From the Guidelines
Limb movements in sleep labs should be assessed and treated according to the American Academy of Sleep Medicine clinical practice guideline, which recommends diagnosing and managing restless legs syndrome and periodic limb movement disorder based on frequency of movements and associated distress or sleep disturbance. The assessment of limb movements during sleep is crucial for diagnosing conditions like periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) 1. These movements are typically measured using surface electromyography (EMG) electrodes placed on the anterior tibialis muscles of both legs.
Key Points to Consider
- A diagnosis of PLMD is made when there are more than 15 movements per hour of sleep in adults and more than 5 movements per hour of sleep in children, often causing sleep fragmentation and daytime sleepiness 1.
- Treatment typically involves medications such as dopamine agonists, gabapentin, or in some cases benzodiazepines, which work by either increasing dopamine activity, modulating calcium channels, or enhancing GABA neurotransmission 1.
- The guideline provides a comprehensive update of the available evidence and a synthesis of clinical practice recommendations for the treatment of RLS and PLMD in adults and children 1.
Management of Limb Movements
The management of limb movements during sleep should focus on reducing the frequency of movements and alleviating associated distress or sleep disturbance 1. This can be achieved through a combination of pharmacological and non-pharmacological interventions, including lifestyle modifications and behavioral therapies.
Pharmacological Interventions
- Dopamine agonists, such as pramipexole or ropinirole, can be effective in reducing the frequency of limb movements and improving sleep quality 1.
- Gabapentin can also be used to reduce the frequency of limb movements and alleviate associated sleep disturbance 1.
- Benzodiazepines, such as clonazepam, may be used in some cases, but their use should be carefully considered due to the risk of dependence and other adverse effects 1.
From the Research
Limb Movements in Sleep Labs
- Limb movements in sleep labs are often associated with sleep-related movement disorders, such as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) 2, 3.
- RLS is a common sleep disorder characterized by an irresistible urge to move the legs, usually accompanied by uncomfortable sensations 3, 4.
- Periodic limb movements of sleep (PLMS) are an electrophysiologic finding commonly accompanying RLS, but most individuals with PLMS do not have RLS 3, 5.
- The clinical significance of PLMS has been argued, and their presence can be a symptom of various sleep disorders, including RLS, narcolepsy, and sleep apnea syndrome 5.
Prevalence and Clinical Significance
- The prevalence of RLS is estimated to be around 5-15% in the general population, and it can present in childhood, with incidence increasing with age 3, 4.
- PLMS are found in 4-11% of adults and are more common in the elderly and in subjects with sleep disturbances 5.
- The clinical relevance of PLMS in primary insomnia is still being debated, with some studies suggesting they may be a symptom of the disease, while others argue they are not clinically significant 5.
Treatment Options
- Treatment options for RLS and PLMD include pharmacologic agents, such as dopaminergic agents, alpha-2 delta calcium channel ligands, opioids, and benzodiazepines, as well as nonpharmacologic therapies, such as iron supplementation and behavioral management 2, 3, 6.
- Dopaminergic agents, such as pergolide and ropinirole, have been shown to be effective in treating RLS, but may lead to augmentation, a limiting factor of long-term use 6, 4.
- Gabapentinoid agents, such as gabapentin enacarbil and pregabalin, have been found to have comparable efficacy to dopaminergics with a lower risk of augmentation 6.