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The PAM-RL ambulatory device for detection of periodic leg movements: a validation study.
Sleep Med. 2005 Sep; 6(5):407-13.SM

Abstract

BACKGROUND AND PURPOSE

Restless legs syndrome (RLS) is usually associated with periodic leg movements (PLM) occurring during wakefulness and sleep. The PLM index obtained by the polysomnographic method reflects the degree of motor symptoms and their consequences on sleep structure. Automated analysis of PLM using actigraphy can assess this condition and can therefore be used to assess therapeutic effects in clinical trials. In the current study we assessed the reliability of the PAM-RL, an ambulatory device measuring limb movements and PLM with a high-time resolution.

PATIENTS AND METHODS

Forty-three patients consecutively referred to the sleep laboratory for insomnia and/or excessive daytime sleepiness underwent one or two nights of polysomnography (PSG) with simultaneous bilateral recording of limb activity by the PAM-RL device. The PSG recordings were blinded and manually analyzed for PLM, while limb actimetry was scored automatically based on the manufacturer's algorithm.

RESULTS

There was a significant correlation between PLM derived from PSG and actimetry (r=0.87, P<0.0001) with good agreement across a wide range of values. The sensitivity and specificity of the PAM-RL device in detecting patients having a polysomnographic PLM index >10 were, respectively, 0.88 and 0.76 with a receiving operating curve having an area under the curve (AUC) of 0.86 for the entire group of patients. All patients with clinically definitive RLS and primary PLM disorder (PLMD) had a PLM index >10 on PSG, but among patients with sleep-related breathing disorders (SRBD) 60% reached this cut-off value. Conversely, only 50% of those patients with an actigraphically assessed PLM index >10 had clinically definitive RLS or PLMD, and 40% had SRBD.

CONCLUSIONS

We demonstrate that automatic detection of PLM derived from the PAM-RL device is highly reliable when compared to the 'gold standard' of polysomnography in patients with RLS and PLMD. Therefore, limb actigraphy can be used routinely to assess motor restlessness in patients with RLS and PLMD. The higher discrepancy in patients with SRBD and insomnia may preclude the use of the device in these patients.

Authors+Show Affiliations

Sleep Laboratory, Department of Psychiatry, University Hospital, Geneva, Switzerland. emilia.sforza@hcuge.chNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

16139771

Citation

Sforza, Emilia, et al. "The PAM-RL Ambulatory Device for Detection of Periodic Leg Movements: a Validation Study." Sleep Medicine, vol. 6, no. 5, 2005, pp. 407-13.
Sforza E, Johannes M, Claudio B. The PAM-RL ambulatory device for detection of periodic leg movements: a validation study. Sleep Med. 2005;6(5):407-13.
Sforza, E., Johannes, M., & Claudio, B. (2005). The PAM-RL ambulatory device for detection of periodic leg movements: a validation study. Sleep Medicine, 6(5), 407-13.
Sforza E, Johannes M, Claudio B. The PAM-RL Ambulatory Device for Detection of Periodic Leg Movements: a Validation Study. Sleep Med. 2005;6(5):407-13. PubMed PMID: 16139771.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The PAM-RL ambulatory device for detection of periodic leg movements: a validation study. AU - Sforza,Emilia, AU - Johannes,Mathis, AU - Claudio,Bassetti, Y1 - 2005/04/01/ PY - 2004/06/24/received PY - 2005/01/17/revised PY - 2005/01/21/accepted PY - 2005/9/6/pubmed PY - 2006/2/8/medline PY - 2005/9/6/entrez SP - 407 EP - 13 JF - Sleep medicine JO - Sleep Med VL - 6 IS - 5 N2 - BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) is usually associated with periodic leg movements (PLM) occurring during wakefulness and sleep. The PLM index obtained by the polysomnographic method reflects the degree of motor symptoms and their consequences on sleep structure. Automated analysis of PLM using actigraphy can assess this condition and can therefore be used to assess therapeutic effects in clinical trials. In the current study we assessed the reliability of the PAM-RL, an ambulatory device measuring limb movements and PLM with a high-time resolution. PATIENTS AND METHODS: Forty-three patients consecutively referred to the sleep laboratory for insomnia and/or excessive daytime sleepiness underwent one or two nights of polysomnography (PSG) with simultaneous bilateral recording of limb activity by the PAM-RL device. The PSG recordings were blinded and manually analyzed for PLM, while limb actimetry was scored automatically based on the manufacturer's algorithm. RESULTS: There was a significant correlation between PLM derived from PSG and actimetry (r=0.87, P<0.0001) with good agreement across a wide range of values. The sensitivity and specificity of the PAM-RL device in detecting patients having a polysomnographic PLM index >10 were, respectively, 0.88 and 0.76 with a receiving operating curve having an area under the curve (AUC) of 0.86 for the entire group of patients. All patients with clinically definitive RLS and primary PLM disorder (PLMD) had a PLM index >10 on PSG, but among patients with sleep-related breathing disorders (SRBD) 60% reached this cut-off value. Conversely, only 50% of those patients with an actigraphically assessed PLM index >10 had clinically definitive RLS or PLMD, and 40% had SRBD. CONCLUSIONS: We demonstrate that automatic detection of PLM derived from the PAM-RL device is highly reliable when compared to the 'gold standard' of polysomnography in patients with RLS and PLMD. Therefore, limb actigraphy can be used routinely to assess motor restlessness in patients with RLS and PLMD. The higher discrepancy in patients with SRBD and insomnia may preclude the use of the device in these patients. SN - 1389-9457 UR - https://www.unboundmedicine.com/medline/citation/16139771/The_PAM_RL_ambulatory_device_for_detection_of_periodic_leg_movements:_a_validation_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1389-9457(05)00046-8 DB - PRIME DP - Unbound Medicine ER -