Abstract
BackgroundPeriodic leg movements (PLM) during sleep (PLMS) are considered strongly related to restless legs syndrome (RLS), and are associated with polymorphisms in RLS risk genes. Various software for automatic analysis of PLMS are available, but only few of them have been validated. Aim of this study was to validate a leg movements count and analysis integrated in a commercially available polysomnography (PSG) system against manual scoring.MethodsTwenty RLS patients with a PLMS index > 20/h and 20 controls with a PLMS index < 5/h were included. Manual and computerized scoring of leg movements (LM) and PLM was performed according to the standard American Academy of Sleep Medicine (AASM) criteria. LM and PLM indices during sleep and wakefulness, the rate of PLMS associated with respiratory events, intermovement interval and periodicity indices were manually and automatically scored.ResultsThe correlation between manual and computerized scoring was high for all investigated parameters (Spearman correlation coefficients 0.751–0.996, p < 0.001; intraclass correlation coefficients 0.775–0.999, p < 0.001). Bland-Altman plots showed high agreement between manual and automatic analysis.ConclusionsThis study validated an automatic LM count and PLM analysis against the gold standard manual scoring according to AASM criteria. The data demonstrate that the software used in this study has an outstanding performance for computerized LM and PLM scoring, and LM and PLM indices generated with this software can be reliably integrated in the routine PSG report. This automatic analysis is also an excellent tool for research purposes.
Highlights
Periodic leg movements (PLM) during sleep (PLMS) are considered strongly related to restless legs syndrome (RLS), and are associated with polymorphisms in RLS risk genes
Several software programs for automatic detection and analysis of leg movements (LM) during sleep (LMS) have been developed and are commonly used in the clinical polysomnography (PSG) routine and research applications, only few of them have been validated and time-consuming visual detection and manual scoring of Periodic leg movements during sleep (PLMS) is still considered the gold standard for research purposes
The main reason for PSG examination was suspected sleep-related breathing disorder (11/20, 55%), followed by insomnia (6/20, 30%), NREM parasomnia (2/20, 10%) and suspected narcolepsy (1/20, 5%). In none of those patients sleep-related breathing disorder was confirmed by PSG, nor was narcolepsy confirmed by MSLT
Summary
Periodic leg movements (PLM) during sleep (PLMS) are considered strongly related to restless legs syndrome (RLS), and are associated with polymorphisms in RLS risk genes. Periodic leg movements (PLM) during sleep (PLMS) are present in more than 80% of patients with restless legs syndrome (RLS) [1], represent a supportive diagnostic criterium, and are associated with polymorphism in various RLS risk genes (BTBD9, TOX3/BC034767, MEIS1, MAP2K5/SKOR1, and PTPRD) [2] They have been observed in other sleep-related or neurological disorders, such as narcolepsy [3], sleep-related breathing disorders [4], Parkinson’s disease [5], multiple system atrophy [6] and REM sleep behaviour disorder [7], as well as in healthy subjects [8, 9].
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