Valid measures of periodic leg movements (PLMs) during a suggested immobilization test using the PAM-RL leg activity monitors require adjusting detection parameters for noise and signal in each recording.
Valid measures of periodic leg movements (PLMs) during a suggested immobilization test using the PAM-RL leg activity monitors require adjusting detection parameters for noise and signal in each recording.
复制标题
在使用 PAM-RL 腿部活动监视器进行建议的固定测试期间，要对周期性腿部运动 (PLM) 进行有效测量，需要调整每次记录中的噪声和信号检测参数。
DOI：
10.1016/j.sleep.2013.08.788
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发表时间：
2014
期刊：
影响因子：
4.8
通讯作者：
Allen,RichardP
中科院分区：
文献类型：
--
作者：
Yang,MyungSung;Montplaisir,Jacques;Desautels,Alex;Winkelman,JohnW;CramerBornemann,MichelA;Earley,ChristopherJ;Allen,RichardP
目的与背景不宁腿综合征（restless legs syndrome，RLS）（Willis-Ekbom disease，WED）患者常伴有周期性的下肢运动（periodic leg movement，PLM）。建议的制动试验（SIT）测量清醒期间WED的感觉和运动特征。胫骨前肌（AT）的表面肌电图（EMG）记录被用作计数PLM的标准。然而，由于一些限制，腿部活动仪，如PAM-RL，作为一个潜在的替代品。在我们的研究中，我们评估的有效性PLM在清醒期间（PLMW）的测量在SIT的PAM-RL使用默认和自定义检测阈值参数相比，以ATEMG.MethodsData获得39名参与者被诊断为原发性WED和谁是稳定的药物治疗的一部分，另一项研究使用SIT反复评估WED症状超过6-12个月。EMG记录和PAM-RL（如可用）用于检测每个SIT的PLMW。该研究的253例SIT获得了完整的PAM-RL和多导睡眠图（PSG）EMG数据。默认PAM-RL（dPAM-RL）根据制造商的噪声（休息）和信号（运动）幅度标准检测腿部运动，该标准旨在准确检测睡眠期间的PLM（PLMS）。自定义PAM-RL（cPAM-RL）类似地检测腿部运动，除了噪声和运动检测参数进行调整，以匹配PAM-RL数据为每个SIT.ResultsThe之间的差异dPAM-RL或cPAM-RL和EMG PLMW的分布是强烈的尖峰（峰度>2），许多小的差异和一些不寻常的大的差异。这些分布更好地描述中位数和四分位数范围比平均值和标准差。尽管dPAM-RL和EMG记录之间存在足够的相关性（r= 0.66），但平均而言，dPAM-RL显著强调了PLMW的数量（中位数：四分位数=-13：-51.2，0.0），并且在Bland-Altman图上具有显著的幅度偏倚，对较大的平均PLMW/h进行更大的强调。cPAM-RL和EMG之间也有足够的相关性（r= 0.70），但PLMW的强调程度最小（中位数四分位数= 0.0;-20，10），并且没有显著的幅度偏倚。两名评分员独立评分13%的SIT显示出足够的评分员间信度为0.96- 0.98。结论我们的研究证实了我们的预期，即使用dPAM-RL测量SIT中的PLMW是无效的，需要调整检测阈值标准。使用为每个SIT定制的参数的PAM-RL提供了有效和可靠的PLMW测量，与AT EMG记录相比具有最小的幅度偏差。
Objective and backgroundIndividuals with restless legs syndrome (RLS) (Willis-Ekbom disease [WED]) usually have periodic leg movements (PLMs). The suggested immobilization test (SIT) measures sensory and motor features of WED during wakefulness. Surface electromyogram (EMG) recordings of the anterior tibialis (AT) are used as the standard for counting PLMs. However, due to several limitations, leg activity meters such as the PAM-RL were advanced as a potential substitute. In our study, we assessed the validity of the measurements of PLM during wakefulness (PLMW) in the SIT for PAM-RL using both default and custom detection threshold parameters compared to AT EMG.MethodsData were obtained from 39 participants who were diagnosed with primary WED and who were on stable medication as part of another study using the SIT to repeatedly evaluate WED symptoms over 6–12 months. EMG recordings and PAM-RL, when available, were used to detect PLMW for each SIT. Complete PAM-RL and polysomnography (PSG) EMG data were available for 253 SITs from that study. The default PAM-RL (dPAM-RL) detected leg movements based on manufacturer’s noise (resting) and signal (movement) amplitude criteria developed to accurately detect PLM during sleep (PLMS). The custom PAM-RL (cPAM-RL) similarly detected leg movements except the noise and movement detection parameters were adjusted to match the PAM-RL data for each SIT.ResultsThe distributions of the differences between either dPAM-RL or cPAM-RL and EMG PLMW were strongly leptokurtic (Kurtosis >2) with many small differences and a few unusually large differences. These distributions are better described by median and quartile ranges than mean and standard deviation. Despite an adequate correlation (r= 0.66) between the dPAM-RL and EMG recordings, the dPAM-RL on average significantly underscored the number of PLMW (median: quartiles = −13: −51.2, 0.0) and on Bland–Altman plots had a significant magnitude bias with greater underscoring for larger average PLMW/h. There also was an adequate correlation (r= 0.70) between cPAM-RL and EMG but with minimal underscoring of PLMW (median quartiles = 0.0; −20, 10) and no significant magnitude bias. Two scorers independently scoring 13% of the SITs showed an adequate interscorer reliability of 0.96–0.98.ConclusionsOur study confirms our expectation that measuring PLMW in a SIT using dPAM-RL is not valid and that adjustments to the detection threshold criteria are required. The PAM-RL, using parameters customized for each SIT provided a valid and reliable measure of PLMW with minimal magnitude bias compared to the AT EMG recordings.