Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring

Marilyn Moro,1 Balaji Goparaju,1 Jelina Castillo,1 Yvonne Alameddine,1 Matt T Bianchi1,2 1Neurology Department, Massachusetts General Hospital, 2Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Introduction: Periodic limb movements of sleep (PLMS) may increase cardiovascular and c...

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Autores principales:	Moro M, Goparaju B, Castillo J, Alameddine Y, Bianchi MT
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	periodic limb movements polysomnography predictors sleep decision analysis cost effectiveness diagnostic Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
Acceso en línea:	https://doaj.org/article/39f68823f2624394a93eb51bd31ac26a
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spelling	oai:doaj.org-article:39f68823f2624394a93eb51bd31ac26a2021-12-02T05:58:04ZPeriodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring1179-1608https://doaj.org/article/39f68823f2624394a93eb51bd31ac26a2016-08-01T00:00:00Zhttps://www.dovepress.com/periodic-limb-movements-of-sleep-empirical-and-theoretical-evidence-su-peer-reviewed-article-NSShttps://doaj.org/toc/1179-1608Marilyn Moro,1 Balaji Goparaju,1 Jelina Castillo,1 Yvonne Alameddine,1 Matt T Bianchi1,2 1Neurology Department, Massachusetts General Hospital, 2Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Introduction: Periodic limb movements of sleep (PLMS) may increase cardiovascular and cerebrovascular morbidity. However, most people with PLMS are either asymptomatic or have nonspecific symptoms. Therefore, predicting elevated PLMS in the absence of restless legs syndrome remains an important clinical challenge.Methods: We undertook a retrospective analysis of demographic data, subjective symptoms, and objective polysomnography (PSG) findings in a clinical cohort with or without obstructive sleep apnea (OSA) from our laboratory (n=443 with OSA, n=209 without OSA). Correlation analysis and regression modeling were performed to determine predictors of periodic limb movement index (PLMI). Markov decision analysis with TreeAge software compared strategies to detect PLMS: in-laboratory PSG, at-home testing, and a clinical prediction tool based on the regression analysis.Results: Elevated PLMI values (>15 per hour) were observed in >25% of patients. PLMI values in No-OSA patients correlated with age, sex, self-reported nocturnal leg jerks, restless legs syndrome symptoms, and hypertension. In OSA patients, PLMI correlated only with age and self-reported psychiatric medications. Regression models indicated only a modest predictive value of demographics, symptoms, and clinical history. Decision modeling suggests that at-home testing is favored as the pretest probability of PLMS increases, given plausible assumptions regarding PLMS morbidity, costs, and assumed benefits of pharmacological therapy.Conclusion: Although elevated PLMI values were commonly observed, routinely acquired clinical information had only weak predictive utility. As the clinical importance of elevated PLMI continues to evolve, it is likely that objective measures such as PSG or at-home PLMS monitors will prove increasingly important for clinical and research endeavors.Keywords: periodic limb movements, polysomnography, predictors, sleep, decision analysis, cost-effectiveness, diagnosticMoro MGoparaju BCastillo JAlameddine YBianchi MTDove Medical Pressarticleperiodic limb movementspolysomnographypredictorssleepdecision analysiscosteffectivenessdiagnosticPsychiatryRC435-571Neurophysiology and neuropsychologyQP351-495ENNature and Science of Sleep, Vol 2016, Iss Issue 1, Pp 277-289 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	periodic limb movements polysomnography predictors sleep decision analysis cost effectiveness diagnostic Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
spellingShingle	periodic limb movements polysomnography predictors sleep decision analysis cost effectiveness diagnostic Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495 Moro M Goparaju B Castillo J Alameddine Y Bianchi MT Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring
description	Marilyn Moro,1 Balaji Goparaju,1 Jelina Castillo,1 Yvonne Alameddine,1 Matt T Bianchi1,2 1Neurology Department, Massachusetts General Hospital, 2Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Introduction: Periodic limb movements of sleep (PLMS) may increase cardiovascular and cerebrovascular morbidity. However, most people with PLMS are either asymptomatic or have nonspecific symptoms. Therefore, predicting elevated PLMS in the absence of restless legs syndrome remains an important clinical challenge.Methods: We undertook a retrospective analysis of demographic data, subjective symptoms, and objective polysomnography (PSG) findings in a clinical cohort with or without obstructive sleep apnea (OSA) from our laboratory (n=443 with OSA, n=209 without OSA). Correlation analysis and regression modeling were performed to determine predictors of periodic limb movement index (PLMI). Markov decision analysis with TreeAge software compared strategies to detect PLMS: in-laboratory PSG, at-home testing, and a clinical prediction tool based on the regression analysis.Results: Elevated PLMI values (>15 per hour) were observed in >25% of patients. PLMI values in No-OSA patients correlated with age, sex, self-reported nocturnal leg jerks, restless legs syndrome symptoms, and hypertension. In OSA patients, PLMI correlated only with age and self-reported psychiatric medications. Regression models indicated only a modest predictive value of demographics, symptoms, and clinical history. Decision modeling suggests that at-home testing is favored as the pretest probability of PLMS increases, given plausible assumptions regarding PLMS morbidity, costs, and assumed benefits of pharmacological therapy.Conclusion: Although elevated PLMI values were commonly observed, routinely acquired clinical information had only weak predictive utility. As the clinical importance of elevated PLMI continues to evolve, it is likely that objective measures such as PSG or at-home PLMS monitors will prove increasingly important for clinical and research endeavors.Keywords: periodic limb movements, polysomnography, predictors, sleep, decision analysis, cost-effectiveness, diagnostic
format	article
author	Moro M Goparaju B Castillo J Alameddine Y Bianchi MT
author_facet	Moro M Goparaju B Castillo J Alameddine Y Bianchi MT
author_sort	Moro M
title	Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring
title_short	Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring
title_full	Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring
title_fullStr	Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring
title_full_unstemmed	Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring
title_sort	periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/39f68823f2624394a93eb51bd31ac26a
work_keys_str_mv	AT morom periodiclimbmovementsofsleepempiricalandtheoreticalevidencesupportingobjectiveathomemonitoring AT goparajub periodiclimbmovementsofsleepempiricalandtheoreticalevidencesupportingobjectiveathomemonitoring AT castilloj periodiclimbmovementsofsleepempiricalandtheoreticalevidencesupportingobjectiveathomemonitoring AT alameddiney periodiclimbmovementsofsleepempiricalandtheoreticalevidencesupportingobjectiveathomemonitoring AT bianchimt periodiclimbmovementsofsleepempiricalandtheoreticalevidencesupportingobjectiveathomemonitoring
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Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring

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