Periodic leg movements during sleep in narcoleptic patients with or without restless legs syndrome

We compared periodic and non‐periodic leg movements during sleep and polysomnography in patients with narcolepsy with cataplexy (NC) with or without restless legs syndrome (RLS) with matched idiopathic RLS (iRLS) and control subjects. We enrolled 100 patients with NC: 17 having RLS were compared with 34 sex‐ and age‐matched patients without RLS and with 17 normal controls and 17 iRLS subjects. Periodic leg movements were highest in iRLS and lowest in controls, with those in NC with RLS very close to iRLS, but higher than those in NC without RLS. The periodicity indexes showed the highest value in iRLS followed by NC with or without RLS and, finally, by controls. The inter‐leg movement intervals peaked between 10 and 50 s in NC with RLS and in iRLS, the former did not display the nocturnal gradual decrease of periodic leg movements typical of iRLS. Periodic leg movements during sleep and polysomnography displayed specific features in RLS and NC, respectively, with NC with RLS showing an intermediate pattern. Even if RLS is only detected by targeted interview in NC, its frequency and impact on night‐time sleep architecture and continuity suggest that this condition should be routinely searched for in NC.

[1]  M. Billiard [Narcolepsy-cataplexy]. , 2019, Schweizer Archiv fur Neurologie und Psychiatrie.

[2]  J. Montplaisir,et al.  Autonomic response to periodic leg movements during sleep in narcolepsy-cataplexy. , 2011, Sleep.

[3]  G. Plazzi,et al.  Restless legs syndrome is frequent in narcolepsy with cataplexy patients. , 2010, Sleep.

[4]  S. Gammeltoft,et al.  Rapid eye movement sleep behaviour disorder in patients with narcolepsy is associated with hypocretin-1 deficiency. , 2010, Brain : a journal of neurology.

[5]  M. Xi,et al.  State-dependent control of lumbar motoneurons by the hypocretinergic system , 2010, Experimental Neurology.

[6]  E. Caylak The genetics of sleep disorders in humans: Narcolepsy, restless legs syndrome, and obstructive sleep apnea syndrome , 2009, American journal of medical genetics. Part A.

[7]  F. Poli,et al.  Searching for a marker of REM sleep behavior disorder: submentalis muscle EMG amplitude analysis during sleep in patients with narcolepsy/cataplexy. , 2008, Sleep.

[8]  O. Bruni,et al.  Age-related changes in periodic leg movements during sleep in patients with restless legs syndrome. , 2008, Sleep medicine.

[9]  Giuseppe Plazzi,et al.  Nocturnal aspects of narcolepsy with cataplexy. , 2008, Sleep medicine reviews.

[10]  J. Montplaisir,et al.  Periodic leg movements during sleep and wakefulness in narcolepsy , 2007, Journal of sleep research.

[11]  F. De Carli,et al.  A model-based approach to homeostatic and ultradian aspects of nocturnal sleep structure in narcolepsy. , 2007, Sleep.

[12]  E. Mignot,et al.  Different periodicity and time structure of leg movements during sleep in narcolepsy/cataplexy and restless legs syndrome. , 2006, Sleep.

[13]  Julie Carrier,et al.  PLMS and PLMW in healthy subjects as a function of age: prevalence and interval distribution. , 2006, Sleep.

[14]  G. Plazzi,et al.  New approaches to the study of periodic leg movements during sleep in restless legs syndrome. , 2006, Sleep.

[15]  M. Terzano,et al.  The official World Association of Sleep Medicine (WASM) standards for recording and scoring periodic leg movements in sleep (PLMS) and wakefulness (PLMW) developed in collaboration with a task force from the International Restless Legs Syndrome Study Group (IRLSSG). , 2006, Sleep medicine.

[16]  Giuseppe Plazzi,et al.  Computer-assisted detection of nocturnal leg motor activity in patients with restless legs syndrome and periodic leg movements during sleep. , 2005, Sleep.

[17]  E. Sforza,et al.  Night-to-night variability in periodic leg movements in patients with restless legs syndrome. , 2005, Sleep medicine.

[18]  J. Montplaisir,et al.  Clinical aspects and pathophysiology of narcolepsy , 2003, Clinical Neurophysiology.

[19]  J. Zeitlhofer,et al.  Urinary 6‐hydroxy‐melatonin‐sulfate excretion and circadian rhythm in patients with restless legs syndrome , 2003, Journal of pineal research.

[20]  Christopher J. Earley,et al.  Restless legs syndrome , 2003, Current treatment options in neurology.

[21]  R. Chervin Epworth sleepiness scale? , 2003, Sleep medicine.

[22]  Richard P Allen,et al.  Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. , 2003, Sleep medicine.

[23]  G. Plazzi,et al.  Italian version of the Epworth sleepiness scale: external validity , 2003, Neurological Sciences.

[24]  C. Trenkwalder,et al.  Endocrine rhythms in patients with restless legs syndrome , 2002, Journal of Neurology.

[25]  P. Achermann,et al.  Sleep Homeostasis and Models of Sleep Regulation , 1999, Journal of biological rhythms.

[26]  A. Walters,et al.  Circadian rhythm of motor restlessness and sensory symptoms in the idiopathic restless legs syndrome. , 1999, Sleep.

[27]  S. Chokroverty,et al.  Circadian rhythm of periodic limb movements and sensory symptoms of restless legs syndrome , 1999, Movement disorders : official journal of the Movement Disorder Society.

[28]  A Värri,et al.  A simple format for exchange of digitized polygraphic recordings. , 1992, Electroencephalography and clinical neurophysiology.

[29]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[30]  J A Hobson,et al.  Neuronal excitability modulation over the sleep cycle: a structural and mathematical model. , 1975, Science.

[31]  E. Wolpert A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. , 1969 .

[32]  A. Chesson,et al.  The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Techinical Specifications , 2007 .

[33]  A. Chesson,et al.  The American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications , 2007 .

[34]  Zhang Jing-xing,et al.  Brief introduction to second edition of International Classification of Sleep Disorders:Diagnostic and Coding Manual , 2007 .

[35]  M. Littner,et al.  Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. , 2005, Sleep.

[36]  Richard P Allen,et al.  Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. , 2003, Sleep medicine.

[37]  A. Borbély A two process model of sleep regulation. , 1982, Human neurobiology.

[38]  A. Rechtschaffen A manual of standardized terminology, techniques and scoring system for sleep of human subjects , 1968 .