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. 2024 Jul 11;47(7):zsae113.
doi: 10.1093/sleep/zsae113.

Large muscle group movements during sleep in restless leg syndrome: neurophysiological and clinical implications

Maria P Mogavero  1   2 , Patrizia Congiu  3 , Giuseppe Lanza  4   5 , Sara Marelli  1   2 , Alessandra Castelnuovo  1   2 , Monica Puligheddu  3 , Lourdes M DelRosso  6 , Luigi Ferini Strambi  1   2 , Raffaele Ferri  4
Affiliations

Large muscle group movements during sleep in restless leg syndrome: neurophysiological and clinical implications

Maria P Mogavero et al. Sleep. .

Abstract

Study objectives: Recently, criteria have been drawn up for large muscle group movements during sleep (LMM), defined as movements lasting for 3-45 seconds in adults, which are often accompanied by changes in sleep stage, arousals, and increases in heart rate. The aim of this study was to characterize LMM in restless legs syndrome (RLS) in order to better evaluate their impact on the neurophysiology of the disorder and, therefore, the possible clinical implications.

Methods: Consecutive, drug-free patients diagnosed with RLS and controls, aged 18 years or more, were retrospectively enrolled. Leg movement activity-short-interval (SILMS), periodic (PLMS), and isolated (ISOLMS) leg movements during sleep-and LMM were detected and scored.

Results: In total, 100 patients and 67 controls were recruited. All movement measures were significantly higher in RLS. A significant positive correlation was found between LMM and ISOLMS index but not PLMS index in both groups. LMM index showed a significant negative correlation with total sleep time, sleep efficiency, and percentage of sleep stages N3 and R, as well as a significant positive correlation with the number of awakenings, and percentage of sleep stages N1 and N2 only in patients with RLS. No significant correlation was found between either LMM or PLMS index and RLS severity.

Conclusions: Different types of movements, including SILMS, ISOLMS, and LMM, play somewhat distinct roles in sleep neurophysiology in RLS. Notably, LMM, a newly recognized category of movements, demonstrates associations with sleep architecture instability and fragmentation, arousals, and awakenings, suggesting potential clinical implications.

Keywords: arousals; isolated leg movements during sleep; large muscle group movements during sleep; periodic leg movements during sleep; restless legs syndrome; sleep-related movements.

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Figures

Figure 1.
Figure 1.
Top graphs: graphic representation of the correlation between total LMM index in TST and PLMS index in patients with RLS (panel A) and controls (panel B). Bottom graphs: a graphic representation of the correlation between total LMM index in TST and ISOLMS index in patients with RLS (panel C) and controls (panel D). In each panel, also the linear regression line (continuous line) is shown along with the 95% prediction lines indicating the area of the graph within which new observations would be expected to occur, with a 95% probability.
See this image and copyright information in PMC

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