Changes in cerebral and autonomic activity heralding periodic limb movements in sleep

Ferrillo, Franco; Beelke, Manolo; Canovaro, Paola; Watanabe, Takehiko; Aricò, Debora; Rizzo, Pierpaolo; Garbarino, Sergio; Nobili, Lino; Carli, Fabrizio De

doi:10.1016/j.sleep.2004.01.008

Cited by 94 publications

(62 citation statements)

References 43 publications

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“…Since CPAP reduces sympathetic activity in patients with sleep apnoea, the recovery of PLM by CPAP might support the hypothesis of GUGGISBERG et al [15]. However, other studies performed in patients with RLS [11,13,16] or sleep apnoea [14] have reported essentially opposite findings. For these reasons, it is difficult to interpret the findings of the current study as an effect of increased sympathetic activity, even if this cannot be completely excluded.…”

Section: Discussionmentioning

confidence: 64%

Periodic leg movements in Cheyne–Stokes respiration

et al. 2008

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Periodic leg movements during sleep (PLMS) are repetitive jerks of the lower limbs. Their occurrence can be isolated or part of various sleep disorders, such as restless legs syndrome (RLS), narcolepsy and obstructive sleep apnoea. Dopamine agonists are very effective in suppressing PLMS in RLS from the first night of administration. PLMS are often associated with cortical and autonomic arousals and may contribute to sleep disruption.Herein, a case of association between PLMS, Cheyne-Stokes respiration (CSR) and severe insomnia is described.Repeated polysomnographic studies demonstrated a clear synchronisation between PLMS and hyperventilation episodes, and the complete recovery of CSR, sleep quality and PLMS during nocturnal ventilation. In the same patient, pharmacological treatment with a dopamine agonist was ineffective on both PLMS and CSR.These results suggest that periodic leg movements during sleep coupled with central breathing events, similar to those observed in conjunction with obstructive events, may have a different origin in terms of neurotransmitter and pathway implicated, compared with periodic leg movements during sleep in restless legs syndrome, and are resolved by treatment of the respiratory abnormalities.

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Section: Discussionmentioning

confidence: 64%

Periodic leg movements in Cheyne–Stokes respiration

et al. 2008

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“…For instance, sleep-disordered breathing is known to be associated with changes in the EEG seconds before respiratory recovery. 55 Similarly, it is well documented that periodic leg movements during sleep are associated with EEG arousals 45,[56][57][58] and phase A manifestations of the cyclic alternating pattern, a measure of NREM sleep instability. 59 This suggests that leg movements are associated with a complex arousal process, progressing from sympathetic activation to increased EEG delta activity to higher-frequency rhythms.…”

Section: Limitations and Implication For Future Studiesmentioning

confidence: 99%

EEG Functional Connectivity Prior to Sleepwalking: Evidence of Interplay Between Sleep and Wakefulness

Desjardins

Carrier

Lina

et al. 2017

Sleep

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Study Objectives: Although sleepwalking (somnambulism) affects up to 4% of adults, its pathophysiology remains poorly understood. Sleepwalking can be preceded by fluctuations in slow-wave sleep EEG signals, but the significance of these pre-episode changes remains unknown and methods based on EEG functional connectivity have yet to be used to better comprehend the disorder. Methods: We investigated the sleep EEG of 27 adult sleepwalkers (mean age: 29 ± 7.6 years) who experienced a somnambulistic episode during slow-wave sleep. The 20-second segment of sleep EEG immediately preceding each patient's episode was compared with the 20-second segment occurring 2 minutes prior to episode onset. Results: Results from spectral analyses revealed increased delta and theta spectral power in the 20 seconds preceding the episodes' onset as compared to the 20 seconds occurring 2 minutes before the episodes. The imaginary part of the coherence immediately prior to episode onset revealed (1) decreased delta EEG functional connectivity in parietal and occipital regions, (2) increased alpha connectivity over a fronto-parietal network, and (3) increased beta connectivity involving symmetric inter-hemispheric networks implicating frontotemporal, parietal and occipital areas. Conclusions: Taken together, these modifications in EEG functional connectivity suggest that somnambulistic episodes are preceded by brain processes characterized by the co-existence of arousal and deep sleep.

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“…7,8 This was followed by an increase in fast EEG activity and HR whether or not the PLM was associated with arousals. This chain of events is most probably under the general control of a common mechanism, i.e., "the cyclic alternating pattern," which has been shown to have a gating control function on the generation of PLM.…”

Section: Discussionmentioning

confidence: 97%

Periodic Limb Movements and Heart Rate Changes

Oksenberg

Gadoth²

2012

Journal of Clinical Sleep Medicine

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Periodic limb movements (PLM) during sleep are believed to be under the control of the sympathetic nervous system and may cause interrupted sleep and daytime sleepiness. The present case highlights the close relationship between PLM and signifi cant heart rate changes independent of the presence of arousals. Thus, in addition to the already known deleterious effect on sleep continuity, moderate-severe PLM may also affect cardiovascular health. Keywords: Periodic limb movement (PLM), heart rate (HR), sympathetic nervous system (SNS), arousals citation: Oksenberg A; Gadoth N. Periodic limb movements and heart rate changes. 1 The presence of a microarousals occurring simultaneously, before or after the onset of this motor event, is a common fi nding.2 The transient increase in heart rate (HR) 3 concomitant with these PLM-related arousal events is frequently observed in patients with and without sleep disorders. report of caseA 67-year-old woman was referred to our sleep disorders unit, with complains of snoring and suspected obstructive sleep apnea. Although she was not aware of breathing pauses during sleep, she reported that her sleep was interrupted by unexplained awakenings. She had a subjective feeling of daytime sleepiness as was apparent from the Epworth Sleepiness Scale (ESS) score of 17 from a maximum of 24. She described a tendency to fall asleep easily in different passive situations. Symptoms of restless legs syndrome (RLS) were not present. 4 She reported retiring to bed at 22:00 and waking up at 06:00. Her body mass index (BMI) was 37. The results of her polysomnographic evaluation revealed an apnea-hypopnea index (AHI) of 8.9, showing mainly hypopneas related to REM sleep (REM AHI = 23.0; NREM AHI = 6.1). Esophageal pressure was not recorded, and scoring of respiratory effort-related arousals (RERAs) was not performed since airfl ow was recorded by a thermistor, which is not a reliable sensor for the measurement of RERAs.She slept during the whole night on her back and snored continuously, with a maximum loudness of 69 dB. Continuous PLM were recorded only during the fi rst third of the night and were scored according to standard criteria.5 Non-PLM were not recorded. There were 199 periodic leg movements, of which 136 (68.3%) were associated with EEG arousals. The PLM index was 28.6, and the PLM arousal index was 19.6. Although not all leg movements were associated with arousals, it was remarkable that continuous brady/tachycardia (between 50-75 bpm, compared to a baseline about 53-55 bpm) was recorded in concomitant with the periodic leg movements (Figure 1). discussionThe present case highlights the close relationship between PLM and signifi cant heart rate changes independent of the presence of arousals. A number of studies have demonstrated a temporal relation between PLM and HR changes. However, a variable portion of these electrocardiographic events were accompanied by cortical arousal. In one study of 8 PLM patients, it was found that HR changes associated with PLM occur whether or not there i...

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Changes in cerebral and autonomic activity heralding periodic limb movements in sleep

Cited by 94 publications

References 43 publications

Periodic leg movements in Cheyne–Stokes respiration

Periodic leg movements in Cheyne–Stokes respiration

EEG Functional Connectivity Prior to Sleepwalking: Evidence of Interplay Between Sleep and Wakefulness

Periodic Limb Movements and Heart Rate Changes

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