title: Cardiovascular variability during periodic leg movements in sleep in children.
abstract: OBJECTIVE
  Periodic leg movements in sleep (PLMS) are episodes of repetitive and stereotypic leg movements occurring during sleep. In adults, research indicates that PLMS affects sleep quality and duration and are associated with a shift to relatively greater sympathetic influence over cardiovascular variables. However, little research has been performed to investigate the effect of PLMS episodes on cardiac autonomic control in children. This study aimed to quantify the effect of PLMS episodes during NREM2 sleep on heart rate variability (HRV) measures of sympathovagal balance in children.
  
  
  METHODS
  Overnight polysomnography data from 20 children (7-12 y) referred for assessment of sleep disordered breathing (SDB) were analyzed retrospectively. Ten children with episodes of PLMS were matched for age and SDB severity with a control group of 10 children without PLMS episodes.
  
  
  RESULTS
  The LF/HF ratio was significantly higher in the PLM+ compared with both the PLM- periods from PLMS subjects (P < 0.001) and the periods from the control group (P < 0.001). However, this effect could not be parsimoniously interpreted due to the likelihood that leg movements had a direct effect on the lower frequencies. Analysis of the ratio PLM+ to PLM+ plus PLM- indicated parasympathetic inhibition during periods of periodic leg movement and the onset of individual leg movements were associated with cardiac acceleration followed by a return to pre-movement levels.
  
  
  CONCLUSIONS
  This study identified vagal inhibition in association with episodes of PLMS in children. Rapid cardiac acceleration occurring concurrently with the onset of individual leg movements also suggested decreased vagal activity associated with the movements.
authors.affiliation: Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Melbourne, Australia. lisa.walter@med.monash.edu.au
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Walter
authors.forename: Alison M
authors.initials: AM
authors.lastname: Foster
authors.forename: Ruth R
authors.initials: RR
authors.lastname: Patterson
authors.forename: Vicki
authors.initials: V
authors.lastname: Anderson
authors.forename: Margot J
authors.initials: MJ
authors.lastname: Davey
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Nixon
authors.forename: John
authors.initials: J
authors.lastname: Trinder
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Walker
authors.forename: Rosemary S C
authors.initials: RS
authors.lastname: Horne
mesh_terms: D002648:Child; D004562:Electrocardiography; D005260:Female; D005583:Fourier Analysis; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D020189:Nocturnal Myoclonus Syndrome / Q000175:diagnosis / Q000503:physiopathology*; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D017286:Polysomnography; D012016:Reference Values; D012815:Signal Processing, Computer-Assisted; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology; D012894:Sleep Stages / Q000502:physiology*; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014630:Vagus Nerve / Q000503:physiopathology*