Hooper Robert G
The Sleep Center, Scottsdale, AZ, USA.
Nat Sci Sleep. 2018 Apr 27;10:127-134. doi: 10.2147/NSS.S147742. eCollection 2018.
Periodic limb movements (PLMs) are routinely measured during polysomnogram (PSG) testing. During the early years of sleep testing, physical movements were identified and over time, consensus ultimately led to the current definitions of movement disorders including criteria used to measure PLMs on PSG testing. There has been considerable debate about the clinical importance of the PLMs measured during PSG testing. Over the last decade, the author has observed significant variations in the actual visible physical movements observed with a PLM event. This report is the result of work to quantify the amount of movement and the frequency of movements observed among individuals who have PLMs.
METHODS/PRINCIPAL FINDINGS: Consecutive PSGs performed in a suburban sleep center for an initial diagnosis of a sleep disorder were retrospectively reviewed to identify those with measured PLMs. Of 646 studies on patients >18 years, 460 met criteria for inclusion. Visual assessment of movements was carried out on all of those with PLM events measured using American Academy of Sleep Medicine guidelines. The movements were quantified based on the number of extremities observed to move. PLMs were observed in 237 of the 460 studies that met inclusion criteria (52%). As expected, the PLMs occurred more frequently in older individuals. PLMs occurred with equal frequency in both sexes. Apnea occurred with equal frequency in those with and without observed physical movements. Of those with PLMs, 62% (147) demonstrated observable physical movements. Significant movements involving three or four extremities occurred in 16% of individuals with PLMs. No physical movements were observed in 38%.
In this uncontrolled, nonrandom, observational series, visual physical movements with a PLM event identify a unique subset of individuals with PLMs. The presence of any visual movements or more pronounced visual movements involving multiple extremities may represent markers for PLM disorder, for clinically significant PLMs with other disorders, or for other clinical conditions or physiologic variables.
在多导睡眠图（PSG）测试期间会常规测量周期性肢体运动（PLMs）。在睡眠测试的早期，人们识别出了身体运动，随着时间的推移，最终达成共识，形成了当前运动障碍的定义，包括用于在PSG测试中测量PLMs的标准。关于PSG测试期间测量的PLMs的临床重要性存在相当多的争论。在过去十年中，作者观察到PLM事件中实际可见的身体运动存在显著差异。本报告是对有PLMs的个体中观察到的运动量和运动频率进行量化工作的结果。
方法/主要发现：对在郊区睡眠中心进行的用于初步诊断睡眠障碍的连续PSG进行回顾性分析，以识别那些测量到PLMs的患者。在对18岁以上患者进行的646项研究中，460项符合纳入标准。根据美国睡眠医学学会指南，对所有有PLM事件测量结果的患者进行运动的视觉评估。根据观察到移动的肢体数量对运动进行量化。在符合纳入标准的460项研究中，有237项观察到了PLMs（52%）。正如预期的那样，PLMs在老年人中更频繁出现。PLMs在男女中出现的频率相同。有身体运动和无身体运动的患者中呼吸暂停出现的频率相同。在有PLMs的患者中，62%（147例）表现出可观察到的身体运动。16%有PLMs的个体出现了涉及三个或四个肢体的显著运动。38%未观察到身体运动。
在这个非对照、非随机的观察系列中，PLM事件中的视觉身体运动识别出了有PLMs的个体的一个独特子集。任何视觉运动或涉及多个肢体的更明显视觉运动的存在可能代表PLM障碍、伴有其他障碍的具有临床意义的PLMs或其他临床状况或生理变量的标志物。
