Benes Heike, Kohnen Ralf
Somni Bene Institute for Medical Research and Sleep Medicine Schwerin and Neurology Department, University of Rostock, Germany.
Sleep Med. 2009 May;10(5):515-23. doi: 10.1016/j.sleep.2008.06.006. Epub 2008 Sep 26.
There is a need for structured methods to improve sensitivity and specificity of diagnostic decision making in Restless Legs Syndrome (RLS). We present the RLS-Diagnostic Index (RLS-DI), a diagnostic algorithm which combines essential and supportive diagnostic criteria from patient interviews, polysomnography and neurological examination in an adaptive procedure.
The RLS-DI consists of 10 items which are related to the essential diagnostic criteria established by the International RLS Study Group (five items) as well as their supportive criteria (3 items) and features associated with RLS (2 items). Items have to be completed using three categories per item that address frequency of occurrence of symptoms or certainty of presence or absence of other diagnostic information. Negative weights were given when the clinically most relevant items were not present. The RLS-DI was administered in a telephone interview to 179 patients (86 with RLS, 93 with other sleep disorders) of the 21 month cohort of one sleep center in Germany.
With receiver-operating characteristics, a cut-off of >or= 11 points on a scale ranging from -22 (no RLS) to 20 (definite RLS) was identified by comparing the RLS-DI total score to the diagnosis of two independent sleep experts. Sensitivity was 93.0%, specificity was 98.9%, and 96.1% of the patients could be correctly diagnosed. Specificity was higher in items related to supportive or associated diagnostic information (95.7%) than in those related to the essential diagnostic criteria (81.7%). Patients with RLS scored a higher RLS-DI than those with primary insomnia or other neurological or psychiatric disorders (p < .001).
The RLS-DI demonstrated the ability to validly diagnose an actual and persistently present Restless Legs Syndrome in patients of a sleep lab population and to exclude those patients whose sleep disturbances have other causes.
需要采用结构化方法来提高不宁腿综合征（RLS）诊断决策的敏感性和特异性。我们提出了RLS诊断指数（RLS-DI），这是一种诊断算法，它在一个适应性程序中结合了患者访谈、多导睡眠图和神经学检查中的基本和支持性诊断标准。
RLS-DI由10个项目组成，这些项目与国际RLS研究小组确立的基本诊断标准（5个项目）及其支持性标准（3个项目）以及与RLS相关的特征（2个项目）相关。每个项目必须使用三个类别来完成，这三个类别涉及症状出现的频率或其他诊断信息存在或不存在的确定性。当临床上最相关的项目不存在时给予负权重。在德国一个睡眠中心对21个月队列中的179名患者（86名患有RLS，93名患有其他睡眠障碍）进行了电话访谈，实施了RLS-DI。
通过将RLS-DI总分与两名独立睡眠专家的诊断进行比较，采用受试者工作特征曲线，确定了在从-22（无RLS）到20（确诊RLS）的量表上≥11分的临界值。敏感性为93.0%，特异性为98.9%，96.1%的患者能够被正确诊断。与支持性或相关诊断信息相关的项目的特异性（95.7%）高于与基本诊断标准相关的项目（81.7%）。患有RLS的患者的RLS-DI得分高于原发性失眠或其他神经或精神疾病患者（p<0.001）。
RLS-DI证明了能够有效诊断睡眠实验室人群中实际且持续存在的不宁腿综合征，并排除那些睡眠障碍有其他原因的患者。
