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Inter-movement interval as a primary stable measure of periodic limb movements of sleep.

ABSTRACT: Periodic leg movements in sleep (PLMS) are generally evaluated by the number of events per hour during sleep, but this is an unstable measure with marked nightly variability and also fails to assess the basic periodicity that essentially characterizes these movements. The inter-movement interval (IMI) evaluates a putative biological process producing the period of PLMS. By contrast, the actual number of PLMS reflects the expression of this biological process that would likely be affected by multiple factors, particularly those disrupting sleep. Thus, this study tests the hypothesis that measurement of IMI duration should be more stable over nights in comparison to any measure based on counting the number of movements. IMI approximates a log-normal distribution. This study, therefore, tests the hypothesis that the means of the log IMI are more stable from night 1 (N1) to night 2 (N2) sleep recordings compared with measures of the number of PLMS.PLMS/h and IMI were measured for two consecutive nights of full sleep recordings for 29 restless legs syndrome (RLS) patients not being treated and 22 healthy controls without RLS. N1-N2 difference between nights was measured as percent of average for the nights.Mean log IMI showed little nightly variability (mean?±?SD for RLS: 3.6%?±?3.7, controls: 7.1%?±?7.0) significantly less p?

SUBMITTER: Skeba P

PROVIDER: S-EPMC4744335 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Inter-movement interval as a primary stable measure of periodic limb movements of sleep.

Skeba Patrick P Hiranniramol Kasidet K Earley Christopher J CJ Allen Richard P RP

Sleep medicine 20151111

<h4>Aim</h4>Periodic leg movements in sleep (PLMS) are generally evaluated by the number of events per hour during sleep, but this is an unstable measure with marked nightly variability and also fails to assess the basic periodicity that essentially characterizes these movements. The inter-movement interval (IMI) evaluates a putative biological process producing the period of PLMS. By contrast, the actual number of PLMS reflects the expression of this biological process that would likely be affe ...[more]

PMID: 26847989

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Project description:ObjectiveUsing narrative review techniques, this paper evaluates the evidence for separable underlying patho-mechanisms of periodic limb movements (PLMs) to separable PLM motor patterns and phenotypes, in order to elucidate potential new treatment modalities.BackgroundPeriodic limb movement disorder (PLMD) is estimated to occur in 5-8% of the paediatric population and 4-11% of the general adult population. Due to significant sleep fragmentation, PLMD can lead to functional impairment, including hyperactivity and delayed language development in children, and poor concentration and work performance in adults. Longitudinal data demonstrate that those with PLMD are at greater risk of depression and anxiety, and a 4-fold greater risk of developing dementia. PLMD has been extensively studied over the past two decades, and several key insights into the genetic, pathophysiological, and neural correlates have been proposed. Amongst these proposals is the concept of separable PLM phenotypes, proposed on the basis of nocturnal features such as the ratio of limb movements and distribution throughout the night. PLM phenotype and presentation, however, varies significantly depending on the scoring utilized and the nocturnal features examined, across age, and co-morbid clinical conditions. Furthermore, associations between these phenotypes with major neurologic and psychiatric disorders remain controversial.MethodsIn order to elucidate potential divergent biological pathways that may help clarify important new treatment modalities, this paper utilizes narrative review and evaluates the evidence linking PLM motor patterns and phenotypes with hypothesised underlying patho-mechanisms. Distinctive, underlying patho-mechanisms include: a pure motor mechanism originating in the spinal cord, iron deficiency, dopamine system dysfunction, thalamic glutamatergic hyperactivity, and a more cortical-subcortical interplay. In support of the latter hypothesis, PLM rhythmicity appears tightly linked to the microarchitecture of sleep, not dissimilarly to the apnoeic/hypopneic events seen in obstructive sleep apnea (OSA).ConclusionsThis review closes with a proposal for greater investigation into the identification of potential, divergent biological pathways. To do so would require prospective, multimodal imaging clinical studies which may delineate differential responses to treatment in restless legs syndrome (RLS) without PLMS and PLMS without RLS. This could pave the way toward important new treatment modalities.

Dataset Information

Inter-movement interval as a primary stable measure of periodic limb movements of sleep.

Publications

Inter-movement interval as a primary stable measure of periodic limb movements of sleep.

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