Dickel M J, Renfrow S D, Moore P T, Berry R B
Long Beach VA Hospital, California.
Sleep. 1994 Dec;17(8):733-8. doi: 10.1093/sleep/17.8.733.
We describe three spinal cord injury cases exhibiting periodic leg movements (PLMs) in both rapid eye movement (REM) and nonrapid eye movement (NREM) sleep. The difference in the average periodicity in REM and NREM sleep was modest, but was generally shorter in REM than in NREM sleep. However, the variability associated with the PLMs was nearly three to six times smaller in REM than in NREM sleep, suggesting that the periodicity of the PLMs in REM sleep was more precise than in NREM sleep. The finding of PLMs in these patients suggests that a spinal cord injury may permit the expression of a spinal PLM generator, which may be an unusual presentation of a spinal locomotor generator. The PLM generator would be displayed when the descending inhibitory spinal pathways are interrupted by a spinal injury. The rapid periodicity of the PLM generator in REM sleep, compared with NREM sleep, may result from an increase in sympathetic activity normally accompanying this sleep state. Alternative explanations for the occurrence of PLMs in spinal injury are the influence of adverse sleeping position, age, an increase in circulating catecholamines and peripheral perfusion. We conclude that the presence of PLMs may be an important, but neglected, sleep disorder in spinal cord patients. Therefore, health care professionals should be aware of the possibility of sleep-related PLMs when these patients have sleep and/or waking complaints.
我们描述了三例脊髓损伤病例，这些病例在快速眼动（REM）睡眠和非快速眼动（NREM）睡眠中均表现出周期性腿部运动（PLM）。REM睡眠和NREM睡眠中平均周期的差异不大，但REM睡眠中的周期通常比NREM睡眠中的短。然而，与PLM相关的变异性在REM睡眠中比在NREM睡眠中小近三到六倍，这表明REM睡眠中PLM的周期性比NREM睡眠中更精确。这些患者中出现PLM的发现表明，脊髓损伤可能使脊髓PLM发生器得以表达，这可能是脊髓运动发生器的一种异常表现。当脊髓损伤中断下行抑制性脊髓通路时，PLM发生器就会表现出来。与NREM睡眠相比，REM睡眠中PLM发生器的快速周期性可能是由于这种睡眠状态下通常伴随的交感神经活动增加所致。脊髓损伤中PLM发生的其他解释包括不良睡眠姿势的影响、年龄、循环儿茶酚胺增加和外周灌注。我们得出结论，PLM的存在可能是脊髓损伤患者中一种重要但被忽视的睡眠障碍。因此，当这些患者有睡眠和/或清醒方面的主诉时，医护人员应意识到与睡眠相关的PLM的可能性。
