Periodic leg movements are part of the B-wave rhythm and the cyclic alternating pattern

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Abstract
Periodic leg movements (PLM) in sleep are supposed to constitute a frequent cause of insomnia. There is some controversy whether PLM are the cause of insomnia by provoking microarousals or whether they are simply an epiphenomenon not causally related to the insomnia. We examined four patients with PLM by overnight polysomnography and concomitant transcranial Doppler sonography (TCD) monitoring, 13 patients with suspected normal pressure hydrocephalus by concomitant overnight polysomnography and intracranial pressure recording, and 10 healthy volunteers by concomitant overnight polysomnography and TCD monitoring. EEG arousals occurred more frequently before than after the PLM. PLM were associated with increase in heart rate, breathing amplitude, and cerebral blood flow velocity assessed by TCD. PLM occurred with a mean wavelength of 40.5 s. This mean wavelength corresponded to similar values calculated for intracranial pressure B-waves (43.3 s) in 13 patients with suspected normal-pressure hydrocephalus, TCD B-wave equivalents (42.2 s) in 10 healthy young adults and the frequency of the cyclic alternating pattern in EEg recordings (40 s). Our data suggest that these cyclic variations with a wavelength of about 40 s are part of a common endogenous rhythm. PLM seem to be an epiphenomenon of this rhythm and not the cause of insomnia.