ControversyCommentary on controversies in sleep medicine: Montplaisir et al.: Periodic leg movements are not more prevalent in insomnia or hypersomnia but are specifically associated with sleep disorders involving a dopaminergic mechanism
Section snippets
How should a clinician classify periodic limb movements of sleep?
Montplaisir et al. [1] convincingly argue that periodic leg movements (PLMs) may often be of limited clinical significance. How then should a clinician approach the problem of PLMs found on a polysomnograph (PSG)? I suggest a working classification in Table 1. The first category is that of PLMs found in normal subjects, especially in the older population. These may be found, for instance, in a PSG performed for possible OSA, but with negative results for sleep disordered breathing. The second
Should polysomnography be performed to confirm the diagnosis of RLS?
If PLMs are non-specific, should they be used to help with the diagnosis of RLS? RLS is not considered a routine indication for PSG in the American Academy of Sleep Medicine (AASM) practice parameters [2]. Nevertheless, many sleep specialists use the presence of PLMs on PSG to confirm the clinical diagnosis of RLS. To determine whether this is appropriate, we must apply Bayesian statistics [3]. The post-test likelihood of a disorder depends on the sensitivity of the test (the probability that
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