J Clin Neurol.  2016 Jan;12(1):107-114. 10.3988/jcn.2016.12.1.107.

Spontaneous Low-Frequency Cerebral Hemodynamics Oscillations in Restless Legs Syndrome with Periodic Limb Movements During Sleep: A Near-Infrared Spectroscopy Study

• Byun JI
• Jung KY
• Lee GT
• Kim CK
• Kim BM

• KMID: 2364927
• DOI: http://doi.org/10.3988/jcn.2016.12.1.107

Abstract

BACKGROUND AND PURPOSE
Periodic limb movements (PLM) during sleep (PLMS) are associated with cortical and cardiovascular activation. Changes in cerebral hemodynamics caused by cortical activity can be measured using near-infrared spectroscopy (NIRS). We investigated oscillatory components of cerebral hemodynamics during PLM and different sleep stages in restless legs syndrome (RLS) patients with PLMS.
METHODS
Four female RLS patients with PLMS, and four age- and sex-matched normal controls were included. PLM and sleep stages were scored using polysomnography, while the spontaneous cerebral hemodynamics was measured by NIRS. The phase and amplitude of the cerebral oxyhemoglobin concentration [HbO] and the deoxyhemoglobin concentration [Hb] low-frequency oscillations (LFOs) were evaluated during each sleep stage [waking, light sleep (LS; stages N1 and N2), slow-wave sleep (stage N3), and rapid eye movement (REM) sleep]. In RLS patients with PLMS, the cerebral hemodynamics during LS was divided into LS with and without PLM.
RESULTS
The cerebral hemodynamics activity varied among the different sleep stages. There were changes in phase differences between [HbO] and [Hb] LFOs during the different sleep stages in the normal controls but not in the RLS patients with PLMS. The [HbO] and [Hb] LFO amplitudes were higher in the patient group than in controls during both LS with PLM and REM sleep.
CONCLUSIONS
The present study has demonstrated the presence of cerebral hemodynamics disturbances in RLS patients with PLMS, which may contribute to an increased risk of cerebrovascular events.

Keyword

restless legs syndrome; periodic limb movement during sleep; near-infrared spectroscopy; hemodynamics; low-frequency oscillations

MeSH Terms

Extremities*
Female
Hemodynamics*
Humans
Oxyhemoglobins
Polysomnography
Restless Legs Syndrome*
Sleep Stages
Sleep, REM
Spectroscopy, Near-Infrared*
Oxyhemoglobins

Figure

• 

  Fig. 1 Amplitudes and phase differences of the oxyhemoglobin concentration [HbO] and the deoxyhemoglobin concentration [Hb] low-frequency oscillations (LFOs) in restless legs syndrome (RLS) patients with periodic limb movements (PLM) during sleep (PLMS) and normal controls. A: Amplitude of [HbO] LFOs measured in the right forehead. B: Amplitude of [HbO] LFOs measured in the left forehead. C: Amplitude of [Hb] LFOs measured in the right forehead. D: Amplitude of [Hb] LFOs measured in the left forehead. E: Phase difference of [Hb] and [HbO] LFOs in PLMS patients and normal controls measured in the right forehead. F: Phase difference of [Hb] and [HbO] LFOs in PLMS patients and normal controls measured in the left forehead. deoxyHb: deoxygenated hemoglobin, LS-PLM: light sleep without periodic limb movement, oxyHb: oxygenated hemoglobin, REM: rapid eye movement, SWS: slow-wave sleep.

• 

  Fig. 2 Cerebral hemodynamics changes with PLM during the light sleep (LS) stage in RLS patients with PLMS. A: Amplitude of [HbO] LFOs measured in the right forehead. B: Amplitude of [HbO] LFOs measured in the left forehead. C: Amplitude of [Hb] LFOs measured in the right forehead. D: Amplitude of [Hb] LFOs measured in the left forehead. E: Phase difference of [Hb] and [HbO] LFOs in PLMS patients and normal controls measured in the right forehead. F: Phase difference of [Hb] and [HbO] LFOs in PLMS patients and normal controls measured in the left forehead. *p<0.05 compared with near-infrared spectroscopy parameters in normal controls during LS. deoxyHb: deoxygenated hemoglobin, LFOs: low-frequency oscillations, LS-PLM: light sleep without periodic limb movement, oxyHb: oxygenated hemoglobin, PLMS: periodic limb movements during sleep, REM: rapid eye movement, RLS: restless legs syndrome.

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