IRCCSTroinaItaly
- Department of Surgery and Medical‐Surgical SpecialtiesUniversity of CataniaCataniaItaly
| | - Michele Terzaghi
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Unit of Sleep Medicine and EpilepsyIRCCS Mondino FoundationPaviaItaly
| | - Alessandra Castelnuovo
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| | | | - Carlos H. Schenck
- Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical CenterUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Luigi Ferini‐Strambi
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
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Marchi NA, Peci A, Haba-Rubio J, Solelhac G, Bayon V, Berger M, Vollenweider P, Marques-Vidal P, von Gunten A, Strippoli MPF, Preisig M, Draganski B, Heinzer R. Periodic leg movements during sleep and cognitive functioning in the older general population. Sleep Med 2023; 109:197-201. [PMID: 37473717 DOI: 10.1016/j.sleep.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The current evidence of a relationship between periodic leg movements during sleep (PLMS) and cognitive functioning is limited and inconsistent. This cross-sectional study assessed associations between PLMS and cognitive functioning among community-dwelling older adults. METHODS We included community-dwelling older adults who underwent a polysomnography and a cognitive assessment. The PLMS index (PLMI) and PLMS arousal index (PLMAI) were categorized into tertiles: PLMI <5/h (reference), 5-29.9/h, ≥30/h; and PLMAI <1/h (reference), 1-4.9/h, ≥5/h. The cognitive assessment consisted of ten scores covering the main cognitive domains: global cognition, processing speed, executive function, language, episodic verbal memory, and visuospatial function. Associations between PLMI, PLMAI, and cognitive scores were assessed using regression unadjusted and adjusted models. RESULTS A total of 579 individuals without dementia were included (mean age: 71.5 ± 4.4 years; men 45.4%). The number of participants in the high-PLMI categories, 5-29.9/h and ≥30/h, was 185 (32.0%) and 171 (29.5%), respectively. Participants in the high-PLMI categories showed no significant difference compared to the reference group regarding their cognitive performance according to the unadjusted and adjusted models. Similarly, we found no association between PLMAI severity and cognitive functioning. CONCLUSIONS This study shows no cross-sectional association between PLMS severity and cognitive functioning among community-dwelling older adults. However, given the paucity of data in this field, further studies are needed to clarify the relationship between PLMS and cognitive functioning.
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Affiliation(s)
- Nicola Andrea Marchi
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada; Department of Psychology, Université de Montréal, Montréal, Canada.
| | - Arton Peci
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Geoffroy Solelhac
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Virginie Bayon
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathieu Berger
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; URP 7330 VIFASOM, Université Paris-Cité, Paris, France; Centre du Sommeil et de la vigilance, Hôtel Dieu, APHP, Paris, France; Sainbiose Laboratory, Inserm U1059, University of Saint-Etienne, France
| | - Peter Vollenweider
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Pierre Françoise Strippoli
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Martin Preisig
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Riccardi S, Ferri R, Garbazza C, Miano S, Manconi M. Pharmacological responsiveness of periodic limb movements in patients with restless legs syndrome: a systematic review and meta-analysis. J Clin Sleep Med 2023; 19:811-822. [PMID: 36692194 PMCID: PMC10071388 DOI: 10.5664/jcsm.10440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES Periodic limb movements during sleep (PLMS) are a frequent finding in restless legs syndrome, but their impact on sleep is still debated, as well the indication for treatment. We systematically reviewed the available literature to describe which drug categories are effective in suppressing PLMS, assessing their efficacy through a meta-analysis, when this was possible. METHODS The review protocol was preregistered on PROSPERO (CRD42021175848), and the systematic search was conducted on and EMBASE (last searched on March 2020). We included original human studies, which assessed PLMS modification on drug treatment with a full-night polysomnography, through surface electrodes on each tibialis anterior muscle. When at least 4 studies were available on the same drug or drug category, we performed a random-effect model meta-analysis. RESULTS Dopamine agonists like pramipexole and ropinirole resulted the most effective, followed by l-dopa and other dopamine agonists. Alpha2delta ligands are moderately effective as well opioids, despite available data on these drugs are much more limited than those on dopaminergic agents. Valproate and carbamazepine did not show a significant effect on PLMS. Clonazepam showed contradictory results. Perampanel and dypiridamole showed promising but still insufficient data. The same applies to iron supplementation. CONCLUSIONS Dopaminergic agents are the most powerful suppressors of PLMS. However, most therapeutic trials in restless legs syndrome do not report objective polysomnographic findings, there is a lack of uniformity in presenting results on PLMS. Longitudinal polysomnographic interventional studies, using well-defined and unanimous scoring criteria and endpoints on PLMS are needed. CITATION Riccardi S, Ferri R, Garbazza C, Miano S, Manconi M. Pharmacological responsiveness of periodic limb movements in patients with restless legs syndrome: a systematic review and meta-analysis. J Clin Sleep Med. 2023;19(4):811-822.
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Affiliation(s)
- Silvia Riccardi
- Sleep Medicine Unit, Regional Hospital of Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Raffaele Ferri
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Corrado Garbazza
- Sleep Medicine Unit, Regional Hospital of Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Regional Hospital of Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Regional Hospital of Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland
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Zhang H, Zhang Y, Ren R, Yang L, Shi Y, Vitiello MV, Sanford LD, Tang X. Polysomnographic features of idiopathic restless legs syndrome: a systematic review and meta-analysis of 13 sleep parameters and 23 leg movement parameters. J Clin Sleep Med 2022; 18:2561-2575. [PMID: 35903949 PMCID: PMC9622979 DOI: 10.5664/jcsm.10160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVES This study aims to explore the polysomnographically measured sleep and leg movement differences between idiopathic restless legs syndrome (RLS) patients and healthy controls. METHODS An electronic literature search was conducted in EMBASE, MEDLINE, all EBM databases, CINAHL, and PsycINFO. Only observational case-control studies were included in the meta-analysis. The differences in 13 sleep parameters and 23 leg movement parameters between RLS patients and healthy controls were explored. RESULTS Thirty-eight studies were identified for systematic review, 31 of which were used for meta-analysis. Meta-analyses revealed significant reductions in total sleep time, sleep efficiency, stage N2 and rapid eye movement (REM) sleep percentages, and increases in wake time after sleep onset, stage shifts per hour, stage N1 percentage, REM latency, arousal index, and apnea-hypopnea index. Some leg movement parameters, such as periodic limb movement during sleep (PLMS) index, PLMS sequence duration, number of PLMS sequence, and periodicity index, were higher in RLS patients compared with healthy controls. Further, our meta-analysis revealed a higher PLMS index during non-REM sleep compared with that during REM sleep. CONCLUSIONS RLS patients manifest a lightening of sleep, increased sleep fragmentation, and greater sleep-related breathing disruption and limb movements during sleep relative to healthy normal individuals. The distributions of PLMS during a night's sleep may provide more information to clarify the specific characteristics of leg movements in RLS. PLMS in RLS are concentrated in non-REM sleep. The periodicity index may be a more sensitive and specific marker of RLS than the PLMS index. CITATION Zhang H, Zhang Y, Ren R, et al. Polysomnographic features of idiopathic restless legs syndrome: a systematic review and meta-analysis of 13 sleep parameters and 23 leg movement parameters. J Clin Sleep Med. 2022;18(11):2561-2575.
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Affiliation(s)
- Haipeng Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V. Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Larry D. Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, Virginia
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Wang T, Xu J, Xu Q, Zhao R, Pan L, Zhu D, Pan Y, Chen L, Lou G, Xu X, Wang J, Zhang L. Peripheral Iron Metabolism is Associated with Leg Movements on Polysomnography but Not with the Severity of Restless Legs Syndrome or Its Impact on Patients. Nat Sci Sleep 2022; 14:1829-1842. [PMID: 36263372 PMCID: PMC9575586 DOI: 10.2147/nss.s378970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose This study investigated the associations of peripheral iron status with different manifestations of restless legs syndrome (RLS), including leg movements (LMs) on polysomnography (PSG), disease severity, and impact on patients. Patients and Methods In this cross-sectional study, 108 patients with RLS were enrolled at Sir Run Run Shaw Hospital's Center for Sleep Medicine. Demographic information, disease characteristics, RLS severity, and impact on patients were assessed through a semi-structured questionnaire. Peripheral iron indicators [serum ferritin, iron, and transferrin concentrations; unsaturated iron-binding capacity (UIBC) and total iron-binding capacity (TIBC); transferrin saturation (TSAT)] were measured following PSG to assess sleep stages, respiratory events, microarousals and LM parameters. Data from patients with and without ferritin concentration < 50 µg/L were compared in crude analyses, and Spearman correlations of other iron indicators with RLS data were examined. An ordinal logistic regression model was used to adjust for age, sex, body mass index, years of education, age at the time of RLS onset, prior treatment (yes/no), C-reactive protein (CRP)/hemoglobin level, total sleep time and apnea-hypopnea index. Results Multivariate analysis showed that periodic LMs during sleep (PLMS) and other LM parameters were significantly associated with a ferritin concentration < 50 µg/L, UIBC, TIBC, and serum transferrin concentration, but not serum iron or TSAT. By contrast, the severity and impact of RLS were not associated with a ferritin concentration < 50 µg/L or other peripheral iron indicators in the multivariate model. Conclusion In this study, peripheral iron status was associated mainly with motor components (LMs on PSG) rather than sensory components (severity and impact of RLS) after adequately controlling for potential confounders, such as CRP and hemoglobin levels. Commonly used peripheral iron metabolism indicators may therefore not be ideal biomarkers of RLS severity or impact on patients.
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Affiliation(s)
- Tiantian Wang
- Department of Pharmacy, Xiasha Campus, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Science, Zhejiang University, Hangzhou, People’s Republic of China
| | - Jiahui Xu
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Qinglin Xu
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Rui Zhao
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Liuqing Pan
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Danyan Zhu
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Science, Zhejiang University, Hangzhou, People’s Republic of China
| | - Yu Pan
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Lehui Chen
- Department of Internal Medicine, Hangzhou Wuyunshan Hospital, Hangzhou, People’s Republic of China
| | - Guodong Lou
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xiaoye Xu
- Department of Nursing, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Jin Wang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Lisan Zhang
- Department of Neurology/Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
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10
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Italia M, Danani A, Dercole F, Ferri R, Manconi M. A calibrated model with a single-generator simulating polysomnographically recorded periodic leg movements. J Sleep Res 2022; 31:e13567. [PMID: 35187745 PMCID: PMC9787571 DOI: 10.1111/jsr.13567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/30/2022]
Abstract
The aim of this study was to assess, with numerical simulations, if the complex mechanism of two (or more) interacting spinal/supraspinal structures generating periodic leg movements can be modelled with a single-generator approach. For this, we have developed the first phenomenological model to generate periodic leg movements in-silico. We defined the onset of a movement in one leg as the firing of a neuron integrating excitatory and inhibitory inputs from the central nervous system, while the duration of the movement was defined in accordance to statistical evidence. For this study, polysomnographic leg movement data from 32 subjects without periodic leg movements and 65 subjects with periodic leg movements were used. The proportion of single-leg and double-leg inputs, as well as their strength and frequency, were calibrated on the without periodic leg movements dataset. For periodic leg movements subjects, we added a periodic excitatory input common to both legs, and the distributions of the generator period and intensity were fitted to their dataset. Besides the many simplifying assumptions - the strongest being the stationarity of the generator processes during sleep - the model-simulated data did not differ significantly, to a large extent, from the real polysomnographic data. This represents convincing preliminary support for the validity of our single-generator model for periodic leg movements. Future model extensions will pursue the ambitious project of a supportive diagnostic and therapeutic tool, helping the specialist with realistic forecasting, and with cross-correlations and clustering with other patient meta-data.
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Affiliation(s)
- Matteo Italia
- Department of Electronics, Information, and BioengineeringPolitecnico di MilanoMilanItaly
| | - Andrea Danani
- Dalle Molle Institute for Artificial IntelligenceUniversity of Southern SwitzerlandUniversity of Applied Science and Arts of Southern SwitzerlandLuganoSwitzerland
| | - Fabio Dercole
- Department of Electronics, Information, and BioengineeringPolitecnico di MilanoMilanItaly
| | | | - Mauro Manconi
- Sleep Medicine UnitNeurocenter of Southern SwitzerlandOspedale CivicoLuganoSwitzerland
- Faculty of Biomedical SciencesUniversita della Svizzera ItalianaLuganoSwitzerland
- Department of NeurologyUniversity HospitalInselspitalBernSwitzerland
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11
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Khachatryan SG, Ferri R, Fulda S, Garcia‐Borreguero D, Manconi M, Muntean M, Stefani A. Restless legs syndrome: Over 50 years of European contribution. J Sleep Res 2022; 31:e13632. [PMID: 35808955 PMCID: PMC9542244 DOI: 10.1111/jsr.13632] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterised by an urge to move the limbs with a circadian pattern (occurring in the evening/at night), more prominent at rest, and relieved with movements. RLS is one of the most prevalent sleep disorders, occurring in 5%-10% of the European population. Thomas Willis first described RLS clinical cases already in the 17th century, and Karl-Axel Ekbom described the disease as a modern clinical entity in the 20th century. Despite variable severity, RLS can markedly affect sleep (partly through the presence of periodic leg movements) and quality of life, with a relevant socio-economic impact. Thus, its recognition and treatment are essential. However, screening methods present limitations and should be improved. Moreover, available RLS treatment options albeit providing sustained relief to many patients are limited in number. Additionally, the development of augmentation with dopamine agonists represents a major treatment problem. A better understanding of RLS pathomechanisms can bring to light novel treatment possibilities. With emerging new avenues of research in pharmacology, imaging, genetics, and animal models of RLS, this is an interesting and constantly growing field of research. This review will update the reader on the current state of RLS clinical practice and research, with a special focus on the contribution of European researchers.
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Affiliation(s)
- Samson G. Khachatryan
- Department of Neurology and NeurosurgeryNational Institute of HealthYerevanArmenia
- Sleep Disorders CenterSomnus Neurology ClinicYerevanArmenia
| | | | - Stephany Fulda
- Sleep Medicine UnitNeurocenter of Southern Switzerland, Ospedale CivicoLuganoSwitzerland
| | | | - Mauro Manconi
- Sleep Medicine UnitNeurocenter of Southern Switzerland, Ospedale CivicoLuganoSwitzerland
- Department of NeurologyUniversity HospitalInselspitalBernSwitzerland
| | - Maria‐Lucia Muntean
- Center for Parkinson's Disease and Movement DisordersParacelsus‐Elena KlinikKasselGermany
| | - Ambra Stefani
- Sleep Disorders Clinic, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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12
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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.
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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
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13
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Ferri R, Sparasci D, Castelnovo A, Miano S, Tanioka K, Tachibana N, Carelli C, Riccitelli GC, Disanto G, Zecca C, Gobbi C, Manconi M. Leg movement activity during sleep in multiple sclerosis with and without restless legs syndrome. J Clin Sleep Med 2022; 18:11-20. [PMID: 34216201 PMCID: PMC8807912 DOI: 10.5664/jcsm.9466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To carry out an analysis of leg movement activity during sleep in a polysomnography dataset of patients with multiple sclerosis (MS) in comparison to idiopathic restless legs syndrome (iRLS) and healthy controls. METHODS In this cross-sectional, observational, instrumental study, 57 patients (males/females: 11/46; mean age 46.2 ± 10.2 years) with a diagnosis of MS underwent a telephone interview assessing the 5 standard diagnostic criteria for RLS and polysomnography. Sleep architecture and leg movement activity during sleep were subsequently compared: 1) 40 patients with MS without RLS (MS-RLS) vs 28 healthy controls; 2) 17 patients with MS with RLS (MS+RLS) vs 35 patients with iRLS; 3) MS+RLS vs MS-RLS. RESULTS MS-RLS and MS+RLS presented increased sleep latency, percentage of sleep stage N1, and reduced total sleep time compared to healthy controls and iRLS, respectively. The periodic limb movements during sleep (PLMS) index was higher in MS-RLS than in healthy controls (P = .035) and lower in MS+RLS compared to iRLS (P = .024). PLMS in MS+RLS were less periodic, less often bilateral, and with shorter single movements compared to the typical PLMS in iRLS. CONCLUSIONS MS is a risk factor for RLS, PLMS, and for a lower sleep quality in comparison to healthy patients. PLMS in MS+RLS are fewer and shorter if compared to iRLS. Our results suggest a dissociation between motor (PLMS) and sensory symptoms (RLS sensory component) in RLS secondary to MS, with possible treatment implications. CITATION Ferri R, Sparasci D, Castelnovo A, et al. Leg movement activity during sleep in multiple sclerosis with and without restless legs syndrome. J Clin Sleep Med. 2022;18(1):11-20.
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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
| | - Davide Sparasci
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Kosuke Tanioka
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naoko Tachibana
- Division of Sleep Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan
| | - Chiara Carelli
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Gianna Carla Riccitelli
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
- Neuropsychology and Behavioural Neurology Research Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Giulio Disanto
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Chiara Zecca
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Claudio Gobbi
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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14
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Ferri R, Mogavero MP, Bruni O, Picchietti DL, Kapoor V, Del Rosso LM. Leg Movements during Sleep in Children Treated with Serotonergic Antidepressants. Sleep 2021; 45:6372262. [PMID: 34536283 DOI: 10.1093/sleep/zsab236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To evaluate leg movements during sleep (LMS) in children taking serotonergic antidepressants, compared to those of children with restless legs syndrome (RLS) and controls, and to assess the time structure of intermovement intervals (IMI). METHODS Twenty-three children (12 girls, mean age 14.1 years) on antidepressants and with a total LMS index ≥15/hour, 21 drug-naïve RLS children (11 girls, mean age 13.6 years) also with total LMS index ≥15/hour, and 35 control children (17 girls, mean age 14.3 years) were recruited. LMS were scored and a series of parameters was calculated, along with the analysis of their time structure. RESULTS Children taking antidepressants showed higher total and periodic LMS (PLMS) indexes than both controls and RLS children, as well as higher short-interval and isolated LMS indexes than controls. LMS periodicity was highest in children on antidepressants. In children taking antidepressants, a well-defined PLMS IMI peak corresponding to ~10-60 s, with a maximum at ~20 s was present, which was much less evident in RLS patients and absent in controls. A progressive decrease of PLMS during the night and more frequent arousals were found in children on antidepressants and with RLS. CONCLUSIONS Children taking serotonergic antidepressants show higher periodicity LMS than children with RLS or controls and have a higher number of PLMS through the night. Antidepressant-associated PLMS in children seem to have features similar to PLMS of adults with RLS. Whether this is a marker of an increased risk to develop RLS later in life needs to be determined.
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Affiliation(s)
- Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Research Institute - IRCCS, Troina, Italy
| | - Maria P Mogavero
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Daniel L Picchietti
- University of Illinois School of Medicine, Carle Illinois College of Medicine, and Carle Foundation Hospital, Urbana, IL, USA
| | - Vidhi Kapoor
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
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15
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REM sleep behavior disorder: Mimics and variants. Sleep Med Rev 2021; 60:101515. [PMID: 34186416 DOI: 10.1016/j.smrv.2021.101515] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia with dream-enactment behaviors occurring during REM sleep and associated with the lack of the physiological REM sleep muscle atonia. It can be isolated and secondary to other neurological or medical conditions. Isolated RBD heralds in most cases a neurodegenerative condition due to an underlying synucleinopathy and consequently its recognition is crucial for prognostic implications. REM sleep without atonia on polysomnography is a mandatory diagnostic criterion. Different conditions may mimic RBD, the most frequent being obstructive sleep apnea during sleep, non-REM parasomnia, and sleep-related hypermotor epilepsy. These diseases might also be comorbid with RBD, challenging the evaluation of disease severity, the treatment choices and the response to treatment evaluation. Video-PSG is the gold standard for a correct diagnosis and will distinguish between different or comorbid sleep disorders. Careful history taking together with actigraphy may give important clues for the differential diagnosis. The extreme boundaries of RBD might also be seen in more severe and complex conditions like status dissociatus or in the sleep disorders' scenario of anti IgLON5 disease, but in the latter both clinical and neurophysiological features will differ. A step-by-step approach is suggested to guide the differential diagnosis.
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16
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Abstract
Periodic leg movements during sleep (PLMS) are a frequent finding in nocturnal sleep registrations that include tibialis anterior electromyographic signals. Different PLMS scoring rules exist and can have a major impact on PLMS frequency, which tends to be underappreciated. There is no consistent evidence that frequent PLMS are a causal risk factor for clinically significant outcomes. Several critical open questions are identified that need to be addressed, including but not limited to the consideration of the full range of all sleep-related leg movement activity.
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Affiliation(s)
- Stephany Fulda
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Via Tesserete 46, Lugano 6900, Switzerland.
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17
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Abstract
Propriospinal myoclonus (PSM) consists of paroxysmal and sudden jerks involving axial flexion trunk and hip muscles, conditioning sudden myoclonias of the trunk and arms/limbs, both spontaneous and triggered by sensory stimulations, emerging in relaxed wakefulness typically during the transition between wake and sleep. Generally, PSM originates from a thoracic myelomere and spreads caudally and rostrally, provoking flexion and/or extension movements, leading to jumps or trunk jerks. They appear triggered by the lying-down position and disappear when the subject stands up. The main consequences are the difficulties in sleep start and the reappearance during the period of wakefulness after sleep onset.
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Affiliation(s)
- Marco Zucconi
- Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Hospital, Via Stamira d'Ancona, 20, Milan 20127, Italy.
| | - Francesca Casoni
- Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Hospital, Via Stamira d'Ancona, 20, Milan 20127, Italy
| | - Andrea Galbiati
- Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Hospital, Via Stamira d'Ancona, 20, Milan 20127, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, Neurologic Unit, Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, IRCCS San Raffaele Hospital, Università Vita-Salute San Raffaele, Milan, Italy
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18
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Zhang Y, Ren R, Yang L, Zhang H, Shi Y, Sanford LD, Tang X. Polysomnographic nighttime features of narcolepsy: A systematic review and meta-analysis. Sleep Med Rev 2021; 58:101488. [PMID: 33934047 DOI: 10.1016/j.smrv.2021.101488] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 02/08/2023]
Abstract
Polysomnographic studies have been conducted to explore nighttime sleep features in narcolepsy, but their relationship to narcolepsy is still imperfectly understood. We conducted a systematic review of the literature exploring polysomnographic differences between narcolepsy patients and healthy controls (HCs) in EMBASE, MEDLINE, All EBM databases, CINAHL, and PsycINFO. 108 studies were identified for this review, 105 of which were used for meta-analysis. Meta-analyses revealed significant reductions in sleep latency, sleep efficiency, slow wave sleep percentage, rapid eye movement sleep (REM) latency, cyclic alternating pattern rate, and increases in total sleep time, wake time after sleep onset (WASO), awakening numbers (AWN) per hour, stage shift (SS) per hour, N1 percentage, apnea hypopnea index, and periodic limb movement index in narcolepsy patients compared with HCs. Furthermore, narcolepsy type 1 patients showed more disturbed nighttime sleep compared with narcolepsy type 2 patients. Children and adolescent narcolepsy patients show increased WASO, AWN, and SS compared with adult patients. Macro- and micro-structurally, our study suggests that narcolepsy patients have poor nighttime sleep. Sex, age, body mass index, disease duration, disease type, medication status, and adaptation night are demographic, clinical and methodological factors that contribute to heterogeneity between studies.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Haipeng Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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19
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Schipper MH, Alvarez-Estevez D, Jellema K, Verbraecken J, Fulda S, Rijsman RM. Sleep-related leg movements in obstructive sleep apnea: definitions, determinants, and clinical consequences. Sleep Med 2020; 75:131-140. [DOI: 10.1016/j.sleep.2020.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/01/2022]
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20
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Zhang Y, Ren R, Yang L, Sanford LD, Tang X. Polysomnographically measured sleep changes in idiopathic REM sleep behavior disorder: A systematic review and meta-analysis. Sleep Med Rev 2020; 54:101362. [PMID: 32739826 DOI: 10.1016/j.smrv.2020.101362] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
Abstract
Polysomnographic studies conducted to explore sleep changes in idiopathic rapid eye movement sleep behavior disorder (iRBD) have not established clear relationships between sleep disturbances and iRBD. To explore the polysomnographic differences between iRBD patients and healthy controls and their associated factors, an electronic literature search was conducted in EMBASE, MEDLINE, All EBM databases, CINAHL, and PsycINFO inception to December 2019.34 studies were identified for systematic review, 33 of which were used for meta-analysis. Meta-analyses revealed significant reductions in total sleep time (SMD = -0.212, 95%CI: -0.378 to -0.046), sleep efficiency (SMD = -0.194, 95%CI: -0.369 to -0.018), apnea hypopnea index (SMD = -0.440, 95%CI: -0.780 to -0.101), and increases in sleep latency (SMD = 0.340, 95%CI: 0.074 to 0.606), and slow wave sleep (SMD = 0.294, 95%CI: 0.064 to 0.523) in iRBD patients compared with controls. Furthermore, electroencephalogram frequency components during REM sleep were altered in iRBD patients compared with controls; however, the specific changes could not be determined. Our findings suggest that polysomnographic sleep is abnormal in iRBD patients. Further studies are needed on underlying mechanisms and associations with neurodegenerative diseases.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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Athavale Y, Krishnan S, Raissi A, Kirolos N, Jairam T, Murray BJ, Boulos MI. Actigraphic detection of periodic limb movements: development and validation of a potential device-independent algorithm. A proof of concept study. Sleep 2020; 42:5518328. [PMID: 31194873 DOI: 10.1093/sleep/zsz117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/06/2019] [Indexed: 12/15/2022] Open
Abstract
STUDY OBJECTIVES We propose a unique device-independent approach to analyze long-term actigraphy signals that can accurately quantify the severity of periodic limb movements in sleep (PLMS). METHODS We analyzed 6-8 hr of bilateral ankle actigraphy data for 166 consecutively consenting patients who simultaneously underwent routine clinical polysomnography. Using the proposed algorithm, we extracted 14 time and frequency features to identify PLMS. These features were then used to train a Naïve-Bayes learning tool which permitted classification of mild vs. severe PLMS (i.e. periodic limb movements [PLM] index less than vs. greater than 15 per hr), as well as classification for four PLM severities (i.e. PLM index < 15, between 15 and 29.9, between 30 and 49.9, and ≥50 movements per hour). RESULTS Using the proposed signal analysis technique, coupled with a leave-one-out cross-validation method, we obtained a classification accuracy of 89.6%, a sensitivity of 87.9%, and a specificity of 94.1% when classifying a PLM index less than vs. greater than 15 per hr. For the multiclass classification for the four PLM severities, we obtained a classification accuracy of 85.8%, with a sensitivity of 97.6%, and a specificity of 84.8%. CONCLUSIONS Our approach to analyzing long-term actigraphy data provides a method that can be used as a screening tool to detect PLMS using actigraphy devices from various manufacturers and will facilitate detection of PLMS in an ambulatory setting.
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Affiliation(s)
- Yashodhan Athavale
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, Canada
| | - Sridhar Krishnan
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, Canada
| | - Afsaneh Raissi
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nardin Kirolos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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22
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Brain regions associated with periodic leg movements during sleep in restless legs syndrome. Sci Rep 2020; 10:1615. [PMID: 32005856 PMCID: PMC6994717 DOI: 10.1038/s41598-020-58365-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
The neural substrates related to periodic leg movements during sleep (PLMS) remain uncertain, and the specific brain regions involved in PLMS have not been evaluated. We investigated the brain regions associated with PLMS and their severity using the electroencephalographic (EEG) source localization method. Polysomnographic data, including electromyographic, electrocardiographic, and 19-channel EEG signals, of 15 patients with restless legs syndrome were analyzed. We first identified the source locations of delta-band (2–4 Hz) spectral power prior to the onset of PLMS using a standardized low-resolution brain electromagnetic tomography method. Next, correlation analysis was conducted between current densities and PLMS index. Delta power initially and most prominently increased before leg movement (LM) onset in the PLMS series. Sources of delta power at −4~−3 seconds were located in the right pericentral, bilateral dorsolateral prefrontal, and cingulate regions. PLMS index was correlated with current densities at the right inferior parietal, temporoparietal junction, and middle frontal regions. In conclusion, our results suggest that the brain regions activated before periodic LM onset or associated with their severity are the large-scale motor network and provide insight into the cortical contribution of PLMS pathomechanism.
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23
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Garbazza C, Hackethal S. Measuring and interpreting periodic leg movements during sleep: easy does it. Sleep 2019; 42:5535524. [DOI: 10.1093/sleep/zsz155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Corrado Garbazza
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Sandra Hackethal
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
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24
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Ferri R, DelRosso LM, Silvani A, Cosentino FII, Picchietti DL, Mogavero P, Manconi M, Bruni O. Peculiar lifespan changes of periodic leg movements during sleep in restless legs syndrome. J Sleep Res 2019; 29:e12896. [DOI: 10.1111/jsr.12896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Raffaele Ferri
- Department of Neurology I.C. Sleep Research Centre Oasi Research Institute ‐ IRCCS Troina Italy
| | - Lourdes M. DelRosso
- Seattle Children's Hospital Seattle WA USA
- University of California San Francisco CA USA
- Benioff Children's Hospital OaklandCA USA
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
| | | | - Daniel L. Picchietti
- University of IllinoisSchool of Medicine and Carle Foundation HospitalUrbana IL USA
| | - Paola Mogavero
- Istituti Clinici Scientifici MaugeriIRCCSScientific Institute of Pavia Pavia Italy
| | - Mauro Manconi
- Faculty of Biomedical Sciences Department of Neurology Sleep and Epilepsy Center Neurocenter of Southern SwitzerlandCivic Hospital (EOC) of LuganoBern UniversityUniversità della Svizzera Italiana Lugano Switzerland
| | - Oliviero Bruni
- Department of Social and Developmental Psychology Sapienza University Rome Italy
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25
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Ferré S, Quiroz C, Rea W, Guitart X, García-Borreguero D. Adenosine mechanisms and hypersensitive corticostriatal terminals in restless legs syndrome. Rationale for the use of inhibitors of adenosine transport. PHARMACOLOGY OF RESTLESS LEGS SYNDROME (RLS) 2019; 84:3-19. [DOI: 10.1016/bs.apha.2018.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Szentkirályi A, Stefani A, Hackner H, Czira M, Teismann IK, Völzke H, Stubbe B, Gläser S, Ewert R, Penzel T, Fietze I, Young P, Högl B, Berger K. Prevalence and associated risk factors of periodic limb movement in sleep in two German population-based studies. Sleep 2018; 42:5248299. [DOI: 10.1093/sleep/zsy237] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/30/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- András Szentkirályi
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Heinz Hackner
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Maria Czira
- Institute for Sleep Medicine and Neuromuscular Disorders, Münster University Hospital, Münster, Germany
| | - Inga K Teismann
- Institute for Sleep Medicine and Neuromuscular Disorders, Münster University Hospital, Münster, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Beate Stubbe
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany
| | - Sven Gläser
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany
- Vivantes Klinikum Berlin Spandau, Department of Internal Medicine and Pulmonary Diseases, Berlin, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany
| | - Thomas Penzel
- Sleep Centre, University Hospital Charité Berlin, Berlin, Germany
| | - Ingo Fietze
- Sleep Centre, University Hospital Charité Berlin, Berlin, Germany
| | - Peter Young
- Institute for Sleep Medicine and Neuromuscular Disorders, Münster University Hospital, Münster, Germany
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
- Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany
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27
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Athavale Y, Krishnan S. A Device-Independent Efficient Actigraphy Signal-Encoding System for Applications in Monitoring Daily Human Activities and Health. SENSORS (BASEL, SWITZERLAND) 2018; 18:E2966. [PMID: 30200566 PMCID: PMC6165564 DOI: 10.3390/s18092966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 12/02/2022]
Abstract
Actigraphs for personalized health and fitness monitoring is a trending niche market and fit aptly in the Internet of Medical Things (IoMT) paradigm. Conventionally, actigraphy is acquired and digitized using standard low pass filtering and quantization techniques. High sampling frequencies and quantization resolution of various actigraphs can lead to memory leakage and unwanted battery usage. Our systematic investigation on different types of actigraphy signals yields that lower levels of quantization are sufficient for acquiring and storing vital movement information while ensuring an increase in SNR, higher space savings, and in faster time. The objective of this study is to propose a low-level signal encoding method which could improve data acquisition and storage in actigraphs, as well as enhance signal clarity for pattern classification. To further verify this study, we have used a machine learning approach which suggests that signal encoding also improves pattern recognition accuracy. Our experiments indicate that signal encoding at the source results in an increase in SNR (signal-to-noise ratio) by at least 50⁻90%, coupled with a bit rate reduction by 50⁻80%, and an overall space savings in the range of 68⁻92%, depending on the type of actigraph and application used in our study. Consistent improvements by lowering the quantization factor also indicates that a 3-bit encoding of actigraphy data retains most prominent movement information, and also results in an increase of the pattern recognition accuracy by at least 10%.
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Affiliation(s)
- Yashodhan Athavale
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada.
| | - Sridhar Krishnan
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada.
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28
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Connecting clinical aspects to corticomotor excitability in restless legs syndrome: a TMS study. Sleep Med 2018; 49:105-112. [DOI: 10.1016/j.sleep.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/27/2018] [Accepted: 05/04/2018] [Indexed: 01/07/2023]
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29
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30
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Ferri R, DelRosso LM, Aricò D, Zucconi M, Ferini-Strambi L, Picchietti DL, Pizza F, Plazzi G, Manconi M, Bruni O. Leg movement activity during sleep in school-age children and adolescents: a detailed study in normal controls and participants with restless legs syndrome and narcolepsy type 1. Sleep 2018; 41:4818765. [DOI: 10.1093/sleep/zsy010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/23/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Lourdes M DelRosso
- University of California, San Francisco, CA
- Benioff Children’s Hospital Oakland, CA
| | | | - Marco Zucconi
- Department of Neurology, Sleep Disorders Center, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Neurology, Sleep Disorders Center, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Daniel L Picchietti
- University of Illinois School of Medicine and Carle Foundation Hospital, Urbana, IL
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
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31
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Ferri R, Silvani A, Rundo F, Zucconi M, Aricò D, Bruni O, Ferini-Strambi L, Manconi M. Data-driven approaches to define the upper limit of the intermovement interval of periodic leg movements during sleep. Sleep 2018; 41:4807239. [DOI: 10.1093/sleep/zsy008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/23/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | | | - Marco Zucconi
- Department of Neurology, Sleep Disorders Center, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | | | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Luigi Ferini-Strambi
- Department of Neurology, Sleep Disorders Center, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
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32
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Garbazza C, Sauter C, Paul J, Kollek J, Dujardin C, Hackethal S, Dorn H, Peter A, Hansen ML, Manconi M, Ferri R, Danker-Hopfe H. Leg Movement Activity During Sleep in Adults With Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2018; 9:179. [PMID: 29780335 PMCID: PMC5945883 DOI: 10.3389/fpsyt.2018.00179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM) activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD) compared to healthy controls. Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of "periodicity," i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI) and the periodic leg movement during sleep arousal index (PLMSAI). Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires. Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL), a longer duration of the periodic leg movements during sleep (PLMS) in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients. Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.
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Affiliation(s)
- Corrado Garbazza
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany.,Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Cornelia Sauter
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Juliane Paul
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Jenny Kollek
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Catharine Dujardin
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Sandra Hackethal
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Hans Dorn
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Anita Peter
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Marie-Luise Hansen
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Heidi Danker-Hopfe
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
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33
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Fulda S, Heinzer R, Haba-Rubio J. Characteristics and Determinants of Respiratory Event–Associated Leg Movements. Sleep 2017; 41:4747916. [DOI: 10.1093/sleep/zsx206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephany Fulda
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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34
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Boulos MI, Murray BJ, Muir RT, Gao F, Szilagyi GM, Huroy M, Kiss A, Walters AS, Black SE, Lim AS, Swartz RH. Periodic Limb Movements and White Matter Hyperintensities in First-Ever Minor Stroke or High-Risk Transient Ischemic Attack. Sleep 2017; 40:2753280. [PMID: 28329254 DOI: 10.1093/sleep/zsw080] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Study Objectives Emerging evidence suggests that periodic limb movements (PLMs) may contribute to the development of cerebrovascular disease. White matter hyperintensities (WMHs), a widely accepted biomarker for cerebral small vessel disease, are associated with incident stroke and death. We evaluated the association between increased PLM indices and WMH burden in patients presenting with stroke or transient ischemic attack (TIA), while controlling for vascular risk factors and stroke severity. Methods Thirty patients presenting within 2 weeks of a first-ever minor stroke or high-risk TIA were prospectively recruited. PLM severity was measured with polysomnography. WMH burden was quantified using the Age Related White Matter Changes (ARWMC) scale based on neuroimaging. Partial Spearman's rank-order correlations and multiple linear regression models tested the association between WMH burden and PLM severity. Results Greater WMH burden was correlated with elevated PLM index and stroke volume. Partial Spearman's rank-order correlations demonstrated that the relationship between WMH burden and PLM index persisted despite controlling for vascular risk factors. Multivariate linear regression models revealed that PLM index was a significant predictor of an elevated ARWMC score while controlling for age, stroke volume, stroke severity, hypertension, and apnea-hypopnea index. Conclusion The quantity of PLMs was associated with WMH burden in patients with first-ever minor stroke or TIA. PLMs may be a risk factor for or marker of WMH burden, even after considering vascular risk factors and stroke severity. These results invite further investigation of PLMs as a potentially useful target to reduce WMH and stroke burden.
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Affiliation(s)
- Mark I Boulos
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Brian J Murray
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ryan T Muir
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Fuqiang Gao
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Gregory M Szilagyi
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Menal Huroy
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexander Kiss
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arthur S Walters
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andrew S Lim
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Richard H Swartz
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
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35
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Ferri R, Koo BB, Picchietti DL, Fulda S. Periodic leg movements during sleep: phenotype, neurophysiology, and clinical significance. Sleep Med 2017; 31:29-38. [DOI: 10.1016/j.sleep.2016.05.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/26/2016] [Accepted: 05/07/2016] [Indexed: 01/09/2023]
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36
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Högl B, Stefani A. Restless legs syndrome and periodic leg movements in patients with movement disorders: Specific considerations. Mov Disord 2017; 32:669-681. [DOI: 10.1002/mds.26929] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Birgit Högl
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - Ambra Stefani
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
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37
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Lo Coco D, Puligheddu M, Mattaliano P, Congiu P, Borghero G, Fantini ML, La Bella V, Ferri R. REM sleep behavior disorder and periodic leg movements during sleep in ALS. Acta Neurol Scand 2017; 135:219-224. [PMID: 27027974 DOI: 10.1111/ane.12593] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess sleep characteristics and the occurrence of abnormal muscle activity during sleep, such as REM sleep without atonia (RSWA), REM sleep behavior disorder (RBD), and periodic leg movements during sleep (PLMS), in patients with amyotrophic lateral sclerosis (ALS). METHODS A total of 41 patients with ALS and 26 healthy subjects were submitted to clinical interview and overnight video-polysomnography. RESULTS A total of 22 patients with ALS (53.6%) reported poor sleep quality. Polysomnographic studies showed that patients with ALS had reduced total sleep time, increased wakefulness after sleep onset, shortened REM and slow-wave sleep, and decreased sleep efficiency, compared to controls. Polysomnographic abnormalities were not different in patients reporting good or poor sleep and were not correlated to clinical and demographic variables. The PLMS index was significantly higher in patients with ALS than in healthy subjects, and 22 patients (53.6%) showed a PLMS index > 15/h, vs 4 (15.4%) controls (P < 0.001). Finally, two patients with ALS (4.9%) had RBD, and two more patients presented RSWA (4.9%), whereas no controls showed abnormalities of REM sleep. CONCLUSION Patients with ALS frequently present abnormalities of sleep that can be documented both at the clinical interview and at the polysomnographic evaluation, including insomnia, fragmented sleep, and increased PLMS. Moreover, abnormalities of REM sleep can be found in some of these patients.
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Affiliation(s)
- D. Lo Coco
- ALS Clinical Research Center; Department of Biomedicine and Clinical Neurosciences; University of Palermo; Palermo Italy
| | - M. Puligheddu
- Sleep Disorder Center - Neurophysiology Unit; University of Cagliari; Monserrato Cagliari Italy
| | - P. Mattaliano
- ALS Clinical Research Center; Department of Biomedicine and Clinical Neurosciences; University of Palermo; Palermo Italy
| | - P. Congiu
- Sleep Disorder Center - Neurophysiology Unit; University of Cagliari; Monserrato Cagliari Italy
| | - G. Borghero
- Neurology Unit; Azienda Ospedaliero-Universitaria di Cagliari and University of Cagliari; Monserrato Cagliari Italy
| | - M. L. Fantini
- Neurology Service; CHU Clermont-Ferrand; UFR Medicine; Clermont-Ferrand France
| | - V. La Bella
- ALS Clinical Research Center; Department of Biomedicine and Clinical Neurosciences; University of Palermo; Palermo Italy
| | - R. Ferri
- Department of Neurology; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina Italy
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Ferri R, Rundo F, Silvani A, Zucconi M, Aricò D, Bruni O, Cosentino FII, Ferini-Strambi L, Manconi M. Sequence analysis of leg movements during sleep with different intervals (<10, 10-90 and >90 s) in restless legs syndrome. J Sleep Res 2017; 26:436-443. [DOI: 10.1111/jsr.12500] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/14/2016] [Indexed: 12/01/2022]
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
| | - Francesco Rundo
- Sleep Research Centre; Department of Neurology I. C.; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina Italy
| | - Alessandro Silvani
- PRISM Laboratory; Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Marco Zucconi
- Sleep Disorders Center; Department of Neurology; Scientific Institute and University Ospedale San Raffaele; Vita-Salute University; Milan Italy
| | - Debora Aricò
- Sleep Research Centre; Department of Neurology I. C.; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology; Sapienza University; Rome Italy
| | - Filomena I. I. Cosentino
- Sleep Research Centre; Department of Neurology I. C.; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center; Department of Neurology; Scientific Institute and University Ospedale San Raffaele; Vita-Salute University; Milan Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center; Neurocenter of Southern Switzerland; Civic Hospital (EOC) of Lugano; Lugano Switzerland
- Department Inselspital; Bern University Hospital; Bern Switzerland
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Shokrollahi M, Krishnan S, Dopsa DD, Muir RT, Black SE, Swartz RH, Murray BJ, Boulos MI. Nonnegative matrix factorization and sparse representation for the automated detection of periodic limb movements in sleep. Med Biol Eng Comput 2016; 54:1641-1654. [PMID: 26872678 DOI: 10.1007/s11517-015-1444-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
Stroke is a leading cause of death and disability in adults, and incurs a significant economic burden to society. Periodic limb movements (PLMs) in sleep are repetitive movements involving the great toe, ankle, and hip. Evolving evidence suggests that PLMs may be associated with high blood pressure and stroke, but this relationship remains underexplored. Several issues limit the study of PLMs including the need to manually score them, which is time-consuming and costly. For this reason, we developed a novel automated method for nocturnal PLM detection, which was shown to be correlated with (a) the manually scored PLM index on polysomnography, and (b) white matter hyperintensities on brain imaging, which have been demonstrated to be associated with PLMs. Our proposed algorithm consists of three main stages: (1) representing the signal in the time-frequency plane using time-frequency matrices (TFM), (2) applying K-nonnegative matrix factorization technique to decompose the TFM matrix into its significant components, and (3) applying kernel sparse representation for classification (KSRC) to the decomposed signal. Our approach was applied to a dataset that consisted of 65 subjects who underwent polysomnography. An overall classification of 97 % was achieved for discrimination of the aforementioned signals, demonstrating the potential of the presented method.
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Affiliation(s)
- Mehrnaz Shokrollahi
- Department of Computer Science, Toronto Rehabilitation Institute, University of Toronto, 555 University Ave, Toronto, ON, M5G 2A2, Canada.
| | - Sridhar Krishnan
- Department of Electrical and Computer Engineering, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Dustin D Dopsa
- Department of Electrical and Computer Engineering, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Ryan T Muir
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Sandra E Black
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Richard H Swartz
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Brian J Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Mark I Boulos
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Zhang X, Sun X, Wang J, Tang L, Xie A. Prevalence of rapid eye movement sleep behavior disorder (RBD) in Parkinson’s disease: a meta and meta-regression analysis. Neurol Sci 2016; 38:163-170. [DOI: 10.1007/s10072-016-2744-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
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Puligheddu M, Congiu P, Aricò D, Rundo F, Borghero G, Marrosu F, Fantini ML, Ferri R. Isolated rapid eye movement sleep without atonia in amyotrophic lateral sclerosis. Sleep Med 2016; 26:16-22. [PMID: 28007355 DOI: 10.1016/j.sleep.2016.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to quantitatively analyze, with the most recent and advanced tools, the presence of periodic leg movements during sleep (PLMS) and/or rapid eye movement (REM) sleep without atonia (RSWA), in a group of patients with amyotrophic lateral sclerosis (ALS), and to assess their eventual correlation with the clinical severity of the disease. METHODS Twenty-nine ALS patients were enrolled (mean age 63.6 years) along with 28 age-matched "normal" controls (mean age 63.8 years). Functional impairment due to ALS was evaluated using the ALS-Functional Rating Scale-Revised (ALS-FRS) and the ALS severity scale (ALSSS). Full video polysomnographic night recordings were obtained, and PLMS were analyzed by considering their number/hour of sleep and periodicity index, the distribution of intermovement intervals, and the distribution during the night. The characteristics of the chin electromyogram (EMG) amplitude during REM sleep were analyzed by means of the automatic atonia index and the number of chin EMG activations (movements). RESULTS The ALS patients showed longer sleep latency than the controls, together with an increase in number of stage shifts, increased sleep stage 1, and decreased sleep stage 2. None of the leg PLMS parameters were different between the ALS patients and controls. The REM atonia index was significantly decreased in the ALS patients, and the number of chin movements/hour tended to increase. Both REM atonia index and number of chin movements/hour correlated significantly with the ALS-FRS; REM atonia was higher and chin movements were less in ALS patients with more preserved function (higher scores on the ALS-FRS). CONCLUSION Abnormal REM sleep atonia seemed to be a genuine effect of ALS pathology per se and correlated with the clinical severity of the disease. It is unclear if this might constitute the basis of a possible risk for the development of REM sleep behavior disorder or represent a form of isolated RSWA in ALS.
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Affiliation(s)
- Monica Puligheddu
- Sleep Disorder Center, Department of Public Health, Clinical & Molecular Medicine, University of Cagliari, Monserrato, CA, Italy; UOC Neurology, University of Cagliari, Monserrato, CA, Italy.
| | - Patrizia Congiu
- Sleep Disorder Center, Department of Public Health, Clinical & Molecular Medicine, University of Cagliari, Monserrato, CA, Italy
| | - Debora Aricò
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Francesco Rundo
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | | | - Francesco Marrosu
- Sleep Disorder Center, Department of Public Health, Clinical & Molecular Medicine, University of Cagliari, Monserrato, CA, Italy; UOC Neurology, University of Cagliari, Monserrato, CA, Italy
| | - Maria Livia Fantini
- Neurology Service, CHU Clermont-Ferrand, UFR Medicine, Clermont-Ferrand, France
| | - Raffaele Ferri
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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Ferri R, Fulda S, Allen R, Zucconi M, Bruni O, Chokroverty S, Ferini-Strambi L, Frauscher B, Garcia-Borreguero D, Hirshkowitz M, Högl B, Inoue Y, Jahangir A, Manconi M, Marcus C, Picchietti D, Plazzi G, Winkelman J, Zak R. World Association of Sleep Medicine (WASM) 2016 standards for recording and scoring leg movements in polysomnograms developed by a joint task force from the International and the European Restless Legs Syndrome Study Groups (IRLSSG and EURLSSG). Sleep Med 2016; 26:86-95. [DOI: 10.1016/j.sleep.2016.10.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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Abstract
Restless legs syndrome (RLS) is a complex disorder that involves sensory and motor systems. The major pathophysiology of RLS is low iron concentration in the substantia nigra containing the cell bodies of dopamine neurons that project to the striatum, an area that is crucial for modulating movement. People who have RLS often present with normal iron values outside the brain; recent studies implicate several genes are involved in the syndrome. Like most complex diseases, animal models usually do not faithfully capture the full phenotypic spectrum of "disease," which is a uniquely human construct. Nonetheless, animal models have proven useful in helping to unravel the complex pathophysiology of diseases such as RLS and suggesting novel treatment paradigms. For example, hypothesis-independent genome-wide association studies (GWAS) have identified several genes as increasing the risk for RLS, including BTBD9. Independently, the murine homolog Btbd9 was identified as a candidate gene for iron regulation in the midbrain in mice. The relevance of the phenotype of another of the GWAS identified genes, MEIS1, has also been explored. The role of Btbd9 in iron regulation and RLS-like behaviors has been further evaluated in mice carrying a null mutation of the gene and in fruit flies when the BTBD9 protein is degraded. The BTBD9 and MEIS1 stories originate from human GWAS research, supported by work in a genetic reference population of mice (forward genetics) and further verified in mice, fish flies, and worms. Finally, the role of genetics is further supported by an inbred mouse strain that displays many of the phenotypic characteristics of RLS. The role of animal models of RLS phenotypes is also extended to include periodic limb movements.
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Athavale Y, Krishnan S, Dopsa DD, Berneshawi AG, Nouraei H, Raissi A, Murray BJ, Boulos MI. Advanced signal analysis for the detection of periodic limb movements from bilateral ankle actigraphy. J Sleep Res 2016; 26:14-20. [PMID: 27457202 DOI: 10.1111/jsr.12438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/22/2016] [Indexed: 11/28/2022]
Abstract
Actigraphy can assist in the detection of periodic limb movements in sleep. Although several actigraphs have been previously reported to accurately detect periodic limb movements, many are no longer available; of the existing actigraphs, most sample too infrequently to accurately detect periodic limb movements. The purpose of this study was to use advanced signal analysis to validate a readily available actigraph that has the capability of sampling at relatively high frequencies. We simultaneously recorded polysomnography and bilateral ankle actigraphy in 96 consecutive patients presenting to our sleep laboratory. After pre-processing and conditioning, the bilateral ankle actigraphy signals were then analysed for 14 simple time, frequency and morphology-based features. These features reduced the signal dimensionality and aided in better representation of the periodic limb movement activity in the actigraph signals. These features were then processed by a Naïve-Bayes binary classifier for distinguishing between normal and abnormal periodic limb movement indices. We trained the Naïve-Bayes classifier using a training set, and subsequently tested its classification accuracy using a testing set. From our experiments, using a periodic limb movement index cut-off of 5, we found that the Naïve-Bayes classifier had a correct classification rate of 78.9%, with a sensitivity of 80.3% and a specificity of 73.7%. The algorithm developed in this study has the potential of facilitating identification of periodic limb movements across a wide spectrum of patient populations via the use of bilateral ankle actigraphy.
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Affiliation(s)
- Yashodhan Athavale
- Department of Electrical & Computer Engineering, Ryerson University, Toronto, Canada
| | - Sridhar Krishnan
- Department of Electrical & Computer Engineering, Ryerson University, Toronto, Canada
| | - Dustin D Dopsa
- Department of Electrical & Computer Engineering, Ryerson University, Toronto, Canada
| | - Andrew G Berneshawi
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Hirmand Nouraei
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Afsaneh Raissi
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Brian J Murray
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark I Boulos
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
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Ferri R, Rundo F, Zucconi M, Manconi M, Aricò D, Bruni O, Ferini-Strambi L, Fulda S. Diagnostic accuracy of the standard and alternative periodic leg movement during sleep indices for restless legs syndrome. Sleep Med 2016; 22:97-99. [DOI: 10.1016/j.sleep.2015.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
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Mancebo-Sosa V, Mancilla-Hernández V, Miranda-Ortiz J, Hernández-Torres A, Gutierrez-Escobar R, Poblano A, Jiménez-Correa U. Sleep architecture alterations in patients with periodic limb movements disorder during sleep and sleep breathing disorders. Sleep Sci 2016; 9:84-8. [PMID: 27656271 PMCID: PMC5022004 DOI: 10.1016/j.slsci.2016.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/05/2016] [Accepted: 06/22/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Sleep movement disorders includes mainly periodic limb movement and others. The more frequent breathing disorders are: obstructive sleep apnea-hypopnea syndrome and primary snoring. OBJECTIVE To compare sleep architecture in periodic limb movements and breathing disorders of different severity, and weight their interactions. METHODS We compared sleep architecture in 160 patients, divided in six groups: periodic limb movements (n=25), obstructive apnea only (n=30), periodic limb movements/snoring (n=30), periodic limb movements/mild apnea (n=25), periodic limb movements/moderate apnea (n=25), periodic limb movements/severe apnea (n=26). Polysomnographic variables were compared by analysis of variance and Tukey test. RESULTS We observed an increase of percentage of awakenings in the group with periodic limb movements/severe apnea. We found an increase of percentage of light sleep in the group with obstructive apnea only with respect to periodic limb movements group. The group with obstructive apnea only presented less rapid eye movements sleep in relation with group with periodic limb movements. We found an increase of awakenings in the group with periodic limb movements/severe apnea to the group with periodic limb movements only. Oxygen saturation showed a decrease in the group with periodic limb movements/severe apnea and obstructive apnea only group to periodic limb movements only group. CONCLUSIONS Periodic limb movements and breathing disorders, resulted in more additive changes in sleep architecture alterations, than as separately disorders, in a complex interaction. Research in these relations deserve more investigations.
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Affiliation(s)
| | | | | | | | | | - Adrian Poblano
- Clínic of Sleep Disorders, School of Medicine, National University of Mexico, Mexico City, México
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Karroum EG, Phan HC, Torrez DM, Trotti LM. Perfect Periodicity: To Be Or Not To Be Periodic Leg Movements. J Clin Sleep Med 2016; 12:452-5. [PMID: 26857061 DOI: 10.5664/jcsm.5606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/04/2016] [Indexed: 11/13/2022]
Affiliation(s)
- Elias G Karroum
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA
| | - Han C Phan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.,Children's Healthcare of Atlanta-Egleston Campus, Atlanta, GA
| | - Daniel M Torrez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.,Children's Healthcare of Atlanta-Egleston Campus, Atlanta, GA
| | - Lynn M Trotti
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA
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Ferri R, Manconi M, Rundo F, Zucconi M, Aricò D, Bruni O, Ferini-Strambi L, Fulda S. A Data-Driven Analysis of the Rules Defining Bilateral Leg Movements during Sleep. Sleep 2016; 39:413-21. [PMID: 26414897 PMCID: PMC4712394 DOI: 10.5665/sleep.5454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/28/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to describe and analyze the association between bilateral leg movements (LMs) during sleep in subjects with restless legs syndrome (RLS), in order to eventually support or challenge the current scoring rules defining bilateral LMs. METHODS Polysomnographic recordings of 100 untreated patients with RLS (57 women and 43 males, mean age 57 y) were included. In each recording, we selected as reference all LMs that occurred during sleep and that were separated from another ipsilateral LM by at least 10 sec of EMG inactivity. For each reference LM and an evaluation interval from 5 sec before the onset to 5 sec after the offset of the reference LM, we evaluated (1) the presence or absence of contralateral leg movement activity and (2) the distribution of the onset-to-onset and (3) the offset-to-onset differences between bilateral LMs. RESULTS We selected a mean of 368 (± 222 standard deviation [SD]) reference LMs per subject. For 42% (± 22%) of the reference LMs no contralateral leg movement activity was observed within the evaluation interval. In 55% (± 22%) exactly one and in 3% (± 2%) more than one contralateral LM was observed. A further evaluation of events where exactly one contralateral LM was observed showed that in most (1) the two LMs were overlapping (93% ± 9% SD) and (2) were classified as bilateral according to the World Association of Sleep Medicine and the International Restless Legs Syndrome Study Group (WASM/ IRLSSG) (96% ± 6% SD) and (3) the American Academy of Sleep Medicine scoring rules (99% ± 2% SD). Although there was a systematic and statistically significant difference in standard LM indices during sleep based on the two different definitions of bilateral LMs, the size of the difference was not clinically meaningful (maximum individual, absolute difference in LM indices ± 2.5). In addition, we found that the duration of LMs within bilateral LM pairs was longer compared to monolateral LMs and that the duration of the single LMs in bilateral LM pairs tended to correlate. CONCLUSIONS The results of this study indicate that the two current standard scoring rules for the definition of bilateral LMs during sleep provide largely corresponding classifications in subjects with RLS and, in a clinical context, can be considered to be equivalent.
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Affiliation(s)
- Raffaele Ferri
- Sleep Research Centre, Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Francesco Rundo
- Sleep Research Centre, Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Marco Zucconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Debora Aricò
- Sleep Research Centre, Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Stephany Fulda
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
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Significant association between systolic and diastolic blood pressure elevations and periodic limb movements in patients with idiopathic restless legs syndrome. Sleep Med 2016; 17:109-20. [DOI: 10.1016/j.sleep.2014.12.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/31/2014] [Accepted: 12/19/2014] [Indexed: 01/27/2023]
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50
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Ferri R, Rundo F, Zucconi M, Manconi M, Aricò D, Bruni O, Ferini-Strambi L, Fulda S. Putting the periodicity back into the periodic leg movement index: an alternative data-driven algorithm for the computation of this index during sleep and wakefulness. Sleep Med 2015; 16:1229-35. [DOI: 10.1016/j.sleep.2015.05.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/30/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
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