Circadian rhythm of periodic limb movements and sensory symptoms of restless legs syndrome

The symptoms of restless legs syndrome (RLS) worsen while patients are sitting or lying and also worsen at night. The current study was designed to determine if the periodic limb movements (PLMs) and sensory symptoms of RLS are modulated by an independent circadian factor. We recorded sleeping and waking PLMs and waking sensory symptoms in eight volunteers with RLS for 3 successive nights and days, starting with a polysomnographic recording of 2 nights, followed by a third night of sleep deprivation and the day after sleep deprivation. This study showed that both the PLMs and sensory symptoms were worst at night with a maximum for both between midnight and 1:00 AM and a minimum between 9:00 and 11:00 AM. Sleep and drowsiness had a tendency to worsen PLMs and sensory symptoms after the night of sleep deprivation. Circadian temperature curves were normal in all four patients with adequate data collection. The highest PLM counts occurred on the falling phase of the circadian temperature curve whereas the lowest PLM counts occurred on the rising phase of the curve. We conclude that the PLM and sensory symptoms in RLS are influenced by a circadian rhythm, and that the “worsening at night” criterion of the RLS Definition Criteria is, at least in part, distinct from the “worsening while lying or sitting” criterion.

[1]  W. B. Webb,et al.  The first night effect: an EEG study of sleep. , 1966, Psychophysiology.

[2]  R. Broughton,et al.  Rapid decline in body temperature before sleep: fluffing the physiological pillow? , 1994, Chronobiology international.

[3]  L. Krahn,et al.  Inhibition of presynaptic catecholamine synthesis with alpha-methyl-para-tyrosine attenuates nocturnal melatonin secretion in humans. , 1994, The Journal of clinical endocrinology and metabolism.

[4]  A J Block,et al.  Indications and standards for cardiopulmonary sleep studies. , 1985, Sleep.

[5]  S. Campbell,et al.  Effects of timed bright-light exposure on shift-work adaptation in middle-aged subjects. , 1995, Sleep.

[6]  C. Guilleminault,et al.  Sleep-related periodic myoclonus in patients complaining of insomnia. , 1975, Transactions of the American Neurological Association.

[7]  S. Reuss,et al.  Day- and nighttime content of monoamines and their metabolites in the pineal gland of rat and hamster , 1994, Neuroscience Letters.

[8]  W. Oertel,et al.  L-dopa therapy of uremic and idiopathic restless legs syndrome: a double-blind, crossover trial. , 1995, Sleep.

[9]  R. Coleman.  Periodic movements in sleep (nocturnal myoclonus) and restless legs syndrome , 1982 .

[10]  S. Chokroverty,et al.  Frequent occurrence of myoclonus while awake and at rest, body rocking and marching in place in a subpopulation of patients with restless legs syndrome , 1988, Acta neurologica Scandinavica.

[11]  L. Akpinar.  Restless Legs Syndrome Treatment with Dopaminergic Drugs , 1987, Clinical neuropharmacology.

[12]  C. Guilleminault,et al.  Atlas and scoring rules , 1993 .

[13]  Christopher Earley,et al.  Toward a better definition of the restless legs syndrome , 1995, Movement disorders : official journal of the Movement Disorder Society.

[14]  T. Pollmächer,et al.  Periodic leg movements (PLM): their relationship to sleep stages. , 1993, Sleep.

[15]  M. LimadeFreitas,et al.  Restless legs syndrome and periodic movements during sleep , 1993 .

[16]  W. Oertel,et al.  Bereitschaftspotential in idiopathic and symptomatic restless legs syndrome. , 1993, Electroencephalography and clinical neurophysiology.

[17]  C. I. Bliss.  Statistics in biology. Vol. 2. , 1968 .

[18]  A. Walters,et al.  Dyskinesias while awake and periodic movements in sleep in restless legs syndrome , 1986, Neurology.

[19]  D. Kripke,et al.  Gender differences in the circadian temperature rhythms of healthy elderly subjects: relationships to sleep quality. , 1989, Sleep.

[20]  W. Oertel,et al.  Electrophysiological pattern of involuntary limb movements in the restless legs syndrome , 1996, Muscle & nerve.

[21]  F. Cirignotta,et al.  Nocturnal myoclonus and restless legs syndrome. , 1986, Advances in neurology.

[22]  C. Pollak,et al.  Periodic movements in sleep (nocturnal myoclonus): Relation to sleep disorders , 1980, Annals of neurology.

[23]  P. Badia,et al.  Time-of-night patterns in PLMS activity. , 1992, Sleep.

[24]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .

[25]  D. Lorrain,et al.  Sensory and motor components of the restless legs syndrome , 1992, Neurology.