Prevalence Of Periodic Leg Movements Research Articles

Different scoring rules for respiratory event-related leg movements: effects on the prevalence of periodic limb movements during sleep and their association with depressive symptoms in patients with obstructive sleep apnea

BackgroundWe compared the prevalence of periodic leg movements during sleep (PLMS) according to two different scoring rules of the American Academy of Sleep Medicine (AASM) 2012 and World Association of Sleep Medicine (WASM) 2016 and determined their association with depressed mood in patients with obstructive sleep apnea (OSA). MethodsPLMS, defined as a periodic leg movements index of >15, were diagnosed on a diagnostic and continuous positive airway pressure (CPAP) titration polysomnography using the AASM 2012 and WASM 2016 rules. The Beck Depression Inventory (BDI) and Epworth Sleepiness Scale (ESS) were used, and multiple regression analyses were performed. ResultsAmong 160 OSA patients, the proportion with PLMS scored by the WASM 2016 criteria was significantly higher than that scored by the AASM 2012 criteria in a diagnostic study (20.6% vs. 16.3%, respectively; P = 0.016) but not in CPAP titration study and only in patients with severe OSA. In adjusted models, PLMS were positively associated with BDI scores and a BDI of ≥10 on both diagnostic and CPAP titration studies when scored by the WASM 2016. By contrast, when scored by the AASM 2012, PLMS were associated with BDI scores (but not BDI of ≥10) only in a CPAP titration study. ConclusionsThere are significant differences in the prevalence of PLMS and their association with depressed mood depending on the scoring rules in patients with OSA. The current AASM scoring criteria underestimate the prevalence of PLMS, and PLMS are more likely associated with depressed mood according to the WASM scoring criteria.

Prevalence of Periodic Leg Movements in Patients at a Sleep Center

Prevalence of Periodic Leg Movements in Patients at a Sleep Center

The prevalence and significance of periodic leg movements during sleep in patients with congestive heart failure

The aim of this study was to evaluate (1) the prevalence of periodic leg movements during sleep (PLMs) in a consecutive sample of congestive heart failure (CHF) outpatients; (2) the presence of correlation between PLMs, subjective daytime sleepiness, and sleep architecture; and (3) the heart rate response to PLMs in CHF. Seventy-nine [50 men, age 59 +/- 11 years, body mass index (BMI) 26 +/- 5 kg/m(2)] consecutive adult stable outpatients with CHF [left ventricular ejection fraction (LVEF) 36 +/- 6%] were prospectively evaluated. The patients underwent assessment of echocardiography, sleepiness (Epworth Scale), and overnight in-lab polysomnography. Fifteen patients (19%) had PLM index >5. These subjects were similar in sex distribution, BMI, subjective somnolence, LVEF, and apnea-hypopnea index (AHI), but were significantly older than subjects without PLMs. Sleep architecture was similar in subjects with and without PLMs. There was a small but significant elevation of heart rate after PLMs (80.1 +/- 9.4 vs. 81.5 +/- 9.2; p < 0.001). The cardiac acceleration was also present in absence of electroencephalogram activation. The prevalence of PLMs in consecutive sample of adult CHF outpatients was 19%. There were no differences in subjective daytime sleepiness, sleep architecture, AHI, and severity of CHF in subjects with and without PLMs. PLMs caused a small but statistically significant cardiac acceleration.

Periodic leg movements during sleep and wakefulness in narcolepsy

The objectives of the study were to measure the prevalence of periodic leg movements during NREM and REM sleep (PLMS) and while awake (PLMW) and to assess the impact of PLMS on nocturnal sleep and daytime functioning in patients with narcolepsy. One hundred and sixty-nine patients with narcolepsy and 116 normal controls matched for age and gender were included. Narcoleptics with high and low PLMS indices were compared to assess the impact of PLMS on sleep and Multiple Sleep Latency Test (MSLT) variables. More narcoleptics than controls had a PLMS index greater than 5 per hour of sleep (67% versus 37%) and an index greater than 10 (53% versus 21%). PLMS indices were higher both in NREM and REM sleep in narcoleptic patients, but the between-group difference was greater for REM sleep. A significant increase of PLMS index was also found with aging in both narcoleptic patients and controls. PLMW indices were also significantly higher in narcoleptic patients. Patients with an elevated index of PLMS had a higher percentage of stage 1 sleep, a lower percentage of REM sleep, a lower REM efficiency and a shorter MSLT latency. The present study demonstrates a high frequency of PLMS and PLMW in narcolepsy, an association between the presence of PLMS and measures of REM sleep and daytime functioning disruption. These results suggest that PLMS represent an intrinsic feature of narcolepsy.

Periodic leg movements in prepubertal children with sleep disturbance

This study's aims were to determine: (1) prevalence of periodic leg movements (PLMs) in walking prepubertal children consulting a sleep clinic for any sleep disorder; (2) associations between PLMs and other sleep and medical disorders; and (3) the response of other sleep disorders to treatment with the dopamine agonist pramipexol. Clinical evaluation and polysomnography were carried out for a period of 12 months on 252 consecutively seen, prepubertal children with sleep disorders (156 males, 96 females; aged 15mo to 11y, mean 7y 1mo, SD3y 10mo). Sleep disorders unrelated to PLMs were treated, and six children received pramipexol for PLMs. Follow-up included clinical evaluation and polysomnography. Twenty-three per cent of children were diagnosed with PLMs on the basis of polysomnography. The presence of PLMs had usually been unrecognized clinically. The only clinical symptom that could be related to periodic limb movement disorder was a report of leg pains at morning awakening. Only two of 58 children had PLMs without other clinical or polysomnographic findings. Comorbidity seen with PLMs included neuropsychiatric syndromes (n=20), isolated sleep disordered breathing (SDB; n=29), and several other comorbid conditions (n=7). Seven of 11 children seen with attention-deficit-hyperactivity disorder also had PLMs. Surgery for SDB was associated with subsequent cessation of PLMs in 15 of 29 children. Five out of six children with PLMs who received pramipexol were able to tolerate the drug and experienced a complete disappearance of their PLMs. Presence of chronic fatigue, sleepiness, disrupted nocturnal sleep, and difficulties in falling asleep should lead to a systematic search for PLMs that is independent of associated syndromes. Isolated treatment of SDB might help eliminate some, but not all, PLMs.

High rates of periodic leg movements of sleep in REM-sleep behavior disorder raise more questions about the relationship between sleep-related movement disorders: Article reviewed: M.L. Fantini, M. Michaud, N. Gosselin, G. Lavigne, J. Montplaisir, Periodic leg movements in REM sleep behavior disorder and related autonomic and EEG activation, Neurology, 59 (2002) 1889–1894

Objectives: Assess prevalence of periodic leg movements (PLMs) of sleep and the association of heart rate changes to these leg movements, in patients with REM behavior disorder (RBD) compared to patients with the restless legs syndrome (RLS). Study design: Case series. Study population: Forty consecutive patients with RBD and 15 patients with RLS. Methods: Polysomnography was performed in patients with RBD (without RLS) and a (presumably) historical age and gender-matched group with primary RLS. Of the 28 RBD patients with a PLM index greater than 10/h, 15 were randomly selected for further analysis of leg movement characteristics and consequences, and again compared to the RLS group. No patients in either group were taking medications known to affect sleep. Scoring of REM was performed without the EMG channel. Fifty leg movements from Stage II sleep were randomly selected for each patient. Change in heart rate from baseline for the 10 beats before, and 15 beats after, each leg movement onset was determined, and averaged within groups. Results: Seventy percent of patients with RBD had a PLM index greater than 10/h. Mean PLM index was no different between the RBD and RLS groups for wake or non-REM, though it was higher for the RBD group during REM sleep. Cardiac acceleration following PLM onset in the RBD group was over twice that seen in the RLS group, even though a smaller percentage of leg movements was associated with cortical arousal in those with RBD. Conclusions: PLM indices are the same in RBD and RLS, further supporting the dopaminergic hypothesis for generation or control of periodic leg movements during sleep (PLMS). PLMS are more common in RBD during REM sleep than observed in RLS. Reduced autonomic activation associated with leg movements in RBD may be related to idiopathic RBD or to a neurodegenerative disorder underlying the RBD. Similarly, the lack of cortical arousal seen with PLMS in RBD may indicate dysregulation of centers responsible for coordinating autonomic and cerebral activity during sleep.

Periodic Leg Movements and Sleep-Disordered Breathing in Children. Periodische Beinbewegungen und schlafbezogene Atmungsstorungen im Kindesalter

Children with OSAS (obstructive sleep apnea syndrome) have a restless sleep. Furthermore they show a changed daytime behavior comparable with attention deficit hyperactivity disorder (ADHD). We investigated the prevalence of periodic leg movements in sleep in OSAS patients to answer the question whether OSAS can be misinterpreted by insufficient diagnostics for example actigraphy alone. 25 children who had no OSAS (controls) (age 3.1 to 14.3 years, median 7.3 years) were examined polysomnographically. 25 age-matched patients with clinically confirmed OSAS and an apnea/hypopnea index (AHI)≥5/h were investigated polysomnographically in one night before treatment (diagnostic night-baseline) and in one night with therapy. In the 3 groups the number of all leg movements (LM) and periodic leg movements (PLM) were counted in the time in bed as well as in the total sleep time (LMS/PLMS). Furthermore the number of LM and PLM was calculated in wakefulness, NREM and REM. The ratio of PLM to LM was calculated. Additionally we calculated, how frequently LMS and PLMS were accompanied by EEG-arousals. 92% of OSAS patients had an enhanced PLMS-Index > 5/h TST. OSAS patients without therapy had a significantly enhanced number of LMS (LMS: 19.2/h TST [qr=12.3]) and PLMS (11.8/h TST [qr=10.6]) in comparison to controls (LMS: 8.9/h TST [qr=2.4], PLMS: 2.3/h TST [qr=2.1]) and treated OSAS patients (LMS: 9.9/h TST [qr=4.7], PLMS: 3.7/h TST [qr=3.6]). Under therapy there was a significant diminution of LM and PLM in NREM and REM but not during wakefulness. Without therapy two thirds of all LMS were PLMS (66.3% [qr=16.4]) while in treated patients the total LMS included one third PLMS (39.6% [qr=32.9]) comparable with controls (28.4% [qr=15.9]). 90.1% [qr=18.9] of all PLMS in controls were accompanied by EEG-arousals but 61.0% [qr=23.9] in OSAS patients and 71.4% [qr=36.7] in treated OSAS patients. OSAS patients in childhood have a PLMD by definition (PLMS>5 per hour TST, changed daytime behavior [2]) resolving by the therapy of sleep disturbed breathing. Because of the overlap of the symptoms sleep-disordered breathing should be considered in the differential diagnosis of children with PLMD, RLS (restless legs syndrome) and ADHD (attention deficit hyperactivity disorder). Different pathogenesis needs an appropriate therapeutic strategy.