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Bansal K, Garcia J, Feltch C, Earley C, Robucci R, Banerjee N, Brooks J. A pilot study to understand the relationship between cortical arousals and leg movements during sleep. Sci Rep 2022; 12:12685. [PMID: 35879382 PMCID: PMC9314423 DOI: 10.1038/s41598-022-16697-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Leg movements during sleep occur in patients with sleep pathology and healthy individuals. Some (but not all) leg movements during sleep are related to cortical arousals which occur without conscious awareness but have a significant effect of sleep fragmentation. Detecting leg movements during sleep that are associated with cortical arousals can provide unique insight into the nature and quality of sleep. In this study, a novel leg movement monitor that uses a unique capacitive displacement sensor and 6-axis inertial measurement unit, is used in conjunction with polysomnography to understand the relationship between leg movement and electroencephalogram (EEG) defined cortical arousals. In an approach that we call neuro-extremity analysis, directed connectivity metrics are used to interrogate causal linkages between EEG and leg movements measured by the leg movement sensors. The capacitive displacement measures were more closely related to EEG-defined cortical arousals than inertial measurements. Second, the neuro-extremity analysis reveals a temporally evolving connectivity pattern that is consistent with a model of cortical arousals in which brainstem dysfunction leads to near-instantaneous leg movements and a delayed, filtered signal to the cortex leading to the cortical arousal during sleep.
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Affiliation(s)
- Kanika Bansal
- US CCDC Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, USA.,Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Javier Garcia
- US CCDC Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, USA
| | | | - Christopher Earley
- Department of Neurology and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ryan Robucci
- Tanzen Medical Inc., Baltimore, MD, USA.,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Catonsville, MD, USA
| | - Nilanjan Banerjee
- Tanzen Medical Inc., Baltimore, MD, USA.,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Catonsville, MD, USA
| | - Justin Brooks
- Tanzen Medical Inc., Baltimore, MD, USA. .,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Catonsville, MD, USA. .,Tanzen Medical Inc, 5926 Lebanon Lane, Elkridge, MD, 21075, USA.
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Brooks J, Feltch C, Lam J, Earley C, Robucci R, Agarwal S, Banerjee N. RestEaze: An Emerging Technology to Characterize Leg Movements During Sleep. J Med Device 2021. [DOI: 10.1115/1.4053160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Several sleep disorders are characterized by periodic leg movements during sleep including Restless Leg Syndrome, and can indicate disrupted sleep in otherwise healthy individuals. Current technologies to measure periodic leg movements during sleep are limited. Polysomnography and some home sleep tests use surface electromyography to measure electrical activity from the anterior tibilias muscle. Actigraphy uses 3-axis accelerometers to measure movement of the ankle. Electromyography misses periodic leg movements that involve other leg muscles and is obtrusive because of the wires needed to carry the signal. Actigraphy based devices require large amplitude movements of the ankle to detect leg movements (missing the significant number of more subtle leg movements) and can be worn in multiple configurations precluding precision measurement. These limitations have contributed to their lack of adoption as a standard of care for several sleep disorders. In this study, we develop the RestEaze sleep assessment tool as an ankle-worn wearable device that combines capacitive sensors and a 6-axis inertial measurement unit to precisely measure periodic leg movements during sleep. This unique combination of sensors and the form-factor of the device addresses current limitations of periodic leg movements during sleep measurement techniques. Pilot data collected shows high correlation with polysomnography across a heterogeneous participant sample and high usability ratings. RestEaze shows promise in providing ecologically valid, longitudinal measures of leg movements that will be useful for clinicians, researchers, and patients to better understand sleep.
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Affiliation(s)
- Justin Brooks
- University of Maryland, Baltimore County, Department of Computer Science and Electrical Engineering, 1000 Hilltop Circle, Catonsville, MD 21250; Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
| | - Cody Feltch
- Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
| | - Janet Lam
- Kennedy Krieger Institute, Department of Neurology and Developmental Medicine, 801 N. Broadway, Baltimore, MD 21205
| | - Christopher Earley
- Johns Hopkins School of Medicine, Department for Neurology, 5501 Hopkins Bayview Circle, Baltimore, MD 21224
| | - Ryan Robucci
- University of Maryland, Baltimore County, Department of Computer Science and Electrical Engineering, 1000 Hilltop Circle, Catonsville, MD 21250; Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
| | - Sanjay Agarwal
- Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
| | - Nilanjan Banerjee
- University of Maryland, Baltimore County, Department of Computer Science and Electrical Engineering, 1000 Hilltop Circle, Catonsville, MD 21250; Tanzen Medical, Inc., 502 Scrimshaw Way, Severna Park, MD 21446
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Cederberg KLJ, Walters AS, Amara AW, Braley TJ, Schuetz ML, Mathison BG, Motl RW. Validity and reliability of the suggested immobilization test for measurement of restless legs syndrome severity in adults with multiple sclerosis. Sleep Med 2021; 84:343-351. [PMID: 34242924 DOI: 10.1016/j.sleep.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE/BACKGROUND Adults with multiple sclerosis (MS) often present with conditions that mimic restless legs syndrome (RLS), thereby adding complexity into the assessment of RLS severity. The current gold-standard measures of RLS severity rely on a fixed seven-day time frame, which limits the ability of these measures for studying acute changes in RLS severity. The present study examined if subjective and objective scores from the suggested immobilization test (SIT) provide a valid and reliable acute measure of RLS severity in persons with MS. PATIENTS/METHODS Participants with MS and RLS (n = 20) and MS without RLS (n = 20) were matched by age, gender, and disability. All participants completed validated questionnaires for RLS severity followed by the SIT, conducted at 18:00 (±15 min) on the same day of the week for two consecutive weeks. Participants wore accelerometer devices for seven nights to capture periodic limb movements (PLMs) during the night. RESULTS Self-reported RLS severity during the SIT had excellent construct validity and convergent validity, but moderate test-retest reliability. Device-measured PLMs, while not themselves a direct measure of RLS severity, were significantly associated with PLMs during the night and had excellent test-retest reliability during the SIT in adults with MS. CONCLUSIONS Our results suggest that the SIT represents a valid acute measure for capturing self-reported sensory aspects of RLS severity and should be considered in future research and clinical practice as a standardized acute measure of subjective RLS severity in adults with MS who present with RLS.
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Affiliation(s)
- Katie L J Cederberg
- Department of Psychiatry and Behavioral Sleep Medicine, Stanford University, Stanford, CA, USA.
| | - Arthur S Walters
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany J Braley
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Morgan L Schuetz
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brianna G Mathison
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Akhmadulina AO, Levin OS, Poluektov MG. [Restless legs syndrome in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:80-88. [PMID: 33205935 DOI: 10.17116/jnevro202012010280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disturbances in sleep and wakefulness are important symptoms of Parkinson's disease (PD) and are associated with negative effects on patients' quality of life. The analysis of literature on the relationship between RLS and PD revealed three main hypotheses explaining the relatively high incidence of RLS in PD: (1) RLS can be considered as an early (prodromal) manifestation or a predictor of PD that can outpace its main symptoms by several years (by analogy with conduct disorder during sleep with REM); (2) the high incidence of RLS in the advanced stage of PD may be associated with augmentation of previously latent RLS symptoms during prolonged dopaminergic therapy of PD; (3) a significant proportion of RLS cases in PD patients are not «classical» RLS, but represent, for example, manifestations of motor or non-motor fluctuations or a special form of stereotypy in the legs. Further research is needed to determine if any of these statements are true.
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Affiliation(s)
- A O Akhmadulina
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - M G Poluektov
- Sechenov First Moscow Medical University, Moscow, Russia
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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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Madhushri P, Ahmed B, Penzel T, Jovanov E. Periodic leg movement (PLM) monitoring using a distributed body sensor network. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:1837-40. [PMID: 26736638 DOI: 10.1109/embc.2015.7318738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Wireless sensors networks represent the architecture of choice for distributed monitoring due to the ease of deployment and configuration. We developed a distributed sleep monitoring system which combines wireless inertial sensors SP-10C by Sensoplex controlled by a custom smartphone application as an extension of the polysomnographic (PSG) monitor SOMNOscreen plus from Somnomedics. While existing activity monitors are wired to the SOMNOscreen, our system allows the use of wireless inertial sensors to improve user's comfort during sleep. The system is intended for monitoring of periodic leg movements (PLM) and user's activity during sleep. Wireless sensors are placed on ankle and toes of the foot in a customized sock. An Android app communicates with wireless sensors over Bluetooth Smart (BTS) link and streams 3D accelerometer values, 4D unit quaternion values and timestamps. In this paper we present a novel method of synchronization of data streams from PSG and inertial sensors, and original method of detection of PLM events. The system was tested using five experiments of simulated PLM, and achieved 96.51% of PLM detection accuracy.
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