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Correlates of PLMs variability over multiple nights and impact upon RLS diagnosis.

Lynn Marie Trotti1, Donald L Bliwise, Sophia A Greer

  • 1Department of Neurology and Program in Sleep, Emory University, 101 Woodruff Circle-WMRB, Suite 6000, Atlanta, GA 30322, USA. lbecke2@emory.edu

Sleep Medicine
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Summary

Nightly leg movements in restless legs syndrome (RLS) vary significantly, impacting diagnosis. More recording nights increase the chance of meeting diagnostic criteria for periodic leg movements (PLMs).

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Area of Science:

  • Neurology
  • Sleep Medicine
  • Biomedical Engineering

Background:

  • Restless legs syndrome (RLS) is a neurological disorder characterized by an urge to move the legs.
  • Periodic leg movements (PLMs) during sleep are a common feature associated with RLS.
  • Understanding the variability of PLMs is crucial for accurate diagnosis and management of RLS.

Purpose of the Study:

  • To quantify the night-to-night variability of periodic leg movements (PLMs) in individuals with restless legs syndrome (RLS).
  • To assess the impact of PLM variability on the diagnosis of RLS based on established criteria.
  • To explore potential clinical correlates of PLM variability in RLS patients.

Main Methods:

  • Twenty RLS patients underwent polysomnography using a validated tri-axial accelerometer worn on the ankle for 10-15 consecutive nights.
  • The periodic leg movement index (PLMI) was calculated for each night.
  • Inter-subject and intra-subject variability in PLMI was analyzed.

Main Results:

  • A substantial mean difference of 25.1/h (range: 3.9-73.8) was observed in PLMI between the lowest and highest recording nights within individuals.
  • Inter-subject variability in PLMI was approximately five times greater than intra-subject variability.
  • Using standard PLMI criteria (5, 10, or 15/h), a single night's recording captured the threshold in 34.1%-70.1% of patients, while five nights increased detection to 62.7%-91.2%.

Conclusions:

  • Significant night-to-night variability in PLMs exists within RLS patients, although an individual's characteristic PLM level can be a quantitative trait.
  • PLM variability was not associated with age, RLS severity, sleepiness, functional status, or mood.
  • Increasing the number of recording nights enhances the probability of meeting diagnostic criteria for PLMs in RLS.