Computer-Assisted Detection of Nocturnal Leg Motor Activity in Patients with Restless Legs Syndrome and Periodic Leg Movements During Sleep

Ferri, Raffaele; Zucconi, Marco; Manconi, Mauro; Bruni, Oliviero; Miano, Silvia; Plazzi, Giuseppe; Ferini‐Strambi, Luigi

doi:10.1093/sleep/28.8.998

Cited by 56 publications

(43 citation statements)

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“…The diagnostic criteria for PLMS [1] identify a spectrum of leg movements with an apparently common PSG phenotype, which may include motor events with a different pathogenesis in terms of neurotransmitter or nervous pathways implicated in their generation. Recently, the investigation of the time structure of leg movements by means of a new analysis [19], has enabled detection of considerable differences in several parameters, such as periodicity, duration, and sleep stage distribution, between PLMS in RLS [20] and those associated with narcolepsy [21] or with REM sleep behaviour disorder [22]. These differences are not detectable by means of the simple conventional PLMS scoring method and corroborate the idea of a possible pathogenetic heterogeneity in the phenomenon generically defined as PLMS.…”

Section: Discussionmentioning

confidence: 99%

Periodic leg movements in Cheyne-Stokes respiration

Manconi

Vitale

Ferri

et al. 2008

European Respiratory Journal

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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: 99%

Periodic leg movements in Cheyne-Stokes respiration

Manconi

Vitale

Ferri

et al. 2008

European Respiratory Journal

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“…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%

The AASM Scoring Manual Four Years Later

Grigg-Damberger

2012

Journal of Clinical Sleep Medicine

119

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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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“…With this software, the detection is performed using a human-supervised automatic approach controlled by the scorer that uses ASDA 16 criteria. The performance of this system has been evaluated and validated, 23 but, in this study, one scorer visually edited the detections proposed by the automatic analysis before computing a final result. In particular, the total LM Index was calculated to represent the total number of LM per hour of sleep, whereas the PLM index was calculated as the number of LMs included in a series of 4 of more PLMs, separated by more than 5 seconds and less than 90 seconds, per hour of sleep.…”

Section: Sleep Scoring and Detection Of Lmsmentioning

confidence: 99%