Ferri Raffaele, Manconi Mauro, Rundo Francesco, Zucconi Marco, Aricò Debora, Bruni Oliviero, Ferini-Strambi Luigi, Fulda Stephany
Sleep Research Centre, Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy.
Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland.
Sleep. 2016 Feb 1;39(2):413-21. doi: 10.5665/sleep.5454.
The aim of this study was to describe and analyze the association between bilateral leg movements (LMs) during sleep in subjects with restless legs syndrome (RLS), in order to eventually support or challenge the current scoring rules defining bilateral LMs.
Polysomnographic recordings of 100 untreated patients with RLS (57 women and 43 males, mean age 57 y) were included. In each recording, we selected as reference all LMs that occurred during sleep and that were separated from another ipsilateral LM by at least 10 sec of EMG inactivity. For each reference LM and an evaluation interval from 5 sec before the onset to 5 sec after the offset of the reference LM, we evaluated (1) the presence or absence of contralateral leg movement activity and (2) the distribution of the onset-to-onset and (3) the offset-to-onset differences between bilateral LMs.
We selected a mean of 368 (± 222 standard deviation [SD]) reference LMs per subject. For 42% (± 22%) of the reference LMs no contralateral leg movement activity was observed within the evaluation interval. In 55% (± 22%) exactly one and in 3% (± 2%) more than one contralateral LM was observed. A further evaluation of events where exactly one contralateral LM was observed showed that in most (1) the two LMs were overlapping (93% ± 9% SD) and (2) were classified as bilateral according to the World Association of Sleep Medicine and the International Restless Legs Syndrome Study Group (WASM/ IRLSSG) (96% ± 6% SD) and (3) the American Academy of Sleep Medicine scoring rules (99% ± 2% SD). Although there was a systematic and statistically significant difference in standard LM indices during sleep based on the two different definitions of bilateral LMs, the size of the difference was not clinically meaningful (maximum individual, absolute difference in LM indices ± 2.5). In addition, we found that the duration of LMs within bilateral LM pairs was longer compared to monolateral LMs and that the duration of the single LMs in bilateral LM pairs tended to correlate.
The results of this study indicate that the two current standard scoring rules for the definition of bilateral LMs during sleep provide largely corresponding classifications in subjects with RLS and, in a clinical context, can be considered to be equivalent.
本研究旨在描述和分析不宁腿综合征（RLS）患者睡眠期间双侧腿部运动（LMs）之间的关联，以便最终支持或质疑当前定义双侧LMs的评分规则。
纳入100例未经治疗的RLS患者（57例女性和43例男性，平均年龄57岁）的多导睡眠图记录。在每次记录中，我们选择所有睡眠期间发生的LMs作为参考，且这些LMs与另一个同侧LMs之间至少有10秒的肌电图静止期。对于每个参考LMs以及从参考LMs开始前5秒到结束后5秒的评估间隔，我们评估了（1）对侧腿部运动活动的有无，（2）双侧LMs开始到开始的分布情况，以及（3）双侧LMs结束到开始的差异。
我们为每位受试者平均选择了368个（±222标准差[SD]）参考LMs。在评估间隔内，42%（±22%）的参考LMs未观察到对侧腿部运动活动。55%（±22%）恰好观察到一次对侧LMs，3%（±2%）观察到不止一次对侧LMs。对恰好观察到一次对侧LMs的事件进行的进一步评估表明，在大多数情况下：（1）两个LMs重叠（93%±9%SD）；（2）根据世界睡眠医学协会和国际不宁腿综合征研究组（WASM/IRLSSG）被分类为双侧（96%±6%SD）；（3）根据美国睡眠医学学会评分规则被分类为双侧（99%±2%SD）。尽管基于双侧LMs的两种不同定义，睡眠期间标准LMs指数存在系统性且具有统计学意义的差异，但差异大小在临床上并无意义（个体最大绝对差异在LMs指数±2.5以内）。此外，我们发现双侧LM对中的LMs持续时间比单侧LMs更长，且双侧LM对中单个LMs的持续时间往往具有相关性。
本研究结果表明，目前用于定义睡眠期间双侧LMs的两种标准评分规则在RLS患者中提供了大致对应的分类，在临床背景下可被视为等效。
