Sleep · 2026
Autonomic correlates of large muscle group movements during non-REM sleep in restless legs syndrome: a comparative analysis with periodic and non-periodic leg movements.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mogavero Maria P, Silvani Alessandro, Lanza Giuseppe, Rundo Francesco, Bruni Oliviero, Congiu Patrizia, Puligheddu Monica, Ferini Strambi Luigi, Ferri Raffaele
Аннотация
STUDY OBJECTIVES: Large muscle group movements during sleep (LMMS) have recently been recognized as a prevalent feature in patients with restless legs syndrome (RLS), yet their autonomic profile remains insufficiently characterized. This study aimed to compare heart rate (HR) changes associated with LMMS to those accompanying short-interval (SILMS), periodic (PLMS), and isolated leg movements (ISOLMS) during non-REM sleep in RLS.
METHODS: Thirty drug-free RLS patients (20 women, mean age 57.6 ± 12.73 years) underwent full-night polysomnography. For each subject, five arousal-associated events per movement type were selected, provided they were isolated by at least 30 seconds of motor/arousal-free sleep. HR changes were analyzed by computing R-R intervals and expressing them as a percentage of baseline, synchronized to movement onset. The area under the curve (AUC,-10 to +20 s), HR change peak, and movement durations were statistically compared using non-parametric tests.
RESULTS: LMMS were significantly longer than other movement types (mean duration: 9.3 s vs. <3.0 s for others) and induced the highest HR response (peak: 129.6%, AUC: 369.3%), followed by SILMS (peak: 125.4%, 266.3%), ISOLMS (peak: 118.2%, 173.4%), and PLMS (peak: 118.5%, 166.9%). SILMS and LMMS were associated with rapid and sustained HR increases, without post-peak bradycardia, while PLMS and ISOLMS showed a modest transient bradycardia following the peak.
CONCLUSIONS: LMMS are associated with strong autonomic activation indicating parasympathetic withdrawal and/or sympathetic activation, distinguishing them from other sleep-related leg movements in RLS. The absence of post-peak bradycardia suggests reduced parasympathetic buffering, potentially reflecting more sustained arousal mechanisms. Statement of Significance This study provides the first detailed characterization of the heart rate dynamics associated with large muscle group movements during sleep (LMMS) in patients with restless legs syndrome (RLS). By comparing LMMS with established motor patterns such as periodic, isolated, and short-interval leg movements during sleep, we show that LMMS induce the strongest and most sustained autonomic responses. These responses are likely driven by sympathetic activation and/or parasympathetic withdrawal due to sustained arousal-related central autonomic commands. These findings support the hypothesis that LMMS represent a physiologically distinct class of sleep-related motor events with unique implications for cardiovascular and sleep disruption risk in RLS.
METHODS: Thirty drug-free RLS patients (20 women, mean age 57.6 ± 12.73 years) underwent full-night polysomnography. For each subject, five arousal-associated events per movement type were selected, provided they were isolated by at least 30 seconds of motor/arousal-free sleep. HR changes were analyzed by computing R-R intervals and expressing them as a percentage of baseline, synchronized to movement onset. The area under the curve (AUC,-10 to +20 s), HR change peak, and movement durations were statistically compared using non-parametric tests.
RESULTS: LMMS were significantly longer than other movement types (mean duration: 9.3 s vs. <3.0 s for others) and induced the highest HR response (peak: 129.6%, AUC: 369.3%), followed by SILMS (peak: 125.4%, 266.3%), ISOLMS (peak: 118.2%, 173.4%), and PLMS (peak: 118.5%, 166.9%). SILMS and LMMS were associated with rapid and sustained HR increases, without post-peak bradycardia, while PLMS and ISOLMS showed a modest transient bradycardia following the peak.
CONCLUSIONS: LMMS are associated with strong autonomic activation indicating parasympathetic withdrawal and/or sympathetic activation, distinguishing them from other sleep-related leg movements in RLS. The absence of post-peak bradycardia suggests reduced parasympathetic buffering, potentially reflecting more sustained arousal mechanisms. Statement of Significance This study provides the first detailed characterization of the heart rate dynamics associated with large muscle group movements during sleep (LMMS) in patients with restless legs syndrome (RLS). By comparing LMMS with established motor patterns such as periodic, isolated, and short-interval leg movements during sleep, we show that LMMS induce the strongest and most sustained autonomic responses. These responses are likely driven by sympathetic activation and/or parasympathetic withdrawal due to sustained arousal-related central autonomic commands. These findings support the hypothesis that LMMS represent a physiologically distinct class of sleep-related motor events with unique implications for cardiovascular and sleep disruption risk in RLS.