Leg actigraphy to quantify periodic limb movements of sleep: a systematic review and meta-analysis

Abstract

Periodic limb movements of sleep (PLMS) are repetitive, stereotyped movements that can disrupt sleep and result in insomnia, non-restorative sleep, and/or daytime sleepiness. Currently, polysomnography is the gold standard and only clinically acceptable means of quantifying PLMS. Leg-worn actigraphy is an alternative method of measuring PLMS, which may circumvent many of the economic and technical limitations of polysomnography to quantify nocturnal leg movements. However, the use of leg actigraphy as a diagnostic means of assessing PLMS has not been systematically evaluated. In this review, the use of leg-worn actigraphy to measure PLMS is systematically evaluated, using both qualitative and quantitative assessment. Findings demonstrate significant heterogeneity among a limited number of studies in terms of type of actigraph utilized, position of the device on the lower extremity, and methods employed to count PLMS. In general, common accelerometers vary in their sensitivity and specificity to detect PLMS, which is likely related to the technical specifications of a given device. A current limitation in the ability to combine data from actigraphs placed on both legs is also a significant barrier to their use in clinical settings. Further research is required to determine the optimal methods to quantify PLMS using leg actigraphy, as well as specific clinical situations in which these devices may prove most useful.

Keywords: Actiwatch®; Leg accelerometry; Leg actigraphy; PAM-RL; Periodic limb movements; Polysomnography.

Copyright © 2014 Elsevier Ltd. All rights reserved.

Figures

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram.

Figure 2

Forest plots of sensitivity and specificity of Actiwatch to detect periodic limb movements at a PLMI threshold of 5/hr when placed on the A) dorsum of the feet and B) bilateral ankles. Data from the dorsum of the feet was not pooled due to heterogeneity of the diagnostic odds ratio (I2 = 44.1%). Data from Kemlink et al., 2008 [26] is included in all plots because both foot dorsum and ankle placement were utilized within subjects on the same night.

Figure 3

Forest plots of sensitivity and specificity of PAM-RL to detect periodic limb movements at a PLMI threshold of A) 5/hr, B) 10/hr, and C) 15/hr. Data using PLMI cut-off of 10/hr was not pooled due to significant heterogeneity of the diagnostic odds ratio (I2 = 32.1%) at this threshold.