Different Periodicity and Time Structure of Leg Movements During Sleep in Narcolepsy/Cataplexy and Restless Legs Syndrome

Ferri, Raffaele; Zucconi, Marco; Manconi, Mauro; Bruni, Oliviero; Ferini‐Strambi, Luigi; Vandi, Stefano; Montagna, Pasquale; Mignot, Emmanuel; Plazzi, Giuseppe

doi:10.1093/sleep/29.12.1587

Cited by 133 publications

(71 citation statements)

References 26 publications

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“…Researchers are studying which muscles are best to record REM sleep without atonia in a PSG, the cut-off points for it, and whether changes in heart rate and periodicity of PLMS can differentiate limb movements in patients with restless legs from those seen in narcolepsy with cataplexy, REM sleep behavior disorder, and asymptomatic older adults. [65][66][67][68] …”

Section: Technical Considerations Recommended By the Aasm Manualmentioning

confidence: 99%

“…The rules will miss some whose symptoms are truly related to their sleep disorder(s), but given increasing pleas for medical economic restraint, full-court press PSG techniques should perhaps be reserved for those whose first study is thought to be false-negative or non-diagnostic. Studies remain to be done and published which confirm that scoring subcortical arousals, cyclic alternating pattern, [70][71][72][73][74] respiratory cycle-related EEG changes to identify respiratory events, [75][76][77] abnormal nocturnal regulation of cardiac autonomic function, 78 computerized analysis of submentalis muscle activity to diagnose REM sleep behavior disorder, 79 and assessment of periodicity and circadian distribution of periodic limb movements 65,66,68,[80][81][82] are warranted, valid, and alter outcomes.…”

Section: In Closingmentioning

confidence: 99%

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The AASM Scoring Manual Four Years Later

Grigg-Damberger

2012

Journal of Clinical Sleep Medicine

126

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lent and incident blood pressure; 6,7 (2) lower neurocognitive test scores; 8 and (3) automobile crashes due to sleepiness. 9 The respiratory review paper also provided suffi cient evidence for scoring hypopneas which caused as little as ≥ 20% to 30% fall in airfl ow and/or ≥ 2% or ≥ 3% desaturations. [10][11][12] However, the AASM wanted rules for scoring hypopneas which had substantial or excellent interscorer reliability. Interrater reliability (IRR) as it relates to scoring sleep in a PSG measures how closely individuals score the same sleep study. IRR when scoring a PSG depends upon the: (1) skill, experience, and training of scorer; (2) technical quality of study; (3) clarity and simplicity of scoring rules; (4) diligence with which scoring rules are applied; and (5) degree of physiological ambiguity of the sleep/wake patterns. 13 When two or more individuals score a stage of sleep or an event in a PSG differently, it can introduce enough variability to lead to a false positive or false negative for a particular diagnosis.The IRR for scoring respiratory events in a PSG is particularly affected by the: (1) duration of the event; (2) degree of reduction in the amplitude of the measured signal(s); (3) level of the oxyhemoglobin desaturation associated with it; and (4) presence and duration of arousal which accompanies it. Ayappa et al. found the percent scoring agreement for scoring apneas using a nasal pressure sensor was excellent (0.91) but only moderate for hypopneas (0.69) or fl ow limitation events (0.64).14 The more subtle the reduction in airfl ow, the more diffi cult to achieve good interscorer agreement: one scorer identifi ed 35% more fl ow limitation events than the other. Whitney et al. found a hypopnea associated with 2% to 5% desaturations could be scored with IRR of 0.90, but scoring agreement inPurpose of Review: Review published studies and critiques which evaluate the impact and effects of the American Academy of Sleep Medicine (AASM) Sleep Scoring Manual in the four years since its publication. Findings: Using the AASM Manual rules to score sleep and events in a polysomnogram (PSG) results in: (1) very large differences in apnea-hypopnea indexes (AHI) when using the recommended and alternative rule for scoring hypopneas in adults; (2) increases in NREM 1 and sleep stage shifts with compensatory decreases in NREM 2 in children and adults when following rule 5.C.b. for ending NREM 2 sleep; (3) increases in NREM 3 in adults scoring slow wave activity in the frontal EEG derivations; (4) improved interscorer reliability; and (5) successfully identifi ed fragmented sleep in children with obstructive sleep apnea (OSA) from primary snorers or normal controls because they had more NREM 1 and stage shifts using rule 5.C.b. Criticism of the Manual most often cited: (1) two rules for scoring hypopneas; (2) alternative EEG montage cancellation effects; (3) scoring stages 3 and 4 as NREM 3; and (4) too few rules for scoring arousals and REM sleep without atonia. Summary: Four years have passed since the...

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Section: Technical Considerations Recommended By the Aasm Manualmentioning

confidence: 99%

Section: In Closingmentioning

confidence: 99%

The AASM Scoring Manual Four Years Later

Grigg-Damberger

2012

Journal of Clinical Sleep Medicine

126

View full text Add to dashboard Cite

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“…Because PLMS can be comorbid with other sleep disorders (i.e. OSA, [4,5] narcolepsy, [14] rapid eye movement behavior disorder [15] their association to and exclusion from other potential causes of a sleep complaint needs to be determined in conjunction with other simultaneously recorded biological signals. HSMD that record multiple biological signals over consecutive nights might be a better alternative for assessing PLMS clinical significance than a single-night PSG, since consecutive recordings would capture night-to-night variability [10] and time-ofnight PLM patterns [16].…”

Section: Why Are Hsmd the Tools To Assess Plms?mentioning

confidence: 99%

“…PLM events meeting criteria are counted to derive a PLM index (number of events per hour of sleep), although the clinical significance of this parameter is questionable [3]. Some authors suggest the time intervals between PLM events may have more clinical meaning [4,7,14,[18][19][20]. HSMD that report event time intervals and autonomic nervous system (ANS) changes could have clinical importance since ANS responses typically accompany electroencephalogram (EEG) arousals.…”

Section: How To Bridge the Plms Information Gap?mentioning

confidence: 99%

“…Activity measures from a chestworn accelerometer could be reported similar to anterior tibialis derived indices, using both frequency and time domain [14]. HSMD with an integrated snore detection signal could potentially identify associations between sleep quality, upper airway resistance, increases in heart rate and activity to ascertain comorbid sleep breathing disorder with PLMS [28].…”

Section: What Is Needed?mentioning

confidence: 99%

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Home Sleep-Monitoring Devices: Bridging the Periodic Limb Movement in Sleep Information Gap

Schramm¹

2017

J Sleep Disord Ther

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The prevalence of periodic limb movement in sleep (PLMS) in patients with Restless Legs Syndrome is estimated between 80 to 90%, >34% of the population over 60 years of age and 36% of healthy subjects were found to have a PLMS index >5 event per hour of sleep. PLMS can be associated with sleep breathing disorders, insomnia, narcolepsy, and REM Behavior disorder. Its prevalence in the general population is unknown. Home sleepmonitoring devices (HSMD) could be used to derive some consensus on the clinical and non-clinical characteristics of PLMS. There is need to derive age-adjusted normative values for PLMS, assess their clinical significance when presenting as comorbidities, phenotyping the genetic variants and tracking the pathophysiology along a continuum to determine signs and symptom changes from pre-clinical to clinical relevance. This article provides information on why and how HSMD is the logical approach in bridging the clinically relevant information gap associated with PLMS. It discusses future directions to be taken in utilizing HSMD to objectively measure PLMS and determine their effect on sleep quality.

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CSF and serum ferritin levels in narcolepsy type 1 comorbid with restless legs syndrome

Barateau

Chenini

Lotierzo

et al. 2020

Ann Clin Transl Neurol

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ObjectivesTo investigate whether cerebrospinal fluid (CSF) and serum ferritin levels differ between patients with narcolepsy type 1 (NT1) comorbid with restless legs syndrome (RLS) or periodic leg movements during sleep (PLMS), and patients with NT1 or controls without comorbid RLS or PLMS.MethodsSixty‐six drug‐free patients with NT1 (44 males, age 38.5 years [14–81]) were enrolled, including 20 with RLS, 18 with PLMS index ≥15/h (six with both RLS and PLMS). Thirty‐eight drug‐free patients (12 males, age 22.5 years [12–61]) referred for sleepiness complaint, but without central hypersomnia, RLS, PLMS were included as controls. Clinical, electrophysiological and biological (CSF/serum ferritin, orexin [ORX]) data were quantified.ResultsNT1 patients with and without RLS did not differ for age, gender, and body mass index (BMI). No between‐group differences were found for CSF ferritin, ORX, and serum ferritin levels. No CSF ferritin, ORX, and serum ferritin level differences were found between NT1 patients with and without PLMS, or with RLS or PLMS versus not. CSF‐ferritin levels were not different between NT1 and controls in adjusted analyses. CSF‐ferritin levels in the whole population correlated positively with age, serum‐ferritin, BMI, negatively with ORX, but not with PLMS index. In NT1, CSF‐ferritin levels correlated with age and serum‐ferritin but not with PLMS.ConclusionThe absence of CSF ferritin deficiency in NT1 with comorbid RLS or PLMS indicates normal brain iron levels in that condition. This result suggests that the frequent association between RLS, PLMS, and NT1 is not based on alterations in brain iron metabolism, a pathophysiological mechanism involved in primary RLS.

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Different Periodicity and Time Structure of Leg Movements During Sleep in Narcolepsy/Cataplexy and Restless Legs Syndrome

Cited by 133 publications

References 26 publications

The AASM Scoring Manual Four Years Later

The AASM Scoring Manual Four Years Later

Home Sleep-Monitoring Devices: Bridging the Periodic Limb Movement in Sleep Information Gap

CSF and serum ferritin levels in narcolepsy type 1 comorbid with restless legs syndrome

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