Video-polysomnographic characterization of sleep movements in children with restless sleep disorder

Bruni

Journal of Clinical Sleep Medicine

2020

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Study Objectives: Restless sleep disorder (RSD) has recently been characterized clinically and polysomnographically in children and differentiated from restless legs syndrome (RLS). Heart rate variability is a reliable method to quantify autonomic changes during sleep. The aim of this study was to characterize heart rate variability in children with RSD, RLS, and individuals without these disorders, with the hypothesis that children with RSD have a shift toward sympathetic predominance during sleep. Methods: We analyzed polysomnographic recordings from 32 children who fulfilled RSD diagnostic criteria (19 boys and 13 girls), 32 children with RLS (20 boys and 12 girls), and 33 individuals without disorders (17 boys and 16 girls). Four electrocardiographic epochs were chosen, 1 for each stage, and were analyzed for automatic detection of R waves. Time domain and frequency domain heart rate variability parameters were obtained and analyzed. Results: In terms of time domain, only the standard deviation of the average interval between successive R waves during stage N3 was slightly but significantly higher in patients with RSD than in patients with RLS. In terms of frequency domain, in patients with RSD, the very-low-frequency and low-frequency bands were increased (vs patients with RLS and individuals without disorders, respectively), whereas low-frequency/high-frequency ratio tended to be increased in both patients with RSD and with RLS. In rapid eye movement sleep, low-frequency/high-frequency ratio was increased in both patients with RSD and with RLS. The low-frequency/high-frequency ratio increased in patients with RLS during quiet wakefulness preceding sleep. Conclusions: Children with RSD have increased sympathetic activation during sleep, particularly N3 and rapid eye movement sleep, compared with individuals without disorders but, as expected, not during wakefulness. Differently, children with RLS have sympathetic activation during relaxed wakefulness preceding sleep and during sleep.

Section: Introductionmentioning

confidence: 96%

Heart rate variability during sleep in children and adolescents with restless sleep disorder: a comparison with restless legs syndrome and normal controls

Bruni

Journal of Clinical Sleep Medicine

2020

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“…In the authors’ opinion, both diagnoses can coexist; as we see in our cohort, 34 children exhibited parasomnias but did not have symptoms consistent with RSD, compared to six with parasomnia and RSD. A similar situation is seen with habitual snoring, which has a large prevalence in the general paediatric population (about 12%) (Lumeng & Chervin, ) but can be easily differentiated from RSD by clinical and polysomnographic characteristics (DelRosso et al., ).…”

Section: Discussionmentioning

confidence: 78%

“…Sleep‐related diagnoses were carried out according to the American Academy of Sleep Medicine (). In addition, the following recently published criteria for the newly identified RSD were also applied in order to identify it among this sample of patients (DelRosso et al., ). (a) The child exhibits a pattern of sleep characterized by ‘restless sleep’ or motor behaviours involving large muscle groups.…”

Section: Methodsmentioning

confidence: 99%

“…In the first two studies published on RSD, we have also indicated clear and systematic criteria for the diagnosis of RSD; however, it is not clear yet how many children would be affected in the general population with the application of the proposed criteria (DelRosso et al., , ). For this, a systematic population study would be needed that requires time, effort and adequate funding, which are not yet available.…”

Section: Introductionmentioning

confidence: 97%

“…We recently identified, in children and adolescents, a potentially new sleep diagnosis called ‘restless sleep disorder’ (RSD), characterized clinically by sleep disruption, frequent nocturnal body movements involving large muscle groups and daytime impairment (DelRosso, Bruni, & Ferri, ). Video‐polysomnographically, patients affected by RSD present with an increased number of body movements (>5/hr), reduced total sleep time and increased number of awakenings, similarly to children with restless legs syndrome (RLS) but without the classic leg movement activity (DelRosso, Jackson, Trotter, Bruni, & Ferri, ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The prevalence of restless sleep disorder among a clinical sample of children and adolescents referred to a sleep centre

Journal of Sleep Research

2019

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Restless sleep disorder (RSD) is a newly described sleep disorder in children characterized by large body movements and repositioning that lasts all night with at least five body movements per hour and a significant impact on daytime behaviours. The authors have previously identified and described the syndrome and compared the sleep parameters and sleep‐related movements to those in children with restless legs syndrome, normal controls and snorers. The current study is a retrospective review of the sleep diagnosis in 300 consecutive children seen and evaluated in a single sleep disorders centre; 252 children underwent polysomnography, as clinically indicated, to identify the proper diagnosis. The current research estimates the prevalence of RSD in a sleep clinical setting to be 7.7% and compares it to the prevalence of other common sleep disorders in the same setting. Another important addition to the literature is the fact that RSD can coexist with other sleep disorders, such as habitual snoring and parasomnia, without confounding the diagnosis.

Restless sleep disorder, restless legs syndrome, and periodic limb movement disorder—Sleep in motion!

Mogavero

2021

Pediatric Pulmonology

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Sleep‐related movement disorders (SRMDs) represent an important part of pediatric sleep disorders. The most common complaint in SRMD is restless sleep at night. Restless sleep is reported in up to 80% of children with restless legs syndrome (RLS) and children with periodic limb movements of sleep (PLMS) disorder (PLMD). However, restless sleep causing daytime behavioral consequences can be seen in children without another apparent condition and has recently been identified as a new independent primary pediatric sleep disorder, called restless sleep disorder (RSD). This study describes these three main SRMDs (RSD, RLS, and PLMD), explains the new consensus criteria for RSD, emphasizes the rapidly evolving areas of research in this field, and proposes recommendations for future research. In particular, the published data constitute convincing evidence that sleep‐related movements are disruptors of sleep quality and continuity. However, while important advancements have recently been reported in adults, a detailed analysis of the phenomenology and consequences of sleep‐related movements has just started in children. New approaches, standardized diagnostic methods, and specific guidelines are needed in the field of pediatric SRMD.